Liver cancer

Liver cancer
Classification and external resources
left lobe liver tumor in 50 years old man operated in King Saud Medical Complex, Riyadh, Saudi Arabia
MeSH	D008113

Liver cancer or hepatic cancer is properly considered to be a cancer which starts in the liver, as opposed to a cancer which originates in another organ and migrates to the liver, known as a liver metastasis. For a thorough understanding of liver cancer it is important to have an understanding of how the liver functions. The liver is one of the largest organs in the body. It is located below the right lung and under the ribcage. The liver is divided into four lobes: the right lobe, the left lobe, the caudate lobe, and the quadrate lobe. Protein is obtained by the liver from the portal vein, which carries nutrient-rich blood from the intestines to the liver. The hepatic artery supplies the liver with blood that is rich in oxygen. Liver cancer thus consists of the presence of malignant hepatic tumors, growths on or in the liver (medical terms pertaining to the liver often start in hepato, or hepatic from the Greek word for liver, hēpar, stem hēpat-). Liver tumors may be discovered on medical imaging, which may occur incidentally to imaging performed for a different disease than the cancer itself, or may present symptomatically, as an abdominal mass, abdominal pain, jaundice, nausea or some other liver dysfunction.^[1]

Classification

There are many forms of liver cancer, although many cancers found in the liver are metastases from other tumors, frequently of the GI tract (like colon cancer, carcinoid tumors mainly of the appendix, etc.), but also from breast cancer, ovarian cancer, lung cancer, renal cancer, prostate cancer, etc.

The most frequent liver cancer is hepatocellular carcinoma (HCC) (also named hepatoma, which is a misnomer because adenomas are usually benign). Patients who develop this cancer normally are in the younger population. This tumor also has a variant type that consists of both HCC and cholangiocarcinoma components. The cells of the bile duct coexist next to the bile ducts that drain the bile produced by the hepatocytes of the liver. Cancers which arise from the blood vessel cells in the liver are known has hemangioendotheliomas.

As well as mixed tumors, rarer forms of liver cancer include:

• mesenchymal tissue
• Sarcoma
• Hepatoblastoma, a rare malignant tumor, primarily developing in children. Most of these tumors form in the right lobe.
• Cholangiocarcinoma (bile duct cancers), which account for 1 or 2 out of every 10 cases of liver cancer. These cancers start in the small tubes (called bile ducts) that carry bile to the intestine.
• Angiosarcoma and hemangiosarcoma: These are rare forms of cancer that start in the blood vessels of the liver. These tumors grow quickly. Often by the time they are found they are too widespread to be removed. Most patients do not live more than a year after diagnosis.
• Lymphoma of liver: A rare form of lymphoma that usually have diffuse infiltration to liver. It may also form a liver mass in rare occasions.

Symptoms of Liver cancer

Symptoms of Cholangiocarcinoma

• Jaundice
• Abdominal pain
• Weight loss
• Hepatomegaly^[2]

Symptoms of hepatocellular carcinoma

• Abdominal mass
• Abdominal pain
• Emesis
• Anemia
• Back pain
• Jaundice
• Itching
• Weight loss
• Fever^[3]

Causes

A 2009 study suggested that l-carnitine deficiency is a risk factor for liver cancer, and that supplementation with it could reduce the risk.^[4]

Japan being member of International Cancer Genome Consortium is leading efforts to map liver cancer's complete genome.

Management

A PET-CT scan may be suggested if doctors are considering surgery as a treatment. It gives more detailed information about the part of the body being scanned.^[5] The correct treatment of liver cancer can mean the difference between life and death. Not all patients with cancers in the liver are potentially curable. These are some of the treatments available: Surgery, Chemotherapy, Immunotherapy, Photodynamic Therapy, Hyperthermia, Radiation Therapy and Radiosurgery.^[6]

Treatment of hepatocellular carcinoma

• Partial hepatectomy to resect all of the tumor.
• Liver transplantation
• Cyroablation
• Chemoembolization
• Radiotherapy
• Sorafenib
• Radiofrequency ablation^[7]
• Radiofrequency ablation combined with local chemotherapy See: http://www.clinicaltrials.gov/ct2/show/NCT00617981?term=Thermodox&rank=3

Treatment of Cholangiocarcinoma

• Photodynamic therapy
• Brachytherapy
• Radiotherapy
• Liver transplantation^[8]

Treatment of hepatoblastoma

• Chemotherapy, including vincristine, cyclophosphamide, and doxorubicin
• Radiotherapy
• Liver transplantation
• Surgical resection^[9]

Epidemiology

Age-standardized death from liver cancer per 100,000 inhabitants in 2004.^[10]

     no data      less than 7.5      7.5-15      15-22.5      22.5-30      30-37.5      37.5-45      45-52.5      52.5-60      60-67.5      67.5-75      75-110      more than 110

Liver cancer as a cause of death is reported at less than 30 cases per 100,000 inhabitants in most of the world, with higher rates observed in parts of Africa and eastern Asia.

See also

• Liver tumor

References

External links

• The Liver Cancer Web Page at Johns Hopkins University
• Liver cancer at Mayo Clinic
• Blue Faery: The Adrienne Wilson Liver Cancer Association