DEFINITION
Hepatocellular carcinoma is a cancer that arises from within the liver. Liver cells are transformed into cancer cells as a result of prolonged damage and regenerative processes. The exact ways the liver cells are transformed into cancer cells is currently under study.
Alternative names: primary hepatocellular carcinoma, liver tumor, primary liver cancer, cancer of the liver
CAUSES
- Cirrhosis caused by hepatitis B, hepatitis C, prolonged alcohol use
- Hemochromastosis (iron storage disease of the liver, non-alcoholic steatohepatitis)
SYMPTOMS
- Enlarged abdomen
- Abdominal pain and tiredness, particularly on the right side under the rib cage
- Weight loss, poor appetite
- Jaundice (yellow discolorations of the skin and eyes)
The symptoms of liver cancer may be the same as symptoms of cirrhosis.
EXAMS AND TESTS
- Enlarged tender liver
- X-ray findings of a liver mass (exam by ultrasound, CT scan or MRI)
- An elevated tumor test - alfafetoprotein (AFP)
- Liver biopsy showing heptocellular carcinoma
SCREENING FOR LIVER CANCER
In many cases, patients who have hepatocellular carcinoma present with large tumors that are difficult to treat. It is important for patients who have been diagnosed with chronic liver disease to have a screening test for liver cancer every 2 to 6 months to include:
- Alphafetoprotein
- Abdominal ultrasound examination
TREATMENTS
Patients who have liver cancer should be referred to a multidisciplinary liver-cancer clinic for evaluation. A multidisciplinary team includes liver surgeons, radiologists, oncologists and hepatologists. UCLA has an active Liver Cancer Center within the Pfleger Liver Institute. Treatment modulaties include:
Radiologic
- Radiofrequency ablation (RFA)
- Percutaneous alchohol injection (PEI)
- Transarterial chemoembolization (TACE)
Surgery
- Surgical resections of the cancer
- Liver transplantation
Oncology
- Anti-cancer drugs that prevent the formation of new blood vessels that supply the cancer (anti-angigenesis medications)
Hepatology
- The underlying hepatitis B should be treated with an anti-viral medication that suppresses virus multiplication in the liver cells
- In some cases, the hepatitis C virus should be treated under strict supervision of the hepatologist
- Medical treatment for the complications of cirrhosis, i.e. ascites , GI bleeding, encephalopathy and bacterial infections (see section on cirrhosis treatment)
