Hepatocellular carcinoma, also called hepatoma or primary liver cancer, is the solid organ tumor whose incidence is rising the most rapidly in the United States. This type of cancer 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.
Hepatocellular carcinoma (HCC) occurs in people with underlying liver disease that has generally progressed to cirrhosis. Any liver disease which has progressed to cirrhosis places an individual at risk for liver cancer. Therefore, conditions such as hepatitis C, fatty liver disease, alcoholic liver disease, primary biliary cirrhosis, hemochromatosis, autoimmune liver disease and hepatitis B can lead to liver cancer if cirrhosis is present.
Interestingly, all people with hepatitis B are at increased risk for developing liver cancer, even those without cirrhosis, although those with cirrhosis have a higher risk of cancer. Cirrhosis is a consequence of an underlying liver disease but not a disease itself. As cirrhosis is often without symptoms, liver cancer is frequently found at the same time cirrhosis is diagnosed.
HCC is diagnosed on imaging studies such as ultrasound, CAT scan or MRI. PET scanning is not useful in liver cancer. Many studies done for other reasons find lesions in the liver that turn out to be cancer. Luckily, most of these “incidentalomas” are benign and are not cancerous. If HCCs are found when small, they can be treated with very good success rates. This is reason that people with known cirrhosis should have screening imaging studies performed one to two times a year.
The current treatments for hepatocellular include surgery, liver transplantation, chemo-embolization, 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 good liver function.
Liver transplantation is a good option. There are options that can be employed to shrink or kill the tumor. These options such as radiofrequency ablation or trans-arterial chemo-embolization, are performed by a radiologist and are generally outpatient procedures which are effective.
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 but the results of chemotherapy remain disappointing.
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. Being told you had liver cancer was an absolute death sentence but now for many people is a bump in the road on the way to a long healthy life. Progress in treating tumors will continue to advance.
David Bernstein, MD, is chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.