liver cancer or hepatocellular carcinoma

What is liver cancer ( hepatocellular carcinoma) ?

Liver cancer or hepatocellular carcinoma is caused by malignancy affecting liver parenchyma.

Liver cancer ( ascites- abdominal swelling )

What is the cause and association of liver cancer ?

Liver cancer is associated with chronic liver damage which is caused by alcohol liver damage, autoimmune disease, hepatitis C, metabolic disease ( haemochromatosis ) and alfatoxins ( from cereals contamination from fungal or biological weapon.)

What is the epidemiology of liver cancer ?

It is common making up 1~2 % of all malignancies but less common than secondary liver malignancies. Increase incidence in regions where hepatitis B and C are endemic. ( Southern Mediterranean and Far East )

How does it present ?

liver cancer present with the symptoms of malignancy such as malaise, weight loss and loss of appetite and sign such as jaundice, fullness of the abdomen, cachexia, lymphadenopathy,abdominal swelling, enlargement of the liver and tenderness in the liver region. A bruit may also be heard while auscultating the liver.

What is the pathogenesis behind liver cancer ?

Macroscopically , liver cancer or hepatocellular carcinoma can undergo haemorrhage and necrosis because lack of fibrous stroma. Vascular invasion, particularly of the portal system,is common. Invasion of the biliary system is less common. Three common appearances: large solitary mass, multifocal nodular pattern or diffuse small foci scattered throughout the liver.

Microscopically, cells resemble normal hepatocytes and can be confused with cells of hepatic adenoma. Tumours that are more differentiated can produce bile.

What is the investigation require ?

Blood : Full blood count, ESR, liver function test, clotting, alpha fetoprotein and hepatitis serology.

Imaging : Abdominal ultrasound may identify a fixed lesion within t a cirrhotic liver, CT scan or MRI scan is a gold standard for staging liver cancer.

Angiography : If transarterial embolisation is required.

Histology : As cites may be aspirated and sent for cytology purpose.

Staging : Chest, abdomen, pelvic and consider bone scan.

How to manage liver cancer ?

Medical :Chemotherapy and radiotherapy have limited role as adjuvant to surgery, but may be used to control unresectable disease temporarily. Examples of chemotherapeutic agents include doxorubicin and carboplastin.

Surgical ; liver resection is indicated if localized to a single lobe. Liver transplantation may be considered if tumour is small and the liver is cirrhotic.

Embolization : Useful for single solitary lesions in cirrhosis.

Ablation : Useful to shrink tumours not amenable to resection. Radiofrequency, cyroablation, or percutanoeus ethanol injection is used.

What is the complication of liver cancer ?

The complication of liver cancer includes biliary tree obstruction, acute liver failure, hepatic rupture, reactive pleural effusion and distant metastases.

What is the prognosis of liver cancer ?

Very poor. Majority of patients die within 1 year if diagnosis and surgical cure is only possible for 5%.

liver cancer

statistics for survival liver cancer

Relation between liver cancer and alfatoxin exposure

liver disease

overview of liver cancer

chemo embolization treatment for liver cancer

Radio frequency ablation treatment for liver cancer

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