-IBIS-1.5.0-
tx
digestive system
liver cancer
diagnoses

definition and etiology

definition:
Neoplasm of the liver: may be benign, primary malignant or metastatic. Most liver cancers in the U.S. are metastatic.

Malignant primary neoplasms of the liver are categorized into:
• hepatomas: liver cell carcinomas
• cholangiocarcinomas: bile duct carcinomas
• combination of the above
• hepatoblastomas
• hemangiomas
• angiosarcomas

etiology:
While the exact etiology of these conditions is unknown or unproven, there are many clear associations and risk factors. Those for hepatocellular carcinoma include chronic hepatitis B, hemochromatosis, cirrhosis, alpha-1-antitrypsin deficiency, administration of exogenous androgens, aflatoxin ingestion. Angiosarcomas are associated with exposure to chemicals such as arsenic and vinyl chloride.

signs and symptoms

general:
• hepatomas do not produce characteristic symptoms or signs
• elevated LDH enzymes may be seen in certain liver cancers; (there are four LDH isoenzymes; all may be at the high end of normal but combine to give an overall elevated LDH level)
• elevated alkaline phosphatase levels may be seen
• history of sudden deterioration in a patient with a non-malignant liver condition
• hepatomegaly
• ascites

hepatoma:
• serum alpha-fetoprotein present in 50% of white and 75-90% of non-white patients
• hemochromatosis
• ESR and WBC may be elevated
• lab findings consistent with hepatic or portal obstruction
• occasional marked hypoglycemia
• hepatitis B antigen present in 50%

infiltrative liver carcinoma:
• increased serum alk. phos.
• increased leukocyte alkaline phosphatase
• increased AST and sometimes ALT
• increased bilirubin
• (+) radioactive liver scan
• (+) blind needle biopsy

course and prognosis

Liver tumors are often difficult to diagnose and grow rapidly. Systemic signs may be present, along with hemorrhage and biliary obstruction. Budd-Chiari syndrome and polycythemia may occur. Most patients present with well-established disease which proves fatal within six months of diagnosis. Surgery can be effective, but is possible only in 25% of patients. Other conventional treatments are ineffective. Small, potentially treatable focal lesions are hard to detect sufficiently soon.

However, as with most cancers, there are examples of patients who have recovered despite the odds, with the help of alternative, conventional or combined treatments.

differential diagnosis

• various neoplasms of the liver
• hepatic metastases
• hepatic abscess or cyst


footnotes