What are the common predisposing risk factors for hepatocellular cancer?
Cirrhosis of the liver, from any cause, is a predisposing risk factor for the development of hepatocellular carcinoma. Hepatitis B, hepatitis C and hemochromatosis are associated with a very high risk. Less common causes include alcohol abuse and anabolic steroid use. Exposure to aflatoxin, produced by the fungus Aspergillus flavus, is a major risk factor in less developed parts of the world, particularly Sub-Saharan Africa. Tropical weather and suboptimal storage of grains can lead to contamination with the fungus.
What are the symptoms of hepatocellular cancer?
The early stages of hepatocellular carcinoma are often "silent," and may go undetected. In most cases, the earliest symptoms are those of the underlying liver disease. These may include abdominal distension, edema, gastrointestinal bleeding, jaundice or encephalopathy (confusion). Weight loss, hemorrhagic ascites (fluid with blood in the abdomen) and new onset of portal vein thrombosis should alert the physician to the possible development of hepatocellular carcinoma.
What are the complications of this disease?
Some complications of hepatocellular carcinoma are systemic in nature, resulting from the release of certain hormones or chemicals from the tumor. These include erythrocytosis (abnormal red blood cell production), hypercalcemia (elevated calcium levels), hypertension (elevated blood pressure), watery diarrhea, hypoglycemia (low blood sugar) and hypercholesterolemia (elevated cholesterol levels).
How is hepatocellular carcinoma diagnosed?
Most often patients are diagnosed in the process of investigating their underlying liver disease. Blood tests reveal elevated levels of AFP (alpha-fetoprotein) in 60 to 70 percent of liver cancer patients. Other diagnostic tests include abdominal CT scan, ultrasound, MRI and angiography. A liver biopsy (ultrasound or CT guided) is indicated if other tests are inconclusive. Histological examination of tissue specimens and tumor staging are performed according to guidelines that identify the types of cells involved and the extent of tumor growth or invasion.
Can hepatocellular cancer be prevented?
The only way to prevent hepatocellular carcinoma is to prevent liver disease. Hepatitis B can be prevented by vaccination. Exposure to aflatoxin could be reduced through better storage of grains. There is no vaccine for hepatitis C, but prevention education could potentially reduce transmission. Newer treatment options for hepatitis C and B also will reduce the risk of cancer.
What is the treatment for hepatocellular carcinoma?
Treatment options for hepatocellular carcinoma depend on a number of factors: the number, size and location(s) of tumors present in the liver; the presence of metastatic cancer sites; the severity of liver disease; the functional status of the patient; and local resources/expertise. Treatment options include surgical resection or removal of the tumor and surrounding tissue from the liver, cryosurgery, hepatic artery chemoembolization, percutaneous ethanol injection, radiofrequency ablation, cisplatin gel injection and liver transplantation.
How can I survive if part of my liver is removed?
The liver is a unique organ in that it can regenerate up to 70 to 80 percent after resection. A healthy liver regenerates to its normal size within four to six weeks. The ability of the healthy liver to regenerate is a vital component of "living donor" liver transplantation, a procedure during which about half of a healthy donor's liver is removed and transplanted in a patient with advanced cirrhosis (although the ability of the liver to regenerate in the presence of cirrhosis is significantly reduced). Most patients with liver cancer have cirrhosis. Even in the presence of cirrhosis, resection of the tumor is possible if the tumor is detected early (when it is small and liver disease mild) since the surviving liver could function quite adequately. However, resection is not possible in the presence of advanced cirrhosis.
Does this disease have a genetic or hereditary link?
No. However, one of the risk factors for developing hepatocellular carcinoma is hereditary hemochromatosis, which does have a genetic association.
If I have hepatocellular carcinoma, am I prone to other types of cancer?
Liver tumors may be primary (originating from the liver) or metastatic (spread from a cancer elsewhere). Liver tumors are seen in combination with other types of cancers.
Will I need endoscopy, biopsies or other tests?
Your doctor may want to do an endoscopy, especially if gastrointestinal bleeding is detected. Other tests might include blood work, ultrasound, CT scan, MRI and liver biopsy.
What is the prognosis for hepatocellular carcinoma?
Tumors that cannot be resected do not respond well to traditional chemotherapy or radiotherapy. Small cancers, arising in the presence of cirrhosis, can be cured by liver transplantation. Early detection is crucial. Patients with cirrhosis should be screened regularly for liver cancer. This is especially important for patients with liver disease due to hepatitis C, hepatitis B or hemochromatosis.
Is there a specialist who treats liver disease?
All gastroenterologists are trained in liver disease to some extent, but there are physicians who are trained specifically in liver disease (hepatologists).