Liver Cancer (Hepatocellular Carcinoma)

Hepatocellular carcinoma is cancer that arises from hepatocytes, the major cell type of the liver. Hepatocellular carcinoma traditionally has been relatively rare in the United States, though with the rise in the number of cases of hepatitis C, the rate of new cases of liver cancer is rising. Worldwide, however, it is either the number one or number two cause of cancer death. It is especially prevalent in parts of Asia and Africa. About 80% of people with hepatocellular carcinomas have cirrhosis. Chronic infection with the
hepatitis B virus and hepatitis C virus also increases the risk of developing hepatocellular carcinoma. Aflatoxins, which are produced by a mold that is a contaminant of nuts (most commonly peanuts), grains,
and beans, have also been implicated as a major risk factor for causing hepatocellular carcinoma. Although
virtually non-existent in the United States, aflatoxins, are common in other parts of the world and often
contaminate food.

Most hepatocellular carcinomas are first suspected based on the results of CAT scans or ultrasound scans. Blood alpha-fetoprotein , a blood tumor marker, is a useful lab test for the diagnosis of hepatocellular carcinoma. About 70% of patients with hepatocellular carcinoma have elevated blood alpha-fetoprotein concentrations; however, it is not specific for this condition. We often see normal alphafetoprotein values in the face of massive tumors in the liver. It is often measured as a part of screening in patients with chronic hepatitis B or chronic hepatitis C and cirrhosis. A rising blood alpha-fetoprotein concentration in someone with chronic liver disease suggests the development of hepatocellular carcinoma. Appropriate radiological scans should be done in such instances.

The definitive diagnosis of hepatocellular carcinoma is made by biopsy. Usually, the liver mass is biopsied
by a radiologist under with the help of a radiological scan. Sometimes, the mass is biopsied using a
laparoscope, a fiber optic instrument that is inserted into the abdomen. Occasionally, open surgical biopsy
is necessary.

Hepatocellular carcinoma is curable by surgery only if the tumor is small. Liver transplantation may also be
curative for relatively small tumors. Surgery or liver transplantation may not be possible in all cases,
usually if the tumor is very large or has spread beyond the liver. If there is invasion of the major blood
vessels of the liver with tumor, the hope for cure or transplant are reduced. For large tumors or cancer that has spread beyond the liver, chemotherapy, ligating (tying) or embolization (clotting) of the hepatic artery,
alcohol injection into the tumor, or radiation may relieve symptoms and prolong life, but these procedures
are not curative.

Liver Spoecialists of Texas and Dr. Galati have a comprehensive approach to liver cancer, collaborating with colleagues in surgery, radiation oncology, medical oncology, and liver transplantation.