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LIVER CANCER – DIAGNOSIS, CAUSES, SYMPTOMS,TREATMENT AND PROGNOSIS. By Dick Aronson
Liver cancer also known as primary or metastatic hepatic carcinoma is a fairly rare form of cancer in the western world (1% of all cancers) but much more common in Africa and parts of Asia (10% to 50% of all cancers). It is much more prevalent in men and incidence increases with age. Liver cancer is rapidly fatal, usually within 6 months from gastrointestinal hemorrhage, hepatic failure or metastasis.
TYPES OF LIVE CANCER Most primary liver tumors are known as hepatomas (hepatocellular carcinoma and primary lower cell carcinoma). Some primary liver cancers originate in the bile duct and these are known as cholangiomas. Some rare liver cancers include Kupffer cell sarcoma and hepatoblastomas (which occur almost exclusively in children and are usually respectable and curable). Metastatic liver cancer is 20 times more common than primary liver cancer and after cirrhosis this is the leading form of liver related death.
SIGNS AND SYMPTOMS Liver cancer does not normally cause symptoms until it is in an advanced stage. Clinical effects of advanced liver cancers include:
CAUSES OF LIVER CANCER The exact cause of liver cancer is unknown in adults but in children it may be a genetic disease. Adult liver carcinomas may result from environmental exposure to carcinogens such as mold, contrast media (no longer in use), androgens and oral estrogens, the hepatitis B virus or by damage to the liver due to cirrhosis caused by too much prolonged imbibing of alcohol.
DIAGNOSIS Liver cancer is difficult to diagnose in the presence of cirrhosis, but several tests can help identify it: The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, electrolyte studies may indicate increased sodium retention, a liver biopsy can make a definitive diagnosis.
TREATMENT Treatments for primary liver cancer depend on the extent (stage) of the disease, age, overall health, feelings and personal preferences. Surgery is the most effective treatment for primary liver cancer, but this is not always possible due to the size or position of the tumor. Radiofrequency ablation is an option for people with small, unresectable hepatocellular tumors and for some types of metastatic liver cancers. During this procedure, the hepatic artery (the artery from which liver cancers derive their blood supply) is blocked, and chemotherapy drugs are injected between the blockage and the liver. Cryoablation may be an option for people with inoperable primary and metastatic liver cancers. Removing the whole liver and replacing it with a liver from another person is another possible form of treatment for primary liver cancer.
Even when treatments fail to provide much improvement in the liver cancer itself, pain and other signs and symptoms caused by liver cancer can be aggressively treated to improve quality of life. In general, the treatments available for children are the same as for adults, and the best approach depends on the stage and type of cancer as well as the child's age and overall health.
PROGNOSIS Prognosis is poor when cancer is advanced, but for small tumors that are confined to the liver, ablative therapies are palliative and surgical resection or liver transplantation is sometimes curative.
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