Hepatic Tumors:

Liver tumors are tumors or growths on or in theliver. These growths can be benign or malignant (cancerous). They may be discovered on medical imaging (even for a different reason than the cancer itself), or may be present in patients as an abdominal mass,hepatomegaly (enlarged liver),abdominal pain, jaundice, or some other liver dysfunction.

There are many forms of liver tumors:

Hepatocellular carcinoma:

This is the most common type of cancer to arise in the liver. Lliver cancer is attributable to patients who became infected with hepatitis B and C viruses.
People become infected with hepatitis viruses by coming in contact with infected person’s blood. After 2 to 3 decades patients infected with these viruses can develop complications of long-standing (chronic) viral infection causing liver scarring (cirrhosis) and liver cancer. Liver cancer is a lethal cancer, untreated patients rarely surviving more than one year

     

DIAGNOSIS

Masses that occur in the liver can be determined to be harmless (benign) or malignant (cancerous) in various ways. The first, involves the use of imaging techniques such as abdominal ultrasound, Computed Axial Tomography (CT) scan / Magnetic Resonance Imaging (MRI) The larger the liver cancer the more likely these imaging techniques will be able to diagnose it .Viral marker for Hepatitis B &C , tumor marker as AFP and liver function tests for chronic liver disease (cirrhosis) should  be done. Fine needle aspiration cytology (FNAC) is avoided in early cases; it is done in special circumstances when the imaging and blood test are producing doubtful results and in advanced condition to get a final diagnosis which is needed for planning non surgical treatment.

Treatment:  There are 3 main treatment options.

   Liver Resection:

Surgery that involves the removal of the tumor along with a small portion of adjacent healthy liver tissue (resection margin) to ensure complete removal of the liver cancer. Liver resections are of various types depending on the size and location of the tumor, the quality and quantity of remaining liver.  liver functional status, general condition and associated other disease(s)of the patient needs careful evaluation.  The common types of liver resections are Right Hepatectomy
( for right lobe tumor), Left Hepatectomy (for left lobe tumor), Extended right and Extended left hepatectomy,( for large right and left lobe tumor) Hepatic Bisegmentectomy and Monosegmentectomy ( for smaller tumor). There is chance of bleeding, bile leak ( biloma), abscess and liver failure in some cases. There is also possibility of recurrence of tumor in the remaining liver.
Every liver cancer is not respectable, only 15%to 18% are respectable. Overall survival after resections are 55%. for three years and 10%  for five years.
 
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Livertransplant:

 

Liver transplant, in which the entire liver is surgically removed and replaced with a new liver from a donor, This is the rapidly advancing treatment strategy. Hepatocellular carcinoma might be synchronous multicentric or in the subsequent period   metachronous multicentric . Total hepatectomy  involves the
 
removal of not only the tumor but also the tumor generating cirrhotic environment existing within  the liver. Liver transplant is a complicated surgery, needs multidisciplinary facilities and also expensive. There are risk involves and need medications and lifelong follow up. Overall survival after Liver transplant for liver cancer is one and two year 75% and 60%.respectively.

Tumor ablation:
 
Cancer cells in the tumor are destroyed by generating heat to the tumour ( radiofrequency ablation/RFA),freezing (cryoablation) or chemical injection (chemoembolisation).
Radiofrequency ablation (RFA):
In RFA, heat is generated locally by high frequency radio waves that are channeled into metal electrodes. A probe is inserted into the center of the tumor and the non-insulated electrodes, which are shaped like prongs, are projected into the tumor. The local heat that is generated melts the tissue (coagulative necrosis) that is adjacent to the probe. The probe is left in place for about 10-15 minutes. The whole procedure is monitored visually by ultrasound scanning. The ideal size of a liver cancer tumor for RFA is less than 5 cm. Larger tumors may require more than one session.
RFA can be performed  laparoscopically (through small holes in the abdomen) or during open exploration of the abdomen. More commonly done by  CT scan guidance.

 

RFA

 

PREVENTION

Since most liver cancer develops in patients with long standing (chronic) hepatitis due to viral infection, prevention of infection is vital. Avoiding contact with an infected person’s blood or blood products  can prevent the transmission of hepatitis viruses. In addition, there is an effective vaccine for hepatitis B. However, there is no vaccine for hepatitis C virus.

Once patients develop infection with hepatitis viruses, the goal is to preserve liver tissue and prevent scarring (cirrhosis). Patients need to learn to avoid activities which can further damage the liver, such as consuming alcohol or taking certain medication
Non alcoholic steato hepatitis  (NASH) is the second most common cause of liver cirrhosis, which may cause liver cancer. Liver cirrhosis could be avoided by prevention of fatty liver disease and its adequate treatment.
Screening for hepatocellular carcinoma:
Screening tests are used to detect liver cancer at the earliest possible stage. There are no good screening tools for liver cancer. Individuals at risk like those suffering from hepatitis B , C or cirrhosis due to any cause  can  be screened by abdominal ultrasound,Computed axial tomography ( CT scan) / Magnetic Resonance Imaging (MRI). A test for alpha faeto protein (AFP), which  may be elevated in 2/3 of patients with liver cancer, but may also be slightly elevated in patients with chronic liver disease. High level of serum AFP is a good indicator  of liver cancer.

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