Liver tumors may be noncancerous (benign) or cancerous (malignant). Cancerous tumors may originate in the liver, or they may spread (metastasize) to the liver from other parts of the body. Cancer originating in the liver is called primary liver cancer; cancer originating elsewhere in the body is called metastatic cancer. The vast majority of liver cancers are metastatic.
Noncancerous liver tumors are relatively common but usually cause no symptoms. Most are detected when people have a scanning test– such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI)– for an unrelated reason. However, some of these tumors use the liver to enlarge or to bleed into the abdominal cavity. The liver usually functions normally, so blood tests show normal or only slightly elevated levels of liver enzymes.
A hepatocellular adenorna is a common noncancerous tumor of the liver
Hepatocellular adenomas occur mainly in women of childbearing age, probably because oral contraceptives increase the risk of this type of growth. These tumors usually cause no symptoms, so most remain undetected. Rarely, an adenoma suddenly ruptures and bleeds into the abdominal cavity, requiring emergency surgery. Adenomas caused by oral contraceptives often disappear when the woman stops taking the drug.
In extremely rare cases, an adenoma may become cancerous.
A hemangioma is a noncancerous tumor of the liver composed of a mass of abnormal blood vessels.
An estimated 1 to 5 per cent of adults have small liver hemangiomas that cause no symptoms. These tumors are usually detected only if the person happens to undergo an ultrasound or computed tomography (CT) scan. They do not require treatment. In infants, large hemangiomas occasionally produce symptoms that lead to their detection, such as widespread clotting and heart failure. Surgery may be required.
A hepatoma (hepatocellularcarcinoraa) is a cancer that begins in the liver cells.
Hepatomas are the most common type of cancer originating in the liver (primary liver cancer). In certain areas of Africa and Southeast Asia, hepatomas are even more common than metastatic liver cancer, and they are a prominent cause of death. In these areas, there is a high prevalence of chronic infection with the Hepatitis B virus, which increases the risk of hepatomas more than 100-fold. Chronic infection with Hepatitis C also increases the risk of hepatomas. Finally, certain cancer-causing substances (carcinogens) produce hepatomas. In subtropical regions where hepatomas are common, food is often contaminated by carcinogens called aflatoxins, substances that are produced by certain types of fungi.
In North America, Europe, and other areas of the world where hepatomas are less common, most people with hepatomas are alcoholics with long-standing liver cirrhosis. Additional types of cirrhosis are also associated with hepatomas, though the risk is lower with primary biliary cirrhosis than with other types.
Fibrolamellar carcinoma is a rare type of hepatorna that usually affects relatively young adults. It is not caused by preexisting cirrhosis, Hepatitis B or C infection, or other known risk factors.
Usually, the first symptoms of a hepatoma are abdominal pain, weight loss, and a large mass that can be felt in the upper right part of the abdomen. Alternatively, a person who has had cirrhosis for a long time may unexpectedly become much more ill. A fever is common. Occasionally, the first symptoms are acute abdominal pain and shock, caused by a rupture or bleeding of the tumor.
In people with hepatomas, blood levels of alpha-fetoprotein typically are high. Occasionally, blood tests reveal low levels of glucose or high levels of calcium, lipids, or red blood cells.
At first, the symptoms do not provide many clues to the diagnosis. However, once the liver enlarges enough to be felt, a doctor may suspect the diagnosis. especially if the person has long-standing cirrhosis. Occasionally, a doctor can hear rushing sounds (hepatic bruits) and scratchy sounds (friction rubs) when a stetho-scope is placed over the liver.
Abdominal ultrasound and computed tomography (CT) scans sometimes detect cancers that have not yet caused symptoms. In some countries where the Hepatitis B virus is common, such as Japan, ultrasound scans are used to screen people with the infection for liver cancer. Hepatic arteriography (X-rays taken after a radiopaque substance is injected into the hepatic artery) may reveal hepatomas. Hepatic arteriography is particularly useful before surgical removal of the hepatoma because it shows the surgeon the precise location of the liver blood vessels.
