Liver Cancer 101

Primary liver cancer, also called hepatocellular carcinoma (HCC) or hepatoma, is a cancer that arises from within the liver. It is the solid organ tumor whose incidence is rising most rapidly in the United States directly related to both hepatitis C and fatty liver. HCC should not be confused with metastatic cancer to the liver. Metastatic cancer to the liver means that a cancer from another organ such as the lung or colon has spread to the liver.

HCC occurs in people with underlying liver disease that has generally progressed to advanced fibrosis or cirrhosis. Any liver disease which has progressed to cirrhosis places an individual at risk for liver cancer. These include conditions such as hepatitis C, hepatitis B, fatty liver disease, alcoholic liver disease, primary biliary cholangitis, hemochromatosis and autoimmune liver disease.

There are, however, two common conditions, hepatitis B and non-alcoholic fatty liver disease, in which HCC can arise without cirrhosis. Therefore, all patients with cirrhosis regardless of etiology and all patients with hepatitis B and fatty liver, even in the absence of cirrhosis, should be screened for primary liver cancer. Liver cancer is frequently asymptomatic and diagnosed at the same time as cirrhosis is diagnosed.
HCC is diagnosed on imaging studies, such as ultrasounds, CAT scans or MRIs. A biopsy usually is not necessary. PET scanning is not useful in primary liver cancer. If HCCs are found when they are small, they can be treated with very good success rates. If HCCs are found when they are large, their prognosis is much worse. This is the reason that people at risk for HCC should have screening imaging studies performed every six months.

The current treatments for hepatocellular include surgery, liver transplantation, chemoembolization, radio frequency ablation and chemotherapy. The best treatment is surgical resection but unfortunately, this option can only be recommended in patients without cirrhosis or in those with cirrhosis whose lesions are peripherally located in the liver and have well preserved liver function. Liver transplantation is a very good options and people with cirrhosis and liver cancer should be evaluated for transplantation. Once a cancer is diagnosed, there are options that can be employed to shrink or kill the tumor. These options, such as radiofrequency ablation or transarterial chemoembolization, are performed by a radiologist and are generally outpatient procedures which are very effective. Usually people undergo these procedures to keep the tumor in check while waiting for a liver transplant. In those patients where the tumor is too large for liver transplantation or in those people with multiple tumors within the liver that preclude transplantation, chemotherapy is available. While overall results of chemotherapy have been disappointing, several new agents have been recently introduced which may improve survival.

The epidemic of liver disease in the United States, especially hepatitis C and fatty liver disease, is leading to a significant rise in primary liver cancers. The medical community has made tremendous strides in treating these cancers. Not long ago, being told you had liver cancer was a death sentence, but now it is simply a bump in the road to a long healthy life. Hopefully, the progress in treating these tumors will continue to advance.

David Bernstein
David Bernstein, MD, is a columnist for Long Island Weekly and chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.

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