Liver Tumor

Liver tumor = tumorous lesion arising in the liver. Liver is one of the common tumor sites; benign tumors are uncommon, and among malignant tumors metastases are more frequent. Primary tumors may arise from hepatic cell cords, bile-duct epithelium, blood vessels or other mesenchymal tissue; most metastatic tumors are metastatic carcinoma, fewer are metastatic sarcoma.

Common Symptoms

Thrombocytosis; heart failure; dyspnea; osteoporosis; inadequate pulse oxygenation; ascites; elevated alpha-fetoprotein; hepatomegaly

Causes and Pathogenesis

(A) Etiology: Despite much research the cause of liver cancer remains unclear; current recognized factors: 1. Cirrhosis: ~80% of hepatocellular-carcinoma patients have hepatitis-cirrhosis, mostly macronodular; due to hepatocyte degeneration/necrosis, interstitial connective-tissue hyperplasia, fibrous septa, nodular regeneration of residual hepatocytes forming lobules; repeated proliferation may lead to atypia and ultimately carcinogenesis. 2. Viral hepatitis: Hepatitis B is closely associated; HBsAg-positive patients have markedly higher liver-cancer incidence than HBsAg-negative; hepatitis C is also closely linked. 3. Aflatoxin-contaminated food: absorbed via GI tract, reaches liver, causes hepatocyte degeneration/necrosis then proliferative carcinogenesis. 4. Chemical carcinogens: nitrate and nitrite are established. 5. Immune status: liver cancer is generally associated with low immune function, especially low cellular immunity. (B) Pathogenesis: Hepatoblastoma is usually solitary, located in right lobe, encapsulated or not, grey-white to brown cut surface with hemorrhage, ossification and necrosis; Ishak and Gkunz (1967) divided it into epithelial and epithelial-mesenchymal types. Pure epithelial tumors are nodular with uniform cut surface, composed of two cell types: fetal-type cells resemble fetal hepatocytes, arranged in irregular two-cell-thick hepatic plates, variable size, often smaller than normal hepatocytes, eosinophilic glycogen-rich cytoplasm, round/oval basophilic nuclei with rare mitoses; embryonic-type cells are less differentiated, arranged in bundles, small dark-staining, scant cytoplasm, little/no glycogen, dark nuclei with frequent mitoses. Mixed tumors show collagen-fiber-separated lobules with fetal and embryonic cell zones supported by reticulin; primitive mesenchymal cells are long spindle with scant cytoplasm and osteoid tissue may be seen. Recently CCSG, SWOG and POG (per Weinberg and Finnegold) divided hepatoblastoma into fetal, embryonic, macrotrabecular and small-cell undifferentiated (anaplastic) types. Hepatocellular carcinoma contains well-differentiated large polygonal cells with eosinophilic cytoplasm forming hepatic-cord structures surrounded by vascular sinusoids. Both tumors may show extramedullary erythropoiesis, often involve right lobe, and about half involve right+left lobe or are multicentric; most frequently metastasize to lung, intra-abdominal local spread is common, CNS metastasis is rare.

Treatment

Surgery, chemotherapy, ablation, targeted-drug therapy

Preventive Measures

1. Pediatric hepatocellular carcinoma often complicates cirrhosis or pre-existing hepatic parenchymal disease; e.g. secondary cirrhosis from biliary atresia and giant-cell hepatitis has increased hepatoma incidence — actively prevent/treat. 2. For high-risk men ≥35 with HBV and/or HCV infection and alcoholism, screening every 6 months. 3. If AFP >400 μg/L but ultrasound shows no liver mass, exclude pregnancy, active liver disease and gonadal embryonal tumors, then perform CT and/or MRI. If AFP is elevated but below diagnostic level, exclude the above causes and closely follow dynamic AFP; shorten ultrasound interval to 1-2 months, add CT/MRI when needed. 4. If liver cancer is highly suspected, recommend DSA hepatic-artery lipiodol angiography. Be alert to anorexia, fatigue, malaise, prolonged low-grade fever, edema, right-upper-quadrant pain for early detection.

Department to Visit

It is recommended to visit the Medical Oncology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.