LIVER TUMORS

The liver is the largest organ of the human body, with weight about 1500 grams. It is located in the entire right upper part of the abdomen, surrounded by the stomach, inferior vena cava, portal vein, pancreas, right kidney and adrenal gland.

Liver tumors are divided into two groups:

1 Benign

The more common benign tumors of the liver include:

• Hemangioma
• Hepatic adenoma
• Focal nodular hyperplasia
• Cysts
• Lipoma
• Fibroma
• Leiomyoma

2. Malignant (Hepatobiliary Cancers)

The types of hepatobiliary cancers include gallbladder cancer, intrahepatic cholangio-carcinoma, and extrahepatic cholangiocarcinoma, hepatocellular carcinoma (HCC),

Most of the hepatobiliary carcinomas are detected in the gallbladder, one-third in the intrahepatic and extrahepatic bile ducts. The rest of the cases are hepatocellular carcinomas.

Risk Factors of Liver Cancer

The most common factors of liver cancer is liver damage cause by birth defects, excessive alcohol intake, or chronic infection with hepatitis B (HBV) and/or C (HCV) virus, also inherited errors of metabolism, such as hereditary hemochromatosis (a hereditary disease associated with too much iron in the liver), porphyria cutanea tarda, α1-antitrypsin deficiency, and Wilson's disease, and autoimmune hepatitis and primary biliary cirrhosis increase risk of liver cancer. Liver cancer may also be linked to obesity and fatty liver disease.

Symptoms of liver cancer

Symptoms can include jaundice, anorexia, weight loss, malaise, stomach ache, fatigue, loss of appetite, abdominal swelling and vomiting also hematemesis (vomiting of blood)

Physical Examination Findings

Physical signs of lever cancer can include hepatomegaly, ascites and pleural effusion (fluid accumulation in the pleural cavity). Paraneoplastic syndromes can also occur.

Evaluation Of Patient With Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma (HCC) is a primary malignancy of the liver.

Evaluation of liver

Liver ultrasonography are the most common method of screening for HCC

Diagnostic HCC imaging involves also: CT (CT during arterial portography, post Lipiodol-CT) and MRI.

In some cases to diagnose HCC needle biopsy is recommended. In addition useful in diagnosing HCC are tumor biomarkers (AFP, CEA, CA-19-9)

Treatment of HCC

• Surgery
• Chemotherapy
• Transarterial Chemoembolization
• Percutaneous Ethanol Injection
• Cryosurgery

Surgery

Partial hepatectomy (liver resection) is a potentially curative therapy for patients with early-stage HCC who are eligible to undergo the procedure. Liver resection includes several techniques:

• Right hepatectomy
• Extended right hepatectomy
• Left hepatectomy
• Segmentectomy
• Trisegmentektomy

Criteria for resection:

Resection is recommended only if liver function can be preserved . At least 20% intact tissue should remain after liver resection and there is no extra-hepatic metastases. Extra-hepatic spread, lymph nodes or vascular invasion are serious contraindications for liver resection

Radiotherapy

Radioresistance (30-40%)

Radiation, due to the risk of hepatitis B development, is very limited

Important factors affecting the resection prognosis

For patients undergoing liver resection survival rate can achieve 5-years. Prognosis of uni-focal tumors is better than multi-focal, but it depends on tumor size (5 cm) and its location. Important factor is presence or absence of capsule and vascular invasion. Optimal tumor characteristics for liver resection are solitary tumors without major vascular invasion.