Pathophysiology

Precipitating Factors
Predisposing Lifestyle
Factors Nutrition and diet
Race Alcoholism
Gender Related hepatic disease
Family History development such as chronic
Inflammation of the liver,
cirrhosis
Viral and bacterial liver
infections
Exposure to industrial and
pharmaceutical products
Oral contraceptives and steroids

Somatic mutations in the DNA of liver cells

Activate oncogene/ deactivate tumor-suppressor gene

Malignant transformation of liver cells

Uncontrolled proliferation of malignant cells in the liver

 Formation of neoplasm

LIVER CANCER

Stage I
One tumor is found in the liver only, less than 2 cm
Fever
Enlarged liver and spleen
Enlarged, hard lymph nodes
Abdominal pain at the right upper quadrant or at epigastrium

Diagnosis

Abdominal ultrasound: can distinguish a solid

mass from a non-cancerous (benign)
accumulation of fluid

Blood count may be normal or show decrease

or increase in red blood cells Liver function
tests may be abnormal, but may also be normal
even in advanced stages of liver cancer

Clotting tests (PT and PTT) may be abnormal

Treatment
Survival
Surgery: Unfortunately, only a small10
5 year: to 30% of patients are
percentage
candidates for surgery and many experience tumor recurrence.
The relative health of the patient and the remaining liver
(cirrhosis involvement) must be taken into account

Chemotherapy: The role for chemo after surgery is unknown.

Although Adriamycin is often recommended, no systematic
studies have been done to see if it increases the cure rate.
Often, side effects of therapy outweigh the benefits

Radiation Therapy: Radiation is often applied to the liver after

 STAGE 2
One tumor is found, but it has spread to the blood vessels, OR more
than one tumor is present, but they are all smaller than 5 cm. (3x
2.7x 7.1 cm)

Same as above plus

Swelling of the abdomen (ascites) or

Jaundice (skin turning yellow) or Treatment
Swelling of the legs (edema) or
There is no standard
Serum alpha-fetoprotein (AFP) istherapy, so clinical trials should be considered.
These include:
elevated in 30-50% of people with
primary liver cancer
Liver Transplantation: this may benefit patients with few (<3) small
tumors (< 5 cm) and without hepatitis B
Diagnostic
Cryosurgery Teststhe tumor using a cold probe) and
(freezing
radiofrequency ablation (inserting a heated probe into the tumor):
CT and MRI scansthese
help may
determine the extent
hold some promiseof to
tumor within
allow the liverof otherwise
for removal
and possible extension into lymph nodes or other abdominal
unresectable tumors, but only a few specialized structures
physicians perform
these techniques
Arteriography involves injection of dye into the artery going to the liver
then taking an x-ray picture. This helps the surgeon determine the
blood supply to the tumor

Survival:
5 year: less than 5- 10%

STAGE 3

Same as above
Treatment
Stage III liver cancer, there is more than one tumor larger than 5 cm,
OR
Nothe cancertherapy
standard has moved beyond
is known the liversurvival.
to prolong to bloodThe
vessels,
usualanother
approach
organ, or to the lymph nodes.
is single-agent chemotherapy such as Adriamycin or 5-FU and
combinations include cisplatin and alpha-interferon. These, however,
have painful side-effects.
Diagnosis
Biopsy: either fine needle (FNA)
Radiation: along with chemotherapy or regular needle
this may biopsy
relieve theallows
pain ofa large
pathologist
liver masses,to
anddistinguish
radiation between
to painfula bone
primary liver cancer
or other or if itmay
metastases
be also appropriatehas spread from another organ

Survival
Investigational methods: combination chemo or new drugs
including derivatives of Adriamycin and 5-FU5%
2 year: less than may prove beneficial.
Chemoembolization (administering a combination of chemotherapy
and colloid particles directly into the liver tumor via its main (hepatic)
artery) may improve symptoms even when there is metastatic disease
 Stage 4
Almost all signs and symptoms are present/ manifested by the patient

Stage IV: the cancer has spread to other locations in the body, such as
the lungs or bones, as well as blood vessels or lymph nodes.