Liver cancer or hepatoma is either primary or secondary. Primary is the type of cancer that originates in the liver from native liver cells and tissues, while secondary is the type of cancer that originates elsewhere in the body and spreads to the liver; since the liver is a highly vascular organ getting its blood from two main sources: the portal vein and the hepatic artery, making it the most common organ for cancer metastases and makes secondaries in the liver 20 times more common in comparison to primary cancers. Metastases mostly come from the gastrointestinal tract, most commonly from colorectal adenocarcinoma (colon cancer).
Primary liver cancer or hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver with hepatocellular differentiation (80%) followed by intrahepatic cholangiocarcinoma (20%) originating from the ducts of the biliary system, and lastly,hepatoblastoma in infants and children within 2 years of life, which is mostly seen in males in association with some syndromes like Beckwith Wiedemann syndrome, familial adenomatous polyposis, progressive familial intrahepatic cholestasis and trisomy 18. There is a rare form of HCC calledthe fibrolamellar type that originates in young adults but with a better prognosis than other variants of HCC along with better resectability.
Clinical features
Symptoms of hepatic dysfunction:
- Painless mass in the right upper abdomen(hypochondrium). On palpation, the liver feels hard and maybe nodular with sharp edges from the cirrhosis and fibrosis.
- Dull aching abdominal pain
- nausea andvomiting
- general Fatigue
- Loss of appetite
- unintentional loss of weight
- Sometimes,when the tumor undergoes sudden necrosis and hemorrhage, it presents with acute severe abdominal pain and symptoms of shock due to the life-threatening spontaneous hemoperitoneum which means accumulation of blood within the peritoneal cavity.
Signs of hepatic dysfunction:
- Jaundice,which is yellowing of skin and mucous membranes that happen due to failure of conjugation of bilirubin or due to compression on biliary tracts by the mass leading to failure of excretion.
- Ascites,which can be a massive fluid collection within the abdominal cavity due to portal hypertension.
- Splenomegaly due to portal hypertension
- Esophageal and gastric varices due to portal hypertension
- Easy bruising due to clotting factor abnormalities
- Palmar erythema
- Spider nevi
- Gynecomastia
- Testicular atrophy due to excessive estrogen
- Hepatic encephalopathy due to excessive ammonia levels in the blood
- Para neoplastic syndrome in 1% of cases, with hypercalcemia, hypoglycemia, hyperlipidemia, hyperthyroidism and erythrocytosis.
- Symptoms of the main malignant source of metastasis
- Acute Liver failure.
