Liver Cancer

Liver cancer, or hepatocellular carcinoma (HCC), also called malignant hepatoma is a primary malignant cancer of the liver and ranks fifth among worldwide causes of cancer mortality. Although relatively rare in the developed world, there are over one million new case per year worldwide and in some regions it is the most common cancer. The incidence is rising, mainly due to the spread of hepatitis C virus.

85% of primary liver cancers are HCCs. Other types include: cholangiocarcinoma (arising in cells lining the bile duct, angiosarcoma (or hemangiosarcoma, arising in blood vessels), and hepatoblastoma, a rare form generally affecting young children.

Hemangiomas, hepatic adenomas and focal nodular hyperplasia are benign liver tumours.

New cases/year World 2008: 749,000 [male: 523,000, female: 226,000];

USA 2011 (est): 26,190; UK 2008: 3,594

Deaths/year World 2008: 695,000 [male: 478,000, female: 217,000];

USA 2011 (est): 19,590; UK 2008: 3,390

Risk factors Much more common in men than in women. Associated with increasing age.Most cases caused by hepatitis virus infection: HBV in Eastern Asia, HBC in Western Europe.  Chronic exposure to environmental toxins, notably aflatoxin B1 that is made by a fungus that infects a variety of cereals, is also a cause of HCC, particularly in China and west Africa.  HCC can also develop from cirrhosis (commonly caused by alcoholism).  Where hepatitis is not endemic the usual cause of HCC is metastasis from primary tumours, particularly in the colon and breast. Only a fraction of chronic HBV carriers develop HCC.Smoking and/or alcohol consumption together with hepatitis infection increases risk. Frequently associated with cirrhosis and 5% of patients with cirrhosis eventually develop HCC.

Aflatoxin (produced by a fungus called Aspergillus) ingestion, chewing betel quid and exposure to vinyl chloride (used in the production of the plastic PVC).

Symptoms

Nausea, jaundice (yellow skin color), increased liver mass. Raised levels of alpha-fetoprotein and/or in alkaline phosphatase arise from some HCCs.

Staging Stage 1: Single tumour: no metastasis.Stage 2: Single or multiple small tumours (less than 5 cm diameter): no metastasis.Stage 3A: Tumours greater than 5 cm diameter: no metastasis.

Stage 3B: Tumour growth into adjacent blood vessels: no further metastasis.

Stage 3C: Tumour growth confined to area around the liver.

Stage 4A: Spread to lymph nodes.

Stage 4B: Spread to other organs in the body.

Major gene mutations Alterations affecting the retinoblastoma pathway (loss of RB1 and INK4A expression and amplification of cyclin D1) occur in 70-100% of cases. Also common are loss of P53 (15-50%), b-catenin (20-40%)
Treatment

Surgery or a liver transplant are options for localised tumours. Few means available for advanced disease and their efficacy is limited. Most frequently used drugs are doxorubicin (Adriamycin) and cisplatin.

Side effects

Nausea, diarrhoea, hair loss, fatigue, general suppression of the immune system and increased infection risk.

Prognosis 5 year survival rate in developed countries: 11%.
Advertisements