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Primary liver cancer
Last reviewed: 23.04.2024
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Primary liver cancer is usually a hepatocellular carcinoma. In most cases of liver cancer, nonspecific symptoms are observed, this delays timely diagnosis. The prognosis is usually unfavorable.
Hepatocellular carcinoma (hepatoma) usually develops in patients with cirrhosis of the liver and often in regions where the infection of viral hepatitis B and C. Is common. Symptoms and signs are usually nonspecific. Diagnosis is based on determining the level of a-fetoprotein (AFP), instrumental examination and liver biopsy. Patients with high risk are recommended screening examination with a periodic determination of AFP and ultrasound. The prognosis is unfavorable, but small localized tumors can be curable and are subject to surgical treatment (liver resection) or liver transplantation.
[Causes of liver cancer
Primary liver cancer (hepatocellular carcinoma), as a rule, is a complication of liver cirrhosis. It is the most frequent type of primary liver cancer and results annually in the US to approximately 14,000 deaths. The disease is more typical for regions outside the US, especially South-East Asia, Japan, Korea and Africa in the Sahara region. In general, the prevalence of pathology corresponds to the geographical spread of chronic hepatitis B (HBV); among carriers of HBV, the risk of developing a tumor increases more than 100-fold. Inclusion of HBV DNA in the host genome can lead to malignant transformation even in the absence of chronic hepatitis or cirrhosis of the liver. Other etiological factors that cause hepatocellular carcinoma include cirrhosis as a consequence of chronic hepatitis C (HCV), hemochromatosis and alcoholic cirrhosis of the liver. Patients with cirrhosis of the liver of another etiology are also at risk. Ecological carcinogens can play a role; for example, food contaminated with fungal aflatoxins is thought to contribute to the development of hepatoma in the subtropical regions.
Symptoms of primary liver cancer
The most frequent symptoms of primary liver cancer are abdominal pain, weight loss, volumetric formation in the right upper quadrant of the abdomen, and unexplained worsening of the condition against a background of stable cirrhosis. There may be fever, hemorrhages from the tumor causing hemorrhagic ascites, shock or peritonitis, which may be the first manifestations of hepatocellular carcinoma. Sometimes there is a noise of friction or crepitation, there are systemic metabolic complications, including hypoglycemia, erythrocytosis, hypercalcemia and hyperlipidemia. These complications can be manifested clinically.
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Diagnosis of primary liver cancer
Diagnosis of primary liver cancer is based on determining the level of AFP 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. A rise of more than 400 μg / l is a rarity, with the exception of testicular teratocarcinoma, much smaller than the primary tumor. Lower levels are less specific and can be determined in hepatocellular regeneration (eg, in hepatitis). The value of other blood indicators, such as des-y-carboxyprothrombin and L-fucosidase, is being studied.
Depending on the protocol adopted and the possibilities, the first instrumental study may be CT with contrast enhancement, ultrasound or MRI. Arteriography of the liver can be useful in diagnosing in doubtful cases and also be used for anatomical verification of vessels in the planning of surgical treatment.
Diagnosis is confirmed if the data of instrumental studies show characteristic changes against the background of an increase in AFP.
A biopsy of the liver under the supervision of ultrasound is performed for the final confirmation of the diagnosis.
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Treatment of primary liver cancer
If the tumor size does not exceed 2 cm and it is limited to one lobe of the liver, the two-year survival rate is less than 5%. Resection of the liver provides better results, but it is only shown in a small percentage of cases in which the tumor is small and limited. Other treatments include chemoembolization of the hepatic artery, intra-tumoral administration of ethanol, cryoablation and radiofrequency ablation, but none of these methods yield very good results. Radiation and systemic chemotherapy is generally ineffective. With a small tumor, the absence of severe concomitant diseases and the development of hepatic insufficiency, liver transplantation is shown instead of liver resection , which gives the best results.
An oncologist, in conjunction with a nutritionist, can be prescribed a diet for liver cancer.
Prevention of primary liver cancer
The use of the HBV vaccine ultimately reduces the number of malignancies, especially in endemic regions. Prevention of the development of cirrhosis of any etiology can also be significant (for example, treatment of chronic HCV infection, early detection of hemochromatosis, treatment of alcoholism).
Screening for patients with liver cirrhosis is advisable, although these events are controversial and did not demonstrate a clear reduction in mortality from primary liver cancer. Usually, one protocol is used, which includes the determination of AFP and ultrasound at intervals of 6 or 12 months. Many authors also recommend screening for patients who have had HBV infection for a long time, even in the absence of liver cirrhosis.