Adult primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver. If the cancer has traveled from another organ and lodged in the liver, it is known as secondary or metastatic liver cancer.
The liver is one of the largest organs in the body. It has two lobes and fills the upper right side of the abdomen inside the rib cage. The liver has many important functions, including:
- Filtering harmful substances from the blood so they can be passed from the body in stools and urine.
- Making bile to help digest fats from food.
- Storing glycogen (sugar), which the body uses for energy.
Liver cancers are commonly referred to as hepatocellular carcinoma (HCC) which is the fifth most common solid tumor in the world.. Prevalence in the U.S. is much lower than the rest of the world. Most cases are seen in people with liver cirrhosis. More than 80 percent of HCC develops in cirrhotic livers and the remaining 20 percent arise in livers without evidence of cirrhosis.
Recurrent Adult Primary Liver Cancer
By definition, liver metastasis is cancer that has spread to the liver from somewhere else in the body. The liver is the most common site for cancers to spread to after the lymph nodes. Most of these originate from cancers of the colon, rectum, pancreas, stomach, esophagus, breast, lung, melanoma and some other less common sites. In the past, they were often considered advanced disease and frequently sent for palliative care. However, today the paradigm has shifted completely. Depending on where they orginate from, aggressive surgical resection couples with chemotherapy will lead to significant improvement and long term survival in this patient population.
Benign Liver Tumors
Benign liver tumors are non-cancerous masses or lesions of the liver. These tumors affect nearly 20 perecent of the U.S. population. Benign lesions of the liver are correspondingly increasing as the use of diagnostic imaging increases. Benign lesions include cystic tumors such as simple cysts, cystadenomas and echinococcal cysts. Benign solid lesions include hepatic adenomas, focal nodular hyperplasia and hemangiomas.
Hepatic Hemangiomas (Liver Hemangioma)
Hepatic hemangiomas are the most common benign solid lesions of the liver. These lesions are usually found in middle-aged women. They are most commonly located in the subcapsular area of the right lobe and measure less than 5 cm. If larger, they may cause non-specific abdominal pain as a result of tumor expansion, hemorrhage or localized thrombosis. Although there are case reports of spontaneous and traumatic rupture of hemangiomas, hemorrhage is uncommon. Rarely, giant hemangiomas may have thrombocytopenia, disseminated intravascular coagulopathy, bleeding and abdominal pain. Hemangiomas are usually solitary but 5 to 10 percent of patients have multiple lesions. These can often be followed conservatively, i.e. no treatment. Surgical treatment should be considered only for patients who are symptomatic or to definitively rule out cancer. Enucleation or resection of the hemangioma is the operative procedure of choice.
Hepatic adenomas (HA) occur mostly in 20 to 40 year old premenopausal women on oral contraceptives. These lesions have a 25 percent risk of rupture of bleeding. Patients commonly present with abdominal pain. The association with oral contraceptives was established in the 70’s and it has become well known that HA are associated with estrogen and progesterone. Understandably, HA have a tendency to grow and rupture during pregnancy, and the risks to the mother and fetus are extremely high. Surgical Resection is the preferred form of treatment for HA because of the risks of rupture, bleeding and malignant transformation. Although there have been anecdotal reports of complete resolution of small HA following the cessation of oral contraceptives, resection is still favored if they persist.
Asymptomatic simple cysts may be followed routinely and often require no treatment. Surgical treatment is recommended for cysts that are symptomatic as in causing problems with digestion, dyspepsia etc. Percutaneous aspiration has a 100 percent recurrence rate and is performed only to secure a diagnosis or as a therapeutic test. The current recommended therapy is laparoscopic unroofing of the cyst. Cystadenomas are most commonly found in the liver parenchyma and less often in the extrahepatic biliary ducts. The pathogenesis is unclear and may be congenital in origin from abnormal bile ducts or from aberrant germ cells.
The disease tends to occur in females 30 to 50 years old. These cystic tumors are often large and symptomatic, causing abdominal pain and/or an abdominal mass. Ten percent of cystadenomas are malignant and there is a 25 precent chance of malignant degeneration. Diagnosis is usually made on an ultrasound and/ or a CT scan and appear as multiloculated cystic lesions with papillary projections. Cystadenomas carry the risk of malignant degeneration, enlargement and infection and should undergo complete resection.