There is a strong association between chronic hepatitis B infection and the development of heptaocellular carcinoma. People with cirrhosis also have an increased risk of liver cancer. Other possible hepatocarcinogens include aflatoxin, nitrosamines, oral estrogen compounds, and numerous other chemicals.
Diagnosis is made using radioisotope scans, CT scans, or hepatic arteriography. Many patients will have advanced disease at diagnosis. Cancer of the liver spreads throughout the organ and invades the portal vein and lymphatics. The most common sites of distant metastases are the lungs and brain.
Radioimmunotherapy is an experimental form of treatment used for some types of liver cancer. A radioactive isotope is attached to a radiolabeled antibody against ferritin, a specific protein found in human liver tumors. The isotope is given intravenously and concentrates in the liver, where it radiates the tumor internally. No immediate treatment side effects have been noted, but thrombocytopenia and neutropenia occur 4-6 weeks after treatment.
The prognosis for liver carcinoma patients is poor. Untreated patients usually die in 3-4 months; treated patients may live 6 to 18 months if they respond to therapy. Long-term survival is seen occasionally after successful subtotal hepatectomy for noninvasive carcinoma. Because the normal metabolic and storage functions of the liver are impaired, patients are at risk for nutritional and bleeding complications.
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