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Figure 1. Location of liver in the body.
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Authors: Paul J Thuluvath, MD; Michael Choti, MD; Jean F.
Geschwind, MD; Lynn Norwitz, BS; Anthony N. Kalloo, MD
Hepatocellular carcinoma is a tumor of the liver. Hepatocellular carcinoma is responsible for over 12,000 deaths per year in the United States where the incidence of the disease is approximately 2.5 per 100,000 population. It is one of the most common malignancies in adults, and is more common in men than women (2-4:1), and blacks than whites. Worldwide, over a million deaths per year (about 10% of all deaths in the adult age range) can be attributed to hepatocellular carcinoma. The occurrence of hepatocellular carcinoma varies widely depending on geographic location. Whereas incidence in the Western world is less than two per 100,000 males, it is currently 40-60 per 100,000 in Africa and parts of the Far East. In the United States, hepatocellular carcinoma is more common in people of East Asian origin. In the future, the prevalence of hepatocellular carcinoma may increase in the United States and parts of Europe because of the high incidence of hepatitis C. At the same time, many experts expect incidence rates to decline in the Far East due to universal immunization for hepatitis B. Figure 2 illustrates the geographic distribution of hepatocellular carcinoma.
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Figure 2. Geographic distribution of hepatocellular carcinoma. Incidence rates (%) in total population A, female; B, male. |
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What is Hepatocellular Carcinoma?
Most primary liver cancers are classified as hepatocellular carcinoma. Hepatocellular carcinoma is a malignant tumor composed of cells resembling hepatocytes ; however, the resemblance varies with the degree of differentiation . Hepatocellular carcinoma is commonly associated with cirrhosis (Figure 3).
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Figure 3. A, Cirrhotic liver with focal tumor; B, histological appearance. |
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This type of liver cancer is potentially curable by surgical resection. However, only those patients with localized disease are surgical candidates. Liver function impairment and degree of tumor localization determine patient prognosis
proliferation . Clinical trials offer alternative treatment options for patients who are not candidates for resection.
Symptoms
In the U.S., a significant number of hepatocellular carcinoma cases are detected during surveillance or investigation of underlying liver disease. Often, patients present with symptoms related to their underlying liver disease. In a report from Hong Kong, 76% of patients with hepatocellular carcinoma presented to their hepatoma clinic with abdominal distention or discomfort; less common presentations included weight loss (4.4%), gastrointestinal hemorrhage (4.4%), and jaundice (2.6%). In the Hong Kong series, only 2% were asymptomatic. Rarely, hepatocellular carcinoma can present as an acute abdomen resulting from spontaneous rupture of the tumor into the peritoneal cavity. Hepatocellular carcinoma should be considered in the differential diagnosis of hemorrhagic ascites.
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