Primary Carcinoma Of Liver

General Information / Anatomy / Function / Statistics

• Also called hepatocellular carcinoma or hepatoma
• Body's largest internal organ and one of the most complex
• Weight up to 4 lbs. and is situated in the right upper quadrant of the abdomen
• Performs numerous biochemical functions such as removing toxins from the blood and produces bile, cholesterol, digestive enzymes and complex proteins
• Stores glycogen which is converted into glucose
• Primary cancer is rare in North America: one to two percent of all cancers
• In Africa and parts of Asia, one of the most common malignancies. In Ethiopia, 20% of all malignancies
• Most patients in U.S. are of late middle age or older
• In Africa, disease strikes in young adulthood or early middle age

Symptoms / Signs

• No obvious symptoms in early stages
• Weight loss, malaise
• Loss of appetite
• Abdominal pain and swelling
• Fever is not uncommon
• Jaundice
• Ascites (buildup of fluid in abdominal cavity)
• Metastasis may result in bone pain, cough from lung involvement or gastrointestinal bleeding

Etiology / Carcinogens / Risks

Diagnosis / Staging / Grading / Types

• Generally not diagnosed until advanced stage
• Enlarged painful liver most common finding on physical examination
• Tumour may be a single mass or a number of small nodules. Important to determine if it is primary or secondary or a benign tumour
• Liver function tests
• Blood test for ALPHAFETOPROTEIN (AFP) has been thought to be a useful screening test, but elevated levels are found in a number of diseases (cancer of testes, stomach, pancreas and lungs--also normal pregnancy) as well as cirrhosis of the liver. Also 30% of Americans with liver cancer do NOT have an elevated AFP
• Liver scans
• Angiography of the liver
• Bone scan
• Chest X-ray
• Ultrasound examinations
• Biopsy provides definite diagnosis but potential bleeding problems may rule out a needle aspiration
• Abdominal exploratory surgery or laparoscopy
• CT scan

Staging

• Localized resectable
• Localized unresectable
• Advanced

Types

• 90% are hepatocellular carcinomas arising from the liver cells (30-70% of patients have cirrhosis)
• 7% arise in the liver's bile ducts
• Fibrolamellar is an unusual type of hepatocellular carcinoma which generally occur in young women
• Remaining are angiosarcomas--very rare but of growing importance because they are associated with polyvinylchloride (PVCs) and other similar industrial toxins

Treatment

• Surgery is the only way to cure primary liver cancer
• Surgical treatment most likely to succeed with a solitary tumour confined to one lobe that can be entirely removed
• Unfortunately most often the malignancy has spread through the liver and cannot be removed
  The liver may already be extensively damaged by cirrhosis or other disease
• Normally with healthy tissue, the liver has an amazing capacity to regenerate and up to 80% can be removed. This usually occurs in young patients with benign tumours or accident victims, rather than in cancer patients
• Radiation is primarily used to manage painful bone metastases
• Chemotherapy and radiation are sometimes helpful in relieving symptoms
• Chemotherapy is usually with DOXORUBICIN or 5-FLUOROURACIL which will sometimes relieve symptoms
• Chemoembolization (definition: delivery of drugs through the hepatic artery directly to the tumour followed by blocking the artery) with drugs (usually doxorubicin) given into the liver via a catheter followed by embolization (definition: blocking) of the artery may be used in selected patients with good liver function
• Cryosurgery with liquid nitrogen (is not curative) is to control cancer only and is for a selective group of patients only. Patients who qualify are ones who have few, slightly larger lesions which are on the surface of the liver .
• Alcohol injection may be used to treat smaller lesion if not resectable (openable)
• Radio - frequency ablation is an experimental technique currently under research

Radiofrequency Ablation (Heat) Treatment for Liver Cancer

Indications:

• Investigational heat treatment for primary and secondary liver cancer.
• Ideally for treatment of liver cancer or metastases, limited usually to treatment of 3 tumours in the liver, or occasionally up to 5 tumours that are accessible to the needle probe through the skin, or during a surgical operation, laparotomy or laparoscopy
• Patients should be in good general health

Procedure:

• Uses a new method of delivering focused radiofrequency waves through a probe which produces alternating current to locally heat the tumour cells in the liver, resulting in tumour cell kill. (Blood flow in tumours is less efficient than normal liver tissue, which causes a greater elevation in temperature of tumour cells compared to surrounding normal cells )
• Provides an efficient (non-systemic) method of delivering hyperthermia directly to localized tumours with a needle probe inserted directly into the liver tumour(s)
• The probe allows the insertion of 4 wires from within the central probe that delivers the radiofrequency alternating current to elevate the temperature of the tumour cells
• The procedure uses ultrasound to accurately guide the probe

Revised May 1999