Liver cancer, adult primary

A tumor in which the cancer starts during adulthood in cells in the liver. Also called hepatocellular carcinoma or hepatoma.

Primary liver cancer is different from cancer that has metastasized (spread) from another place in the body to the liver.

The signs and symptoms may include a hard lump just below the rib cage on the right side (from swelling of the liver), discomfort in the upper abdomen on the right side, pain around the right shoulder blade, or yellowing of the skin (jaundice).

There is often an increase in the blood levels of alpha-fetoprotein (AFP) and alkaline phosphatase. A rapid deterioration of liver function may be the only clue to the presence of the tumor.

Hepatocellular carcinoma is potentially curable by surgery, but surgery is the treatment of choice for only a small fraction of patients who have localized disease. Laparoscopy may detect metastatic disease, tumor in both lobes of the liver, or an inadequate liver remnant, and avoid the need for open surgery to explore the liver .Liver transplantation can be curative as well, but is only appropriate for 5% of patients presenting with a hepatoma.

Therapy other than surgery is best as part of a clinical trial. Such trials evaluate the efficacy of systemic or infusional chemotherapy, hepatic artery ligation or embolization, percutaneous ethanol (alcohol) injection, radiofrequency ablation, cryotherapy (freezing the tumor), and radiolabeled antibodies, often in conjunction with surgical resection (removal) and/or radiation therapy.

The prognosis (outlook) depends on the degree of local tumor replacement and the extent of liver function impairment.

Primary liver cancer (hepatocellular carcinoma) is the most common cancer in some parts of the world. It is still relatively uncommon in the US but its incidence is rising, principally in relation to the spread of hepatitis B and hepatitis C. People who have a disease of the liver called cirrhosis are also more likely to get adult primary liver cancer. The iron storage disease hemochromatosis also increases the risk of developing hepatocellular carcinoma.

Hepatitis B and C appear to be the most significant causes of hepatocellular carcinoma worldwide. People who have both hepatitis B and hepatitis C may be at a higher risk if they consume more than 3 oz. (80 grams) of alcohol a day. A first-degree relative with hepatocellular carcinoma also increases the risk.

Hepatocellular carcinoma is associated with cirrhosis in 50% to 80% of patients; 5% of cirrhotic patients eventually develop hepatocellular cancer.

Aflatoxin has also been implicated as a factor in the etiology (causation) of primary liver cancer in parts of the world where this mycotoxin – a toxin from a mold infestation-occurs in high levels in food.

Workers exposed to vinyl chloride before controls on vinyl chloride dust were instituted developed sarcomas in the liver, most commonly angiosarcomas.