A liver biopsy, in which a small sample of liver tissue is removed by needle for examination under a microscope, can confirm the diagnosis The risk of bleeding or other injury during a liver biopsy generally is low.
Prognosis and Treatment
Usually, the prognosis for people with a hepatoma is poor because the tumor is detected too late. Occasionally, a person with a small tumor may do very well after the tumor is surgically removed.
Other Primary Liver Cancers
A cholangiocarcinoma is a cancer that originates in the lining of the bile channels in the liver or bile ducts. In the Orient, infestation with parasites called liver flukes may be partly responsible for this cancer. People with long-standing ulcerative colitis and sclerosing cholangitis occasionally develop cholangiocarcinoma.
A hepatoblastoma is one of the more common cancers in infants. Occasionally, it occurs in older children and may produce hormones called gonadotropins that result in early (precocious) puberty. A hepatoblastoma is usually detected because of overall failing health and a large mass in the upper right part of the abdomen.
An angiosarcoma is a rare cancer originating in the blood vessels of the liver. An angiosarcoma may be caused by exposure to vinyl chloride in the workplace.
Diagnosis and Treatment
Cholangiocarcinomas, hepatoblastomas, and angiosarcomas can be diagnosed only by liver biopsy, in which a sample of liver tissue is re-moved by needle for examination under a microscope. Usually, treatment has little value, and most people die within a few months of when the tumor is detected. If the cancer is detected relatively early, however, the tumor may be surgically removed, offering the hope of long-term survival.
Metastatic Liver Cancers
Metastatic liuercancers are tumors thathave spread to the liver from elsewhere in the body.
Metastatic liver cancer most commonly comes from the lung, breast, colon, pancreas, and stomach. Leukemia and other blood cell cancers, such as lymphomas, may involve the liver. Sometimes the discovery of a metastatic liver tumor is the first indication that a person has cancer.
Often, the first symptoms include weight loss and poor appetite. Typically, the liver is enlarged and hard and may be tender. Fever may be present. Occasionally the spleen is enlarged, especially if the cancer originated in the pancreas. The abdominal cavity may become distended with fluid, a condition called ascites. At first, jaundice is absent or mild, unless the cancer is blocking the bile ducts. In the weeks before the person dies, jaundice progressively worsens. Also, the person may become confused and drowsy as toxins accumulate in the brain, a condition called liver encephalopathy.
In the late stages of the disease, a doctor usually can diagnose metastatic liver cancer fairly easily, but the diagnosis is more difficult in the early stages. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) of the liver may reveal the cancer, but these scans can't always detect small tumors or distinguish a tumor from cirrhosis and other abnormalities. The tumors often cause liver malfunction, which can be detected by blood tests.
A liver biopsy, in which a sample of liver tissue is removed by needle for examination under a microscope, confirms the diagnosis in only about 75 per cent of the cases. To improve the chances of obtaining cancerous tissue, ultrasound can be used to guide the insertion of the biopsy needle. Alternatively, a biopsy specimen may be obtained while a doctor looks at the liver through a laparoscope (a fiber-optic viewing tube that is inserted through the abdominal wall).
Leukemia usually is diagnosed based on the results of blood and bone marrow tests. Typically, a liver biopsy isn't needed.
Depending on the type of cancer, anticancer drugs may temporarily shrink the tumor and pro-long life, but they do not cure the cancer. Anticancer drugs may be injected into the hepatic artery, which then delivers a high concentration of the drugs directly to the cancer cells in the liver. This technique is more likely to shrink the tumor and to produce fewer side effects, but it hasn't been proved to prolong life. Radiation therapy to the liver can sometimes reduce severe pain, but it has little other benefit.
If only a single tumor is found in the liver, a surgeon may remove it, especially if it comes from cancer of the intestine. However not all experts consider this surgery worthwhile. For most people with extensive cancer all a doctor can do is relieve the symptoms.
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