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Liver Cancer Overview
Liver cancer (hepatocellular carcinoma) is a cancer arising from the liver. It is also known as primary liver cancer or hepatoma. The liver is made up of different cell types (for example, bile ducts, blood vessels, and fat-storing cells). However, liver cells (hepatocytes) make up 80% of the liver tissue. Thus, the majority of primary liver cancers (over 90%-95%) arises from liver cells.
When we speak of liver cancer, however, it is often referring to cancer that has spread to the liver, having originated in other organs (such as the colon, stomach, pancreas, breast, and lung). More specifically, this type of liver cancer is called metastatic liver disease (cancer) or secondary liver cancer.
The Causes of Liver Cancer
Liver cancer is a common cancer in the world. A deadly cancer, liver cancer will kill almost all patients who have it within a year. In 2000, it was estimated that there were about 564,000 new cases of liver cancer worldwide, and a similar number of patients died as a result of this disease. About three-quarters of the cases of liver cancer are found in Southeast Asia (China, Hong Kong, Taiwan, Korea, and Japan). This reflects the prevalence of hepatitis B infection
On the other hand, in Japan, North America and Europe, hepatitis C infection is a much more common cause; alcohol abuse is also an important contributing factor. All of these diseases cause continual damage to the liver, which can result in severe scarring (cirrhosis) that then can lead to cancer.
Other cause of liver cancer:
- Gender, men are much more likely than women to have liver cancer
- Obesity
- Diabetes
- Liver cancer is also strongly associated with hereditary tyrosinemia, alpha 1 anti-trypsin deficiency
Liver Cancer Symptoms:
- Weight loss
- Abdominal pain
- Jaundice
- Ascites
Diagnosis of Liver Cancer
- Blood Test
Liver cancer is not diagnosed by routine blood tests, including a standard panel of liver tests. Diagnosis of liver cancer depends so much on the vigilance of the physician screening with a tumor marker (alpha-fetoprotein) in the blood and radiological imaging studies. Since most patients with liver cancer have associated liver disease (cirrhosis), their liver blood tests may not be normal to begin with. If these blood tests become abnormal or worsen due to liver cancer, this usually signifies extensive cancerous involvement of the liver. At that time, any medical or surgical treatment may be too late. There is no reliable or accurate screening blood test for liver cancer. The most widely used biochemical blood test is alpha-fetoprotein (AFP). In adults, high blood levels (over 500 nanograms/milliliter) of AFP are seen in only three situations:
- Liver cancer
- Germ cell tumors (cancer of the testes and ovaries)
- Metastatic cancer in the liver (originating in other organs)
Generally, normal levels of AFP are below 10 ng/ml. Moderate levels of AFP (even almost up to 500 ng/ml) can be seen in patients with chronic hepatitis. Moreover, many patients with various types of acute and chronic liver diseases can have mild or even moderate elevations of AFP.
- Imaging Studies
Imaging studies play a very important role in the diagnosis of liver cancer. A good study can provide information as to the size of the tumor, the number of tumors, and whether the tumor has involved major blood vessels locally or spread outside of the liver.
- Ultrasound
Ultrasound examination is usually the first study ordered if liver cancer is suspected in a patient. The accuracy of an ultrasound depends very much on the technician and radiologist who perform the study (operator dependent). Studies from Japan and Taiwan report that ultrasound is the most sensitive imaging study for diagnosing and characterizing liver cancer. But in these studies, highly experienced individuals performed the scans. An ultrasound has the advantages of not requiring intravenous contrast material and not involving radiation.
- Computerized axial tomography (CT scan)
Computerized axial tomography (CT scan) is a very common for the workup of tumors in the liver. The ideal CT study is a multi-phase, spiral CT scan using oral and intravenous contrast material.
- Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI) can provide very clear images of the body. Its advantage over CT is that MRI can provide sectional views of the body in different planes. Newer MRIs can actually reconstruct images of the biliary tree (bile ducts and gallbladder) and of the arteries and veins of the liver.
The quality depends on the age of the machine and the ability of the patients to hold their breath for up to 15 to 20 seconds at a time. Furthermore, many patients, because of claustrophobia, cannot tolerate being in the MRI scanner. However, the current open MRI scanners generally do not provide as high quality images as the closed scanners do. MRI sometimes finds lesions that can tell the radiologist more about the blood vessel (vascular) characteristics of the tumor; more importantly, there is no radiation risk.
- PET (Positron Emission Tomography)
Another potential test used for many other cancers is a PET (positron emission tomography) scan. However, this is not very useful in liver cancer.
Liver Cancer Treatments
Oncare's News Article about Liver Cancer： (to be updated)
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