Liver Cancer Hepatocellular Carcinoma (cont.)
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
In this Article
- What is liver cancer?
- What is metastatic liver cancer?
- What causes liver cancer?
- What are the risk factors for liver cancer?
- What are liver cancer symptoms and signs?
- How is liver cancer diagnosed?
- What is the treatment for liver cancer?
- What is the follow-up after treatment for liver cancer?
- What is the prognosis of liver cancer?
- Are there alternative and complementary therapies for liver cancer?
- How is liver cancer staged?
- Can liver cancer be prevented?
- Find a local Doctor in your town
What are the risk factors for liver cancer?
Incidence rates of hepatocellular cancer are rising in the United States due to increasing prevalence of cirrhosis caused by chronic hepatitis C and non-alcoholic fatty liver disease.
Cirrhosis of the liver due to any cause is a risk factor for liver cancer. The risk factors for liver cancer in cirrhosis are being male, age 55 years or older, Asian or Hispanic ethnicity, family history in a first-degree relative, obesity, hepatitis B and C, alcohol use, and elevated iron content in the blood.
Chronic hepatitis B infection even without cirrhosis is a risk factor for liver cancer.
What are liver cancer symptoms and signs?
Liver cancer causes no symptoms of its own. As the tumor grows, it may cause symptoms of pain in the right side of the abdomen or a feeling of fullness when eating. Some patients may have worsening of symptoms of chronic liver disease or cirrhosis, which often precedes the development of cancer of the liver. For example, patients may complain of cachexia (wasting), increased swelling of the feet and belly, and yellowing of the eyes (jaundice).
How is liver cancer diagnosed?
The best way to detect liver cancer is through surveillance ultrasound of the liver done every six months in a patient with a diagnosis of cirrhosis and to treat the liver cancer as soon as it is detected.
Once a suspicion of liver cancer arises, a physician will order one the following:
- Blood tests: alfa-fetoprotein (AFP), which may be elevated in 70% of patients with liver cancer. AFP levels could be normal in liver cancer. A rising level of AFP is suspicious for liver cancer. Other labs tests include des-gamma-carboxy prothrombin, which can be elevated in most patients with liver cancer.
- Imaging studies: Multiphasic helical CT scan and MRI with contrast of the liver are the preferred imaging for detecting the location and extent of blood supply to the cancer. If any imaging study is inconclusive, then an alternative imaging study or follow-up imaging study should be performed to help clarify the diagnosis. Lesions smaller than 1 cm are usually difficult to characterize.
- Liver biopsy is performed to sample tissue from the lesion in the liver, which is then analyzed by the pathologist to confirm the suspected diagnosis of liver cancer. Liver biopsy is not needed in every case, especially if the imaging study and lab markers are characteristic for liver cancer. Risks of liver biopsy are infection, bleeding, or seeding of the needle track with cancer. Seeding is when cancer cells get on the needle used for a biopsy and spread to other areas touched by the needle. Liver biopsy of suspected liver cancer carries the added risk of seeding the liver biopsy needle track in 1%-3% of cases. If a liver biopsy is inconclusive, then a repeat imaging study is recommended at three- to six-month intervals. Liver biopsy as well as imaging studies help in classifying liver cancers as per the Barcelona Clinic Liver Cancer staging system.
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