Hepatocellular carcinoma

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

Definition
Hepatocellular carcinoma involves a malignant tumor of the liver.

Causes, incidence, and risk factors

Hepatocellular carcinoma accounts for 80% to 90% of all liver cancers. It occurs more often in men than women and occurs mostly in people 50 to 60 years old. The disease is more common in parts of Africa and Asia than in North or South America and Europe.

The cause of liver cancer is usually Cirrhosis, or scarring of the liver. Cirrhosis may be caused by viral hepatitis, primarily hepatitis B and C, alcohol abuse, hemochromatosis, certain autoimmune diseases of the liver, and a whole host of other diseases that result in chronic inflammation of the liver leading to scarring. The most common cause for Cirrhosis in the U.S. is alcohol abuse.

Symptoms

• Abdominal pain or tenderness, particularly in the right-upper quadrant
  
• Enlarged abdomen
  
• Easy bruising or bleeding
  
• Jaundice (a yellow discoloration of the skin and eyes)

• Physical examination shows an enlarged, tender liver.
  
• A liver biopsy shows hepatocellular carcinoma.
  
• Serum alpha fetoprotein may be elevated.
  
• There may be a mass shown on abdominal CT scan.
  
• A liver scan may indicate an abnormality.
  
• Liver enzymes (liver function tests) are elevated.

Aggressive surgery or liver transplantation may be successful in treating small or slow-growing tumors if they are diagnosed early.

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

Support Groups
The stress of illness can often be eased by joining a support group with members who share common experiences and problems. See liver disease - support group and cancer - support group.

Expectations (prognosis)
The usual outcome is poor, because only 10% to 20% of hepatocellular carcinomas can be removed completely using surgery. If the cancer cannot be completely removed, the disease is usually fatal within 3 to 6 months, although this is highly variable. Survival much longer than this occasionally occurs.

Complications

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

Prevention
Preventing and treating viral hepatitis may help reduce risk. Avoid excessive alcohol consumption. Certain patients may benefit from hemochromatosis screening.

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