Primary liver cancer or hepatocellular carcinoma is a cancer that occurs spontaneously in the liver and develops directly in the liver cells. The patient may present with liver pain, fever, altered general condition, or jaundice. The treatment of primary tumors depends on the size and number of lesions, the extent of the disease, and the presence of cirrhosis.
Primary liver cancer: definition
Primary liver cancer or hepatocellular carcinoma is a cancer that occurs in the liver spontaneously , and develops directly at the expense of hepatic cells (liver cells).
Causes and risk factors of primary liver cancer
Primary liver cancer:
- Has been increasing for several years;
- Is more common in certain regions of the globe : Africa (tropical areas) and Southeast Asia;
- Occurs around age 60 in Europe and North America and around age 35 in Africa and Asia;
- Is mainly observed in humans;
- Is most often linked to the evolution of pre-existing cirrhosis . In France, cancerization of cirrhosis due to alcohol varies between 10 and 30%. In tropical areas (but not exclusively), cancerization is most often linked to cirrhosis of viral origin ( hepatitis B or C virus). When liver cancer develops on a liver showing no lesions of cirrhosis, the role of dietary factors has been put forward, and in particular that of certain toxins (aflatoxin polluting groundnut flour in Africa).
Symptoms of primary liver cancer
The patient may present with pain around the liver , fever , deterioration in general condition (weight loss, loss of appetite, fatigue) or jaundice ( yellow discoloration of the skin).
Diagnosis of primary liver cancer
Careful examination of the abdomen finds a liver of increased volume (hepatomegaly), hard with an irregular surface , sometimes tender or painful.
Additional examinations and analyzes
Biological examinations find non-specific elements:
- Anemia (decreased hemoglobin level in the blood);
- Increase in the number of white blood cells in the blood;
- Change in the blood level of enzymes produced by the liver (increase in gamma-GT, alkaline phosphatase , etc.).
The alpha-fetoprotein (AFP) assay is useful for the diagnosis of primary liver cancer . This protein is present from the 8th week of embryonic life and then decreases in the adult. In the context of primary liver cancer, AFP increases significantly 9 times out of 10. However, AFP is found to be increased in other diseases (viral hepatitis, certain digestive cancers, pregnant women). However, it is interesting to remember that in a subject with chronic liver disease, the increase in AFP should raise suspicion of the occurrence of cancer.
Other biological parameters directly linked to cancer are sometimes found: hypercalcemia (increased calcium in the blood), hypoglycemia .
Radiological examinations find elements in favor of the diagnosis of cancer: helical scanner, MRI (more precise). Ultrasonography of the liver finds one or more suggestive masses . Ultrasound with contrast material is a recent imaging examination which makes it possible to characterize the vascularization of a nodule.
The puncture-biopsy is useful for the diagnosis and to evaluate the prognosis . However, a negative puncture does not eliminate the diagnosis of hepatocellular cancer.
Primary liver cancer: evolution of the disease
The evolution of liver cancers is often bad because the liver produces many substances essential for many functions of the body. The patient’s risk of death is generally linked to hemorrhagic or infectious complications .
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Primary liver cancer: treatments
The treatment of primary tumors depends on the size and number of lesions , the extension assessment and the presence or absence of cirrhosis.
The curative treatment in case of cancer on cirrhosis is transplantation .
For other cases (isolated, small nodules) or in case of impossibility of transplantation, the treatment involves surgery if it is feasible (general condition of the patient, location and volume of the tumour) in the form of partial removal of the affected liver, or resection of the nodule.
