Liver cancer

The incidence of liver cancer in patients with hemochromatosis can be as high as 45 percent, and often the tumor is multifocal.

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Hepatocellular carcinoma is responsible for over 12,000 deaths per year in the United States. Worldwide, it causes over a million deaths per year, making it one of the most common malignancies in adults. It is more common in men than women, and in blacks than whites. It is especially prevalent in parts of Asia and Africa. In the United States, primary liver cancer is most prevalent in people of East Asian origin.

Most people with liver cancer have no symptoms until the disease is advanced. Later stages of liver cancer, when the cancer is very large or when it impairs the functions of the liver, can produce symptoms such as abdominal pain, weight loss, lack of appetite, and finally the development of jaundice and abdominal swelling.

Most liver cancers are first diagnosed with CAT scans, magnetic resonance imaging, or ultrasound scans. These tests range from 60 to 100 percent accuracy, with larger tumors being more detectable. About 70 percent of patients with liver cancer have elevated blood concentrations of a tumor marker called alpha-fetoprotein. If there is doubt about the presence of liver cancer, the definitive diagnosis is made by liver biopsy.

Treatment of liver cancer is based on the size of the tumor, its location, and its spread to blood vessels and nearby or distant organs. "Resection" surgery, where a portion of the liver is removed, offers the only cure for the disease and the best long-term chance of survival. Patients with smaller tumors and without cirrhosis or metastases to other organs are the best candidates for liver resection. New surgical techniques such as cryosurgery—freezing the tumor and tissue around it—or radio frequency ablation—destroying the tumor with a heat probe—may work for some patients who are not good candidates for liver resection.

For patients who have small tumors, confined to the liver, but advanced cirrhosis, liver transplantation is the treatment of choice. Liver transplant is the only treatment option for patients with tumors that cannot be surgically or medically removed. However, larger or more extensive tumors have a high risk for early recurrence after liver transplantation.

Traditional chemotherapy and radiation have not been effective for treating liver cancer. The five-year survival rate for patients with liver cancer who have one or two small tumors is now about 50 to 60 percent.