Synonyms
- Primary liver cell carcinoma
- Hepatocellular carcinoma
- HCC
- Hepatom
Definition
Liver cancer (hepatocellular carcinoma) is a malignant degeneration and uncontrolled growth of the cells of the liver tissue. The most common cause of liver cancer (hepatocellular carcinoma) is attributed to liver cirrhosis. Patients who suffer from liver cirrhosis (a spongy, connective tissue-infiltrated liver structure with loss of function) either as a result of hepatitis or excessive alcohol consumption have a greatly increased risk of developing liver cell carcinoma (liver cancer).
80% of all hepatocellular carcinomas (liver cancer) are diagnosed as a result of liver cirrhosis. 4% of all liver cirrhosis patients develop hepatocellular carcinoma. 50% of patients with hepatocellular carcinoma (liver cancer) have previously had hepatitis B, 25% hepatitis C The metabolic disorder hemochromatosis as well as patients with an early childhood infection with HB viruses have an increased risk of developing hepatocellular carcinoma.
The regular intake of androgens (male sex hormones) e.g. by bodybuilders has also shown an increased risk of hepatocellular carcinoma. The connection between diabetes mellitus and an increased risk of liver cancer (hepatocellular carcinoma) also seems to be certain today. Recent studies have also discovered a molecular mechanism that is believed to be responsible for the development of hepatocellular carcinoma (liver cancer).
It has been shown that in 60% of carcinoma patients, a so-called tumor suppressor gene (FHIT) is disturbed. This is a mechanism at the genetic level that is supposed to suppress tumor cell growth and whose disruption leads to uncontrolled cell division via protein formation. This topic might also be of interest to you: End-stage liver cancerThe fungus Aspergillus flavus, which grows on cereals in humid climates, among other things, is also said to have a carcinome-promoting effect.
The subdivision of hepatocellular carcinoma (forms of liver cancer) is based on the different growth types: solitary (single), multicenter (at several sites), diffuse infiltrating (distributed everywhere and growing into it), histology and tissue structure, and the so-called TNM classification. If the liver tumor has not yet penetrated a blood vessel, it would be classified according to T1. It is important that this is only a tumor.
If there are several, but they are not larger than 5 cm, or if there is already an invasion of the blood vessel system, this stage would be classified as T2. Several tumors with a size of more than 5 cm or an invasion of the hepatic vein (V. portae) would be designated as T3. All tumors that have already infiltrated neighboring organs or the peritoneum (peritoneum, peritoneal cancer) would be named T4.
If lymph node metastases are already found in or around the liver, this stage would be additionally classified as N1 (N=node), and if distant metastases are found in the body, it would be classified as M1. In summary, these findings are once again divided into stages. Thus, stage I: T1N0M0, stage II: T2N0M0, stage III: T3-4N0M1 and stage IV: all findings with M1.
There is also a so-called CLIP score, in which points are awarded from 0-2 in the categories Child Pugh (statement on liver restriction), tumor morphology, detection of the tumor marker alpha-fetoprotein and presence of liver thrombosis. As with any disease, it is very important to ask for the patient’s medical history (anamnesis), which should include the type, timing and duration of symptoms. In many cases there is a yellowing of the skin and eyes of the patient, which should make the doctor think of a liver disease already at the moment of eye contact.
The doctor should also ask whether cirrhosis of the liver or hepatitis infection is already known, or whether the patient has an alcohol problem. In addition to the general physical examination, the doctor should also palpate the area above the liver to find out if there is an enlargement of the liver or if the actual tumor is already palpable. Sometimes it happens that the listening (auscultation) with the stethoscope results in a pathological flow noise, which is caused by a compression of the corresponding blood vessels or high blood pressure in the hepatic vascular system caused by liver cirrhosis and/or liver carcinoma.
Another important examination option is ultrasound, with which the doctor can already detect a tumorous change in many cases.Here, a statement can also be made as to whether a finding is a primary carcinoma or daughter tumors (metastases) from other organs. A so-called color Doppler examination using ultrasound makes the flow of blood clear and indicates whether there has been excess pressure in the liver system and whether any changes found in the liver are already being supplied with blood or have broken through the blood vessel system (see stage classification). Computer tomography (CT) can also be used afterwards.
An x-ray of the chest or a scintigraphy of the skeleton should be performed later to exclude a primary tumor elsewhere in the body. Smaller tumor foci (1-2cm) can best be detected by magnetic resonance imaging of the vessels (MR-Angio). A general MRI of the liver can also be useful.
A blood test can possibly detect proteins that are formed by the tumor (tumor markers). The so-called alpha-fetoprotein is specifically elevated in patients with hepatocellular carcinoma (liver cancer). However, the search for tumor markers is not so much an option for a primary diagnosis as for a follow-up, in which a sudden further increase can mean a recurrence of the tumor or a transition from liver cirrhosis to hepatocellular carcinoma.
At the time of diagnosis of a hepatocellular carcinoma (liver cancer), 50% of the cases show multiple tumors in the liver (multilocular growth), 25% show thrombosis of the portal vein and 10% show infiltration of the hepatic veins and the inferior vena cava. After the diagnosis of hepatocellular carcinoma, it must always be assumed that the tumor has already spread to other organs. Hepatocellular carcinoma is feared for its rapid metastasis in the brain, lungs and bones. The physician should therefore also order a so-called “tumor staging” as soon as possible, in which he examines the most frequently affected metastatic organs of the hepatocellular carcinoma by means of appropriate imaging (X-ray, CT, scintigraphy).