Few cancers originate in the liver. Primary
liver tumors usu-ally are associated with
chronic liver disease, hepatitis B and C, and
cirrhosis. Hepatocellular carcinoma (HCC),
the most common type of primary liver
tumor, usually cannot be resected because
of rapid growth and metastasis elsewhere.
Other types include cholangiocellular
carcinoma and combined hepatocellular
and cholangiocellular carcinoma. If found
early, resection may be possible; however,
early detection is unlikely.
4. RISK FACTORS
• Cirrhosis, hepatitis B and C, and exposure to certain chem-ical
toxins have been implicated in the etiology of HCC.
• Cigarette smoking, especially when combined with alcohol use, has
also been identified as a risk factor.
• Other substances that have been implicated include aflatoxins and
other similar toxic molds.
• Metastases from other primary sites, particularly the digestive
system, breast and lung, are found in the liver 2.5 times more
frequently than tumors due to primary liver cancers.
5. CLINICAL MANIFESTATIONS
• Early manifestations include pain (dull ache in upper right quadrant,
epigastrium, or back), weight loss, loss of strength, anorexia, and
• Liver enlargement and irregular surface may be noted on palpation.
• Jaundice is present only if larger bile ducts are occluded.
• Ascites develops if such nodules obstruct the portal veins or if tumor
tissue is seeded in the peritoneal cavity.
6. ASSESSMENT AND DIAGNOSTIC
Diagnosis is made on the basis of clinical signs and symptoms, history and physical examination,
and results of laboratory studies.
Leukocytosis (increased WBC counts), erythrocytosis (increased red blood cell counts),
hypercalcemia, hypoglycemia, and hypoc-holesterolemia may also be seen on laboratory
Elevated levels of serum alpha-fetoprotein (AFP) may be found.
IV or intra-arterial injection of antibodies tagged with
radioactive isotopes that specifically attack tumor-
associated antigens percutaneous placement of a high-
intensity source for inter-stitial radiation therapy
Systemic chemotherapy; embolization of tumor vessels
An implantable pump to deliver high-concentration chemo-
therapy to the liver through the hepatic artery
8. Percutaneous biliary drainage
Percutaneous biliary drainage is used to
bypass biliary ducts obstructed by the liver,
pancreatic, or bile ducts in patients with
inoperable tumors or those who are poor
Complications include sepsis, leakage of bile,
hemorrhage, and reobstruction of the biliary
Observe patient for fever and chills, bile
drainage around the catheter, changes in vital
signs, and evidence of biliary obstruction,
including increased pain or pressure, pruritus,
and recurrence of jaundice.
9. Other nonsurgical treatment
• Hyperthermia: heated by laser or
radiofrequency energy is directed to
tumors to cause necrosis of the tumors while
sparing normal tissue.
• Radiofrequency thermal ablation (tumor
cell death from coagulation necrosis).
• Immunotherapy: lymphocytes with antitumor
reactivity are administered.
• Embolization (ischemia and necrosis of the
• For multiple small lesions, ultrasound-guided
injection of alcohol promotes dehydration
of tumor cells and tumor necrosis.
10. SURGICAL MANAGEMENT
Hepatic resection can be performed
when the primary hepatic tumor is
localized or when the primary site can
be completely excised and the
metastasis is limited.
Capitalizing on the regenerative
capacity of the liver cells, surgeons
have successfully removed 90% of the
liver. The presence of cirrhosis limits the
ability of the liver to regenerate. In
preparation for surgery, the patient’s
nutritional, fluid, and general physical
status are assessed, and efforts are
undertaken to ensure the best physical
11. • Removal of a lobe of the
liver is the most common
surgical procedure for
excising a liver tumor.
• In patients who are not
candidates for resection or
transplantation, ablation of
HCC may be accomplished
by chemicals such as
ethanol or by physical
means such as
radiofrequency ablation or
• Removing the liver and
replacing it with a healthy
donor organ is another
way to treat liver cancer.