A rare form of cancer, liver cancer (primary and metastatic hepatic carcinoma) has a high mortality. It’s responsible for roughly 2% of all cancers in the United States and for 10% to 50% in Africa and parts of Asia. Liver cancer is most prevalent in men (particularly in those older than age 60); incidence increases with age. It’s rapidly fatal, usually within 6 months, from GI hemorrhage, progressive cachexia, hepatic failure, or metastasis.
Most primary liver tumors (90%) originate in the parenchymatous cells and are hepatomas (hepatocellular carcinoma, primary lower-cell carcinoma). Some primary tumors originate in the intrahepatic bile ducts and are known as cholangiomas (cholangiocarcinoma, cholangiocellular carcinoma). Rarer tumors include a mixed-cell type, Kupffer cell sarcoma, and hepatoblastomas (which occur almost exclusively in children and are usually resectable and curable).
The liver is one of the most common sites of metastasis from other primary cancers—particularly those of the colon, rectum, stomach, pancreas, esophagus, lung, or breast—or melanoma. In the United States, metastatic liver carcinoma is more than 20 times more common than primary carcinoma and, after cirrhosis, is the leading cause of liver-related death. At times, liver metastasis may appear as a solitary lesion, the first sign of recurrence after a remission.
The immediate cause of liver cancer is unknown, but it may be a congenital disease in children. Adult liver cancer may result from environmental exposure to carcinogens, such as the chemical compound aflatoxin (a mold that grows on rice and peanuts), thorium dioxide (a contrast medium formerly used in liver radiography), Senecio alkaloids, androgens, or oral estrogens.
Roughly 30% to 70% of patients with hepatomas also have cirrhosis. (Hepatomas are 40 times more likely to develop in a cirrhotic liver than in a normal one.) Whether cirrhosis is a premalignant state or alcohol and malnutrition predispose the liver to develop hepatomas is still unclear. Another risk factor is exposure to the hepatitis B virus, although this risk will probably decrease with the availability of the hepatitis B vaccine.
Signs and symptoms
Signs and symptoms of liver cancer include:
a mass in the right upper quadrant
a tender, nodular liver on palpation
severe pain in the epigastrium or the right upper quadrant
a bruit, hum, or rubbing sound if the tumor involves a large part of the liver
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