arises from the liver’s workhorse cells, the hepato-
cytes. Hepatocytes continually regenerate;
researchers believe the continued replication of
the hepatitis VIRUSeventually creates changes in
the processes of regeneration (cellular DNA alter-
ations) that cause hepatocyte growth to become
uncontrolled. Primary liver cancer is rare in peo-
ple who have otherwise healthy livers. Because of
its rich BLOOD supply and numerous functions
related to blood filtration, the liver is a common
site for metastatic cancers.
Symptoms and Diagnostic Path
Liver cancer typically does not present symptoms
until the cancer is quite advanced, and even then
symptoms often are vague. Such symptoms might
include upper ABDOMINAL PAIN, ASCITES(fluid accu-
mulation in the abdominal cavity),NAUSEA, lack of
APPETITE, and JAUNDICE. The diagnostic path typi-
cally includes blood tests to assess liver function
and hepatitis status, abdominal ULTRASOUND or
COMPUTED TOMOGRAPHY(CT) SCAN, and PERCUTANEOUS
LIVER BIOPSY.
Some doctors advocate regular testing to meas-
ure blood levels of ALPHA FETOPROTEIN(AFP), a pro-
tein that many liver tumors produce, in people
who are at high risk for developing liver cancer
(such as those who have chronic hepatitis or
severe CIRRHOSIS). However, there is no consensus
within the medical community as to the effective-
ness of AFP screening for those not at high risk
because numerous factors cause erroneous test
results.
Treatment Options and Outlook
Treatment for liver cancer depends on whether
the cancer is primary or secondary. Treatment for
secondary liver cancer is generally palliative, aim-
ing to relieve symptoms such as PAIN. For primary
liver cancer, surgical removal of the tumor is the
preferred option. However, people who have long-
standing cirrhosis may have too much damage for
the liver to remain functional after surgery. Large
or multiple tumors also are difficult to remove
without causing substantial damage to the
remaining liver tissue. The surgeon may use
RADIOFREQUENCY ABLATIONor chemical ablation to
kill tumor cells without removing the tumor; this
is primarily a palliative treatment. LIVER TRANS-
PLANTATIONis occasionally an option when the liver
cancer is primary, small, and well contained.
Conventional external-beam RADIATION THERAPY
often is not very successful in altering the course
of liver cancer to increase survival, though it can
shrink liver tumors to relieve pain and other
symptoms. A precise technique for targeting liver
tumors with radiation, three-dimensional confor-
mal radiation therapy (3DCRT), shows promise for
improving the therapeutic value of radiation ther-
apy in liver cancer. Similarly, conventional
CHEMOTHERAPYis not very effective against liver
cancer, though in some people directly infusing
chemotherapy agents into the hepatic ARTERY,
called hepatic artery infusion (HAI) chemother-
apy, has therapeutic benefit.
Because liver cancer tends to be either well
advanced or metastatic at the time of its diagnosis,
the overall outlook remains among the least posi-
tive despite the numerous advances in cancer
treatments overall. The five-year survival rate, the
standard measure for cancer treatment success, is
about 30 percent when surgery can remove the
tumor and about 5 percent when surgery is not a
viable treatment option. Prevention efforts offer
the greatest opportunity for defeating liver cancer.RISK FACTORS FOR LIVER CANCER
anabolic steroid use chronic arsenic exposure
chronic hepatitis B infection chronic HEPATITISC INFECTION
CIRRHOSIS HEMOCHROMATOSIS
LIVER DISEASE OF ALCOHOLISM smoking and ALCOHOLabuse
vinyl chloride exposure in combination
WILSON’S DISEASERisk Factors and Preventive Measures
The most significant risk factor for liver cancer is
infection with chronic hepatitis B or hepatitis C.
Other circumstances that increase risk include cir-
rhosis, LIVER DISEASE OF ALCOHOLISM, exposure to
hepatotoxic chemicals (especially arsenic, which
remains a contaminant in water supplies through-
out the United States as a result of past industrial
waste practices, and the industrial chemical vinyl
chloride), and smoking in combination with ALCO-
HOLabuse.
The single most important preventive measure
for liver cancer is hepatitis vaccination to prevent70 The Gastrointestinal System