-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