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Liver Cancer

What do doctors call this condition?

Primary or metastatic hepatic carcinoma

What is this condition?

Liver cancer is more common in men (particularly those over age 60) than women and its incidence increases with age. Primary tumors (those arising in the liver itself) are called hepatomas. However, most cases of liver cancer are the result of metastasis (the spread of cancer from another area) from the intestine, rectum, stomach, pancreas, esophagus, lung, breast, or skin. In the United States , metastatic liver cancer is 20 times more common than primary liver cancer.

No cure exists at this time.

What causes it?

The cause of primary liver cancer is unknown, but it may be a congenital disease in children. In adults, it may result from exposure to environmental carcinogens and possibly androgens and oral estrogens.

Notably, 30% to 70% of people with hepatomas also have cirrhosis, a chronic degenerative liver disease. (Hepatomas are 40 times more likely to develop in a cirrhotic liver than in a normal one. Researchers aren't sure if cirrhosis is a precancerous state or if alcohol and malnutrition predispose a person to develop hepatomas.

Another risk factor is exposure to the hepatitis B virus, although this risk will probably decrease with the availability of the hepatitis B vaccine.

What are its symptoms?

Liver cancer may cause:

  • Weight loss, weakness, appetite loss, fever

  • A mass in the right upper part of the abdomen

  • Tenderness in the liver that the examiner can feel on examination

  • Severe pain in the center or right upper part of the abdomen

  • An abnormal sound, such as a hum or rubbing sound, heard by the examiner (if the tumor involves a large part of the liver)

  • Jaundice or fluid buildup in the abdomen

  • Swelling of the feet or legs.

How is it diagnosed?

To confirm liver cancer, the doctor will remove and analyze some liver tissue - a procedure called a liver biopsy. If cirrhosis is present, liver cancer can be hard to diagnose; however, your doctor may order the following lab tests to aid confirmation:

  • Liver function tests indicating abnormal liver function.

  • Alpha-fetoprotein (a protein normally produced in the liver) at abnormally high levels.

  • Chest X-ray may rule out cancer spread.

  • Liver scan may show certain defects.

  • Arteriography (a type of X-ray that visualizes arteries) may define large tumors.

Other blood tests may indicate sodium retention (causing functional kidney failure), low blood sugar, increased calcium, increased white blood cell count, or decreased cholesterol.

How is it treated?

Liver cancer is often advanced at the time of diagnosis, which means the tumor can't be removed surgically. (Only a single tumor in one liver lobe can safely be removed-if the person doesn't have cirrhosis jaundice, or fluid buildup in the abdomen.) In this case, radiation therapy is usually done to relieve symptoms. Unfortunately, the liver has a low tolerance for radiation, so this therapy has not increased survival to date.

Another treatment option is chemotherapy. Some people have pumps implanted in the body for long-term infusion of chemotherapy drugs on an outpatient basis.

If cancer has spread to the liver from another site, the surgeon may remove the organ or the person may get chemotherapy. For some people, liver transplantation is now an alternative.

What can a person with liver cancer do?

  • Follow your prescribed diet carefully. The doctor will instruct you to restrict salt, fluids, and protein. You can't drink alcohol.

  • Don't take Tylenol or other drugs that contain acetaminophen your liver can't metabolize it.

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