In the United States, Hepatocellular Carcinoma is one of the few cancers that is becoming more common.
Liver cell cancers (hepatocellular carcinoma) originate from liver tissue when the cells of the liver itself start to grow out of control. If the cancer started within the liver itself it is called primary liver cancer. The majority of the liver cancers have metastasized (spread) from an organ other than the liver. These organs include colon (large intestine), stomach, breast, lung, pancreas and kidneys. This is called secondary liver cancers, and are 20 times more common than primary liver cancers. Approximately 50% of the time the primary site is gastrointestinal tract.
Liver is the largest organ in human body and situated below the diaphragm (muscular tissue layer which separates the belly from the chest) inside the abdomen (belly). The liver is divided into a larger right and small left lobe. Back side of the liver has a ‘H’ shaped depression where the gall bladder, blood vessels and lymph nodes are located.
The basic structural component of the liver is the liver cell, or hepatocyte. The hepatic lobule is the building block of the liver tissue consisting of a blood vessels, biliary tracts and hepatocytes; arranged in linear parallel cords, and a central vein.
Liver is one of the most metabolically active organs in the body. There are many important functions done by liver which are vital for life. Some of the functions are as follows.
According to statistics from SEER (Surveillance, epidemiology and end-results program) cancer statistics review, in both both men and women, deaths from liver cancer in the United States increased at the highest rate in comparison to other cancers, and there has been a sharp increase in the incidence of liver cancer. Although liver cancer still occurs more frequently in world’s less developed regions, it is a major health issue in the United States.
Worldwide distribution of liver cancer is more common in sub-Saharan Africa and Southeast Asia than in the US. In many of these countries it is the most common type of cancer. More than 700,000 people are diagnosed with this cancer annually and it is a major cause of cancer deaths around the world. Liver cancer is more common in men. It is commonly diagnosed in the age group from 55 to 64 years of age.
Patients who develop primary hepatocellular carcinoma usually have no symptoms except those related to their chronic liver disease including yellowish discoloration of eyes and skin (Jaundice), vomiting of blood due to bleeding into stomach or esophagus, abdominal distention and cognitive impairment due to altered brain function (Encephalopathy). Some patients may get upper abdominal pain, weight loss, feeing full after eating small amounts (early satiety), or a palpable mass in the upper abdomen. Obstructive jaundice caused by invasion of the biliary tree causes deep yellowish discoloration of skin and the eyes and itching. When the symptoms appear, the disease is usually advanced.
In secondary liver cancers, the symptomatology depends according to the primary site of the cancer. If the primary site is colon, the patient may develop altered bowel habits like constipation, bleeding from the rectum, passage of mucous and abdominal mass. Patients with primary stomach cancers will experience early fullness after eating small amounts, vomiting blood, tarry stools and upper abdominal discomfort. In patients with primary site in the breast may have symptoms like nipple discharge, nipple retraction, lump in the breast and skin ulcers. Patients with lung cancer as the primary site will experience difficulty in breathing, long term non-relieving cough and coughing of blood. Therefore, it is important to mention your doctor about any symptom you have which may be very important to find the primary site for metastasized liver cancer.
According to American cancer society, the commonest risk factor for liver cancer is long-term (chronic) infection with hepatitis B virus or hepatitis C virus. In USA hepatitis C is becoming more common whereas in developing countries and Asian hepatitis B is more common. Heavy drinkers, people sharing contaminated needles, unprotected sex, childbirth and very rarely blood transfusions have higher risk of getting infected with hepatitis B and C.
They can also be passed on through blood transfusions, although this is very rare in the United States since the start of blood product testing for these viruses. In developing countries, children sometimes contract hepatitis B infection (viral hepatitis) from prolonged contact with family members who are infected. People with cirrhosis have an increased risk of liver cancer and alcohol abuse is a leading cause of cirrhosis in the United States, which in turn is linked with an increased risk of liver cancer. Obesity, tobacco smoking, Type 2 diabetes and some other rare diseases like alpha1-antitrypsin deficiency, Glycogen storage diseases and Wilson disease; increase the risk of developing liver cancer. Long-term anabolic steroid used by some athletes to increase their strength and muscle mass, can slightly increase the risk of hepatocellular cancer.