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Primary liver cancer
Last reviewed: 05.07.2025
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Primary liver cancer is usually hepatocellular carcinoma. Most liver cancers have non-specific symptoms, which delays timely diagnosis. The prognosis is usually poor.
Hepatocellular carcinoma (hepatoma) usually develops in patients with liver cirrhosis and often in regions where viral hepatitis B and C infection is common. Symptoms and signs are usually nonspecific. Diagnosis is based on alpha-fetoprotein (AFP) levels, instrumental examination, and liver biopsy. Screening examination with periodic AFP determination and ultrasound is recommended for high-risk patients. The prognosis is poor, but small localized tumors may be curable and are subject to surgical treatment (liver resection) or liver transplantation.
[ Causes of liver cancer
Primary liver cancer (hepatocellular carcinoma) is usually a complication of cirrhosis. It is the most common type of primary liver cancer, causing approximately 14,000 deaths annually in the United States. The disease is more common in regions outside the United States, particularly Southeast Asia, Japan, Korea, and sub-Saharan Africa. Overall, the prevalence of the disease corresponds to the geographic distribution of chronic hepatitis B (HBV); among HBV carriers, the risk of developing the tumor increases more than 100-fold. Incorporation of HBV DNA into the host genome can lead to malignant transformation even in the absence of chronic hepatitis or cirrhosis. Other etiologic factors causing hepatocellular carcinoma include cirrhosis secondary to chronic hepatitis C (HCV), hemochromatosis, and alcoholic cirrhosis. Patients with cirrhosis of other etiologies are also at risk. Environmental carcinogens may play a role; for example, food contaminated with fungal aflatoxins is thought to contribute to the development of hepatoma in subtropical regions.
Symptoms of Primary Liver Cancer
The most common symptoms of primary liver cancer are abdominal pain, weight loss, a right upper quadrant mass, and unexplained deterioration in the presence of stable cirrhosis. Fever may be present, hemorrhage from the tumor causes hemorrhagic ascites, shock, or peritonitis, which may be the first manifestations of hepatocellular carcinoma. Friction rubs or crepitations are sometimes present, and systemic metabolic complications, including hypoglycemia, erythrocytosis, hypercalcemia, and hyperlipidemia, may develop. These complications may manifest clinically.
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Diagnosis of primary liver cancer
Diagnosis of primary liver cancer is based on AFP levels and instrumental examination. The presence of AFP in adults demonstrates differentiation of hepatocytes, which most often indicates hepatocellular carcinoma; high AFP levels are observed in 60-90% of patients. An increase of more than 400 μg/L is rare, with the exception of testicular teratocarcinoma, which is much smaller than the primary tumor. Lower levels are less specific and can be determined in hepatocellular regeneration (for example, in hepatitis). The value of other blood parameters, such as des-y-carboxyprothrombin and L-fucosidase, is being studied.
Depending on the adopted protocol and capabilities, the first instrumental examination may be CT with contrast enhancement, ultrasound or MRI. Liver arteriography may be useful in diagnostics in questionable cases and also used for anatomical verification of vessels when planning surgical treatment.
The diagnosis is confirmed if the instrumental research data demonstrate characteristic changes against the background of an increase in AFP.
An ultrasound-guided liver biopsy is performed to definitively confirm the diagnosis.
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Treatment of primary liver cancer
If the tumor is less than 2 cm in size and is confined to one lobe of the liver, the two-year survival rate is less than 5%. Liver resection provides better results, but it is indicated only in a small percentage of cases where the tumor is small and confined. Other treatments include hepatic artery chemoembolization, intratumoral ethanol injection, cryoablation, and radiofrequency ablation, but none of these methods provide very good results. Radiation and systemic chemotherapy are generally ineffective. If the tumor is small, there are no severe comorbidities, and liver failure has developed, liver transplantation is indicated instead of liver resection, providing better results.
An oncologist, together with a nutritionist, can prescribe a dietary nutrition for liver cancer.
Prevention of primary liver cancer
The use of the HBV vaccine ultimately reduces the incidence of malignancies, especially in endemic regions. Prevention of liver cirrhosis of any etiology may also be of significant importance (e.g., treatment of chronic HCV infection, early detection of hemochromatosis, treatment of alcoholism).
Screening of patients with cirrhosis is reasonable, although these measures are controversial and have not demonstrated a clear reduction in mortality from primary liver cancer. A single protocol is usually used, which includes AFP determination and ultrasound at intervals of 6 or 12 months. Many authors also recommend screening of patients with a long history of HBV infection, even in the absence of cirrhosis.