Hepatocellular Carcinoma

Predominance is found greater in men than women

When cancer is determine primary – it originated in the liver
When cancer is secondary – it originated in some other part of the body

When discussing liver cancer,  Hepatocellular Cancer occurs 80% of the time

Is difficult to treat and complete removal by surgery is successful in less then 20% of the cases.

Causes worldwide include:

   -  Hepatitis B and C
   -  Metastases  (secondary cause)
   -  Alcoholic Liver Cirrhosis
   -  Hemochromatosis
   -  Fungal infection:  Aspergillus flavus
   -  Genetics

Increases progressively with age – typically seen after 5th decade

80% are closely associated with cirrhois

Diagnosis with Alpha-fetoprotein

Ultrasound, CT, and MRI can be used for further evaluation

Liver biopsy can help staging.

TNM staging

T0 – no evidence of primary tumor
T1 – solitary tumor without vascular invasion
T2 – solitary tumor with vascular invasion or multiple tumors none more than 5 cm
T3 – multiple tumors larger than 5 cm or tumor involving a major breach of the portal or hepatic vein
T4 – tumors with direct invasion of adjacent organs other than the gallbladder or with perforation of the visceral peritoneum

Treatment:

   -  Surgical resection of the cancer may be curative in less then 20%

   -  Liver transplant in individuals with advance cirrhosis

   -  Chemotherapy

   -  Cryosurgery – is a newer technique designed to freeze tissue

   -  Radiotherapy

   -  Hormone therapy with Tamoxifen
 
   -  Long-acting Octreotide

   -  Some drug therapy used for Palliative
            .  Interferon
            .  Cisplatin
            .  Fluorouracil
            .  Taxol
            .  Doxorubicin
            .  Epirubicin

    -  Sorafenib – a new drug that has shown some promising results