Usually associated with chronic liver disease, hepatitis B and C infections, and
cirrhosis. Hepatocellular carcinoma (HCC) is the most common type of primary liver
cancer. HCC is usually nonresectable because of rapid growth and metastasis. Other types of primary liver cancer include cholangiocellular carcinoma and
combined hepatocellular and cholangiocellular carcinoma. If found early,
resection may be possible, but early detection is unlikely.Liver Metastases
Metastases from other primary sites are found in the liver in about half of all
advanced cancer cases. Malignant tumors are likely to reach the liver eventually, by way of the portal
system or lymphatic channels, or by direct extension from an abdominal tumor. Moreover, the liver apparently is an ideal place for these malignant cells to
thrive.Clinical Manifestations
The early manifestations of malignancy of the liver include pain, a continuous
dull ache in the right upper quadrant, epigastrium, or back. Weight loss, loss of strength, anorexia, and anemia may also occur. The liver may be enlarged and irregular on palpation. Jaundice is present only if the larger bile ducts are occluded by the pressure of
tumor on bile ducts. Ascites develops if tumor obstructs the portal veins or if tumor tissue is seeded
in the peritoneal cavity.Assessment and Diagnostic Findings
Diagnosis is based on clinical signs and symptoms, the history and physical
examination, and the results of laboratory and x-ray studies. Increased serum levels of bilirubin, alkaline phosphatase, AST, GGT, and lactic
dehydrogenase may occur. Leukocytosis, erythrocytosis, hypercalcemia, hypoglycemia, and
hypocholesterolemia