Introduction to Liver Cancer
Last Modified: November 1, 2001
Incidence and Risk Factors
Cancer of the liver is a rare malignancy in the United States, but in
parts of Asia and Africa, it is one of the most common
malignancies. In the United States, the average age on onset is 60
to 70 years; the disease occurs more frequently in males than
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.
Clinical Manifestations and Diagnosis
Signs of liver cancer include weakness, anorexia, fever of unknown
origin, abdominal fullness or bloating, and dull upper quadrant
abdominal pain. The clinical presentation will vary depending on the
presence or absence of cirrhosis. Patients with cirrhosis exhibit
rapid onset of symptoms; in the absence of cirrhosis, signs are much
more subtle. As the tumor grows, pain may radiate to the back.
Patients must be assessed carefully, as weight loss is often obscured
by ascites. The liver is generally tender to palpation, and jaundice
and portal hypertension may be present.
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.
Surgical resection is attempted if no nodal involvement or distant
spread is found. Even with resection, recurrence of liver cancer is
common, and 5-year survival is rare. Patients may be treated with
chemotherapy infused directly into the hepatic circulation. With this
type of treatment (intra-arterial chemotherapy)
, a catheter is
surgically placed in the hepatic artery and the chemotherapeutic
agent is continuously infused. The most commonly used agents are
5-FU, doxorubicin, and methotrexate. Side effects of this technique
include toxic hepatitis (which subsides after discontinuation of
therapy) and catheter displacement or occlusion.
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
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
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