Hepatocellular carcinoma (HCC) is a cancer of the liver, accounting for 80 – 90% of all liver cancer cases worldwide.
Most of these cases are the aftereffect of cirrhosis (scarring of the liver) which is usually secondary to disorders such as viral hepatitis, hepatitis B & C, alcohol abuse, hemochromatosis (the excessive absorption of dietary iron), various autoimmune disease of the liver, and other disorders that cause chronic liver inflammation.
In parts of the world where hepatitis is endemic, primary malignancies of the liver such as HCC occur more than any other type of cancer. It should be noted that hepatitis A and several other viral hepatitides do not result in chronic infection and, thus, do not cause HCC.
In North American, Europe, and parts of the world where hepatitis is not endemic, HCC occurs much less frequently (it is considered a rare tumor in the U.S.) and such malignancies are usually the result of metastasizing tumors located elsewhere in the body.
Hepatitis B and/or C assist the progression of hepatocellular carcinoma because such hepatitides cause the body’s immune system to attack the liver cells, some of which are undoubtedly infected by the hepatitis virus.
This stimulates a cycle of cellular damage followed by cellular repair that often results in mistakes during the repair process. These mistakes may include the mutation of liver cell machinery that cause liver cells to replicate at a higher rate, resulting in tumor growth.
Furthermore, cell machinery mutation may also result in cells that live much longer than normal cells, once again resulting in tumor growth.
Common Signs and Symptoms
A major indicator of the presence of hepatocellular carcinoma in the body is abdominal pains and/or tenderness in the right-upper quadrant of the abdomen (where the liver is lcoated). Other indicators include an enlarged abdomen, easy bruising and/or bleeding, and jaundice (a yellow discoloration of the skin and eyes).
Diagnosis
Most patients with chronic viral hepatitis are surveilled with ultrasound to aid in the detection of hepatocellular carcinoma. Ultrasound is readily accessible worldwide and it is very cost-effective. In the Western world, however, the most common method of HCC detection is computed tomography (CT scan).
This procedure is considerably more accurate than ultrasound in detecting small/ and or poorly defined tumors. Magnetic resonance imaging (MRI) is an alternative to the CT scan, but is more expensive and not as readily available because MRI machines are rare and comparatively few radiologist are skilled at finding tumors with MRI. It should be noted, that in most parts of Europe, parts of Asia, and in the U.S., MRI are being used quite frequently for tumor detection.
Treatment
If HCC is diagnosed early, aggressive surgical resection or liver transplantation can be successful in reducing and/or reversing symptoms. These procedures usually lend themselves to the longest survival rates after diagnosis, but are only possible in 10-15% of cases. It should be noted that surgery and transplantation are usually only effective in patients with small and/or slow growing tumors.
HCC does not usually respond well to chemotherapy and/or radiation treatments. However, chemo and radiation are often administered to shrink large tumors, resulting in an elevated the chance of successful surgery and/or transplantation.
A new technique known as cryosyrgery, is being used to destroy tumors in the brain, breast, kidney, prostate, and liver. This surgery is characterized byt he destruction of abnormal tissue using sub-zero temperatures. In this procedure, the tumor is not removed, but is reabsorbed into the body. Initial results have shown that cryosurgery has roughly the same results as surgical resection.
Many other treatments such as hormone therapy, high intensity focused ultrasound, and various injections have been shown to minimize symptoms, but are not curative. Because of the disease’s high morbidity and mortality rates, patients should consider ascertaining information regarding new and experimental treatments from their physicians.
Prognosis
HCC’s typical outcome is poor, because only 10 – 20% of such tumors are candidates for surgical resection and/or transplantation. If the tumor cannot be completely removed, HCC usually results in death within 3 to 6 months. It should be noted that patients have survived much longer than this.
