Hepatocellular carcinoma

Definition

Hepatocellular carcinoma is cancer of the liver.

Alternative Names

Primary liver cell carcinoma; Tumor - liver; Liver cancer; Cancer - liver

Causes, incidence, and risk factors

Hepatocellular carcinoma accounts for most liver cancers. This type of cancer occurs more often in men than women. It is usually seen in people ages 50 - 60.

The disease is more common in parts of Africa and Asia than in North or South America and Europe.

Hepatocellular carcinoma is not the same as metastatic liver cancer, which starts in another organ (such as the breast or colon) and spreads to the liver.

In most cases, the cause of liver cancer is usually scarring of the liver (cirrhosis). Cirrhosis may be caused by:

• Alcohol abuse (the most common cause in the U.S.)
• Certain autoimmune diseases of the liver
• Diseases that cause long-term inflammation of the liver
• Hepatitis B or C virus infection
• Too much iron in the body (hemochromatosis)

Patients with hepatitis B or C are at risk for liver cancer, even if they do not have cirrhosis.

Symptoms

• Abdominal pain or tenderness, especially in the upper-right part
• Easy bruising or bleeding
• Enlarged abdomen
• Yellow skin or eyes (jaundice)

Signs and tests

Physical examination may show an enlarged, tender liver.

Tests include:

• Abdominal CT scan
• Abdominal ultrasound
• Liver biopsy
• Liver enzymes (liver function tests)
• Liver scan
• Serum alpha fetoprotein

Some high-risk patients may get periodic blood tests and ultrasounds to see whether tumors are developing.

Treatment

Aggressive surgery or a liver transplant can successfully treat small or slow-growing tumors if they are diagnosed early. However, few patients are diagnosed early.

Chemotherapy and radiation treatments are not usually effective. However, they may be used to shrink large tumors so that surgery has a greater chance of success.

Sorafenib toslate (Nexavar), an oral medicine that blocks tumor growth, is now approved for patients with advanced hepatocellular carcinoma.

Support Groups

You can ease the stress of illness by joining a support group with members who share common experiences and problems. See:

• Cancer - support group
• Liver disease - support group

Expectations (prognosis)

The usual outcome is poor, because only 10 - 20% of hepatocellular carcinomas can be removed completely using surgery.

If the cancer cannot be completely removed, the disease is usually fatal within 3 - 6 months. However, survival can vary, and occasionally people will survive much longer than 6 months.

Complications

• Gastrointestinal bleeding
• Liver failure
• Spread (metastasis) of the carcinoma

Calling your health care provider

Call your health care provider if you develop persistent abdominal pain, especially if you have a history of any liver disease.

Prevention

Preventing and treating viral hepatitis may help reduce your risk. Childhood vaccination against hepatitis B may reduce the risk of liver cancer in the future.

Avoid drinking excessive amounts of alcohol. Certain patients may benefit from screening for hemochromatosis.

If you have chronic hepatitis or known cirrhosis, periodic screening with liver ultrasound or measurement of blood alpha fetoprotein levels may help detect this cancer early.

References

National Cancer Institute. Adult primary liver cancer treatment PDQ. Updated May 22, 2009.

Roberts LR. Liver and biliary tract tumors. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 206.