Updated: 19 January 2006

1 Clinico-pathologic Considerations

The most common primary liver malignancy is hepatocellular carcinoma. A variant of hepatocellular cancer, fibrolamellar carcinoma, has somewhat better prognosis.

Cholangiocarcinoma (intrahepatic bile duct carcinoma) is relatively unusual and should be managed according to the guidelines for bile duct malignancies (Section 11).

2 Diagnostic Pathology

Any liver lesion more than 2 cm in size should be considered as a possible primary malignancy, particularly in the background of cirrhosis or chronic hepatitis B or C infection. The diagnosis is usually made on clinical grounds, and preoperative needle aspiration is not encouraged because of risk of hemorrhage or tumour seeding. Fine needle biopsy is primarily utilized for unresectable lesions prior to planning alternative therapies.

3 Radiology/ Imaging

Liver malignancies may be imaged by ultrasound or CT scan. The sensitivity of CT scan is improved with the use of CT angiography with images taken in various phases of circulation through the liver. The increasing use and availability of PET or PET/ CT scans may help identify occult especially extrahepatic disease that might render a solitary or limited liver tumour unresectable for cure. MRI can be considered for those patients being considered for resection.