Hepatocellular Carcinoma
(Liver Cancer)
Medical Author: Tse-Ling Fong, MD
Medical Editor: Leslie J. Schoenfield, MD, PhD
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The Relationship of Chronic Viral Hepatitis,
Alcoholism, and Cirrhosis to Liver Cancer
Medical Author: Jay W. Marks, MD
Medical Editor: Leslie J. Schoenfield, MD, PhD
Cancer can start within the liver (primary liver cancer or
hepatocellular cancer) or spread to the liver (metastatic liver cancer) from
other sites, such as the colon. Cancer that starts in the liver, which I
will refer to simply as liver cancer, is the fifth most common cancer in the
world. In the U.S., it is among the 10 most common cancers. This cancer is more
frequent among Native Americans, Asians, Pacific Islanders, and Hispanics than among
Caucasians.
Liver cancer is a bad cancer. It has frequently spread
beyond the liver by the time it is discovered, and only 5% of patients with
liver cancer that has begun to cause symptoms survive even five years without treatment.
The only hope for patients who are at risk for liver cancer is regular surveillance so
that the cancers can be found early. Early cancers can be treated by
surgical removal (resection), destruction of the individual tumors, or liver transplantation. Although
the current techniques for surveillance are not very good at detecting early
liver cancer, newer techniques are being tested and appear to be better.
The most common diseases associated with liver cancer
are chronic viral hepatitis, alcoholism, and cirrhosis (scarring of
the liver). Moreover, chronic viral hepatitis is common in alcoholism,
and both viral hepatitis and alcoholism cause cirrhosis which usually precedes the
development of cancer. Therefore, the contributions and interrelationships
of alcohol abuse, viral hepatitis, and cirrhosis in the development of liver
cancer are complex. Despite the complexity, it is important to try to understand
the contributions of each disease so that patients at highest risk for liver cancer
can be targeted for surveillance. Theoretically, they also might be targeted
with treatments that prevent the development of liver cancer, when such
treatments are developed.
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What is liver cancer (hepatocellular carcinoma, HCC)?
Liver cancer (hepatocellular carcinoma) is a cancer arising from the liver. It is also known
as primary liver cancer or hepatoma. The liver is made up of different cell
types (for example, bile ducts, blood vessels, and fat-storing cells). However, liver
cells (hepatocytes) make up 80% of the liver tissue. Thus, the majority of
primary liver cancers (over 90 to 95%) arises from liver cells and is called
hepatocellular cancer or carcinoma.
When patients or physicians speak of liver cancer,
however, they are often referring to cancer that has spread to the liver, having
originated in other organs (such as the colon, stomach, pancreas, breast, and lung). More
specifically, this type of liver cancer is called metastatic liver disease
(cancer) or secondary liver cancer. Thus, the term liver cancer actually can
refer to either metastatic liver cancer or hepatocellular cancer. The subject of
this article is hepatocellular carcinoma, which I will refer to as liver cancer.
What is the scope of the liver cancer problem?
Liver cancer is the fifth most common cancer in the world. A deadly cancer,
liver cancer will
kill almost all patients who have it within a year. In 1990, the World Health
Organization estimated that there were about 430,000 new cases of liver cancer worldwide,
and a similar number of patients died as a result of this disease. About three
quarters of the cases of liver cancer are found in Southeast Asia (China, Hong Kong,
Taiwan, Korea, and Japan). Liver cancer is also very common in sub-Saharan Africa
(Mozambique and South Africa).
The frequency of liver cancer in Southeast Asia and sub-Saharan Africa is greater than
20 cases per 100,000 population. In contrast, the frequency of liver cancer in North
America and Western Europe is much lower, less than five per 100,000 population.
However, the frequency of liver cancer among native Alaskans is comparable to that seen
in Southeast Asia. Moreover, recent data show that the frequency of liver cancer in the
U.S. overall is rising. This increase is due primarily to chronic hepatitis C,
an infection of the liver that causes liver cancer.
Next: What are the population characteristics (epidemiology) of
liver cancer? »
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Liver Cancer
Hepatitis A and B Immunizations »
Introduction to hepatitis
The term 'hepatitis' means inflammation of the liver. Hepatitis can be caused
by viruses, other
infectious agents, alcohol, and other chemicals. The two viruses that most
commonly infect the liver are the hepatitis A virus and the hepatitis B virus.
Although their names are similar, these viruses are not related. They differ in
the way they are transmitted from person to person and their ability to cause
chronic infection.
Hepatitis A
Hepatitis A is caused by a virus which is spread predominately through the
fecal-oral route when small amounts of infected fecal matter are inadvertently
ingested. Infected individuals shed large amounts of the virus in their stool,
starting about two weeks before symptoms present, and continue shedding the
virus in their stool for one to three
months.
- Close contact with an infected person increases the chances of
contracting
the virus.
...
Read the Hepatitis A and B Immunizations article »
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