The commonest liver tumour is a secondary (metastatic) tumour , particularly from the gastrointestinal tract, breast or bronchus. Clinical features are variable but usually include hepatomegaly. MRI is comparable to CT at detecting metastases. However, ultrasound is cheaper and more readily available. Primary liver turn ours may be benign or malignant. The commonest are malignant.
Hepatocellular carcinoma (HCC)
This is one of the commonest cancers worldwide. although it is uncommon in the Western Hemisphere.
Carriers of HBV and HCV have an extremely high risk of developing HCC. In areas where HBV is prevalent. 90% of patients with this cancer are hepatitis B positive. Cirrhosis is present in over 80% of these patients. The development of HCC is related to the integration of viral DNA into the genome of the host hepatocyte. Primary liver cancer is also associated with other forms of cirrhosis. e.g. alcoholic cirrhosis and haemochromatosis. Males are affected more than females; this may account for the high incidence seen in haemochromatosis and low incidence in PBC. Other suggested aetiological factors are aflatoxin (a metabolite of a fungus found in groundnuts) and androgenic steroids. and there is an association with the contraceptive pill.
The tumour is either single or occurs as multiple nodules throughout the liver. Histologically it consists of cells resembling hepatocytes. It can metastasize via the hepatic or portal veins to the lymph nodes. bones and lungs.
HCC usually presents below the age of 50 years. The clinical features include weight loss. anorexia. fever. an ache in the right hypochondrium and ascites. The rapid development of these features in a cirrhotic patient is suggestive of HCC. On examination. an enlarged. irregular. tender liver may be felt.
Serum o-fetoprotein is raised. Ultrasound or radioisotope scans show large filling defects in 90% of cases. A liver biopsy. particularly under ultrasonic guidance. is performed for diagnosis.
Surgical resection is occasionally possible. Chemotherapy and radiotherapy are unhelpful.
Survival is seldom more than 6 months.
Cholangiocarcinomas can be extrahepatic or intrahepatic. Intrahepatic adenocarcinomas arising from the bile ducts account for approximately 10% of primary turnours. They are not associated with cirrhosis or hepatitis B. In the Far East they may be associated with infestation with Clonorchis sinensis. The clinical features are imilar to primary HCC except that jaundice is frequent with hilar tumours. Treatment is unsuccessful and patients usually die within 6 months.
The commonest benign tumour is a haemangioma. This is usually found incidentally on ultrasound or CT and requires no treatment. Hepatic adenomas are associated with oral contraceptives. They can present with abdominal pain or intraperitoneal bleeding. Resection is only required for symptomatic patients.