Liver cancer (hepatocellular carcinoma)

The liver is one of the largest organs in the body, located in the upper right portion of the abdomen.

Hepatocellular carcinoma (HCC) is a cancer that arises in the liver. It is also known as hepatoma or primary liver cancer. HCC is the fifth most common cancer in the world.

Symptoms

Abdominal pain is the most common symptom of HCC and usually occurs when the tumor is very large or has spread to other parts of the body. Unexplained weight loss or unexplained fevers are warning signs in patients with cirrhosis. Sudden appearance of abdominal swelling (ascites), yellowing of the eyes and skin (jaundice), or muscle wasting suggests the possibility of HCC.

Causes/Risk Factors

It is well established that individuals with hepatitis B and/or hepatitis C virus infection are at increased risk of developing HCC. Alcohol-related liver disease is also a risk factor for the development of HCC.

There are certain chemicals that are associated with liver cancer–aflatoxin B1, vinyl chloride and thorotrast. Aflatoxin is produced by a funguscalled Aspergillus flavus and is found in foods such as peanut, rice, soybean, corn and wheat. Furthermore, thorotrast is no longer used in radiology exams, and vinyl chloride is a compound found in plastics.

Patients with cirrhosis from any cause such as the hepatitis virus, hemochromatosis and alpha-1-antitrypsin deficiency are at increased risk of developing HCC.

Screening/Diagnosis

HCC cannot be diagnosed with routine blood tests. Screening should be done by specific blood tests such as tumor marker and alpha-fetoprotein (AFP) tests, combined with radiological imaging. Radiological imaging tests are very important and may include one or more of the following: ultrasound, CT scan, MRI scan (magnetic resonance imaging), and angiography.

If HCC is suspected, usually the first step to proceed with is to perform a liver ultrasound.

The ideal workupis multiphase CT scan with the use of oral and IV contrast.

MRI can actually reconstruct images of the biliary tree, and the arteries and veins of the liver.

Angiography is a test  where a contrast agent  is injected into a large artery in the groin.

Treatment

The prognosis depends on the stage of the tumor and the severity of the associated liver disease. There are some factors that predict a poor outcome. These include:

• DemographicsSymptoms: weight loss, decreased appetite.
• Signs of impaired liver function: jaundice, ascites or mental confusion related to liver disease (encephalopathy).
• Blood tests - Staging of tumor.

Chemotherapy:
This may include the injection of anti-cancer chemicals into the body through a vein or through chemoembolization.

The technique of chemoembolization is a procedure where chemotherapy medication is injected directly into the blood vessels that supply the tumor.,

Ablation:
Ablation (tissue destruction) therapy by using radiofrequency waves, proton beam radiation, or injecting alcohol into the tumor.

https://www.mayoclinic.org/diseases-conditions/liver-cancer/symptoms-causes/syc-20353659