Atlas of pathophysiology, 2 Edition

Part II - Disorders

Gastrointestinal Disorders

Liver Cancer

Liver cancer, also known as primary or metastatic hepatic carcinoma, is a rare form of cancer in the United States. It's rapidly fatal, usually within 6 months, from GI hemorrhage, progressive cachexia, liver failure, or metastasis.

Age Alert

Liver cancer is most prevalent in men (particularly over age 60), and incidence increases with age.

It's common for patients with hepatomas to also have cirrhosis. (Hepatomas are 40 times more likely to develop in a cirrhotic liver than in a normal one.) Whether cirrhosis is a premalignant state or alcohol and malnutrition predispose the liver to develop hepatomas is still unclear. Other risk factors are exposure to the hepatitis C or hepatitis B virus.

Clinical Tip

The liver is one of the most common sites of metastasis from other primary cancers, particularly those of the colon, rectum, stomach, pancreas, esophagus, lung, breast, or melanoma. In the United States, metastatic carcinoma is more than 20 times more common than primary carcinoma and, after cirrhosis, is the leading cause of death related to liver disease. Liver metastasis may appear as a solitary lesion, the first sign of recurrence after a remission.

Causes

·   Immediate cause unknown

·   Possibly congenital in children

·   Environmental exposure to carcinogens

·   Androgens

·   Oral estrogens

·   Cirrhosis

Pathophysiology

Most primary liver tumors (90%) originate in the parenchymal cells and are hepatomas (hepatocellular carcinoma, primary lower-cell carcinoma). Primary tumors that originate in the intrahepatic bile ducts are known as cholangiomas (cholangiocarcinoma, cholangiocellular carcinoma). Rarer tumors include a mixed-cell type, Kupffer cell sarcoma, and hepatoblastomas (which occur almost exclusively in children and are usually resectable and curable).

Signs and symptoms

·   Mass or enlargement in right upper quadrant

·   Tender, nodular liver on palpation

·   Severe epigastric or right upper quadrant pain

·   Bruit, hum, or rubbing sound if tumor is large

·   Weight loss, weakness, anorexia, fever

·   Dependent edema

·   Ascites

·   Jaundice

Diagnostic test results

·   Needle or open biopsy of the liver confirms cell type.

·   Blood chemistry reveals elevated serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, alkaline phosphatase, lactic dehydrogenase, and bilirubin, indicating abnormal liver function.

·   Alpha-fetoprotein levels are elevated.

·   Chest X-ray reveals possible metastasis.

·   Liver scan shows filling defects.

·   Serum electrolyte studies reveal hypernatremia and hypercalcemia; serum laboratory studies reveal hypoglycemia, leukocytosis, or hypocholesterolemia.

Treatment

·   Resection if cancer is in early stage; few hepatic tumors are resectable

·   Liver transplantation for a small subset of patients

·   Palliative measures

§  Radiation therapy, chemotherapy

§  Controlling signs and symptoms of encephalopathy

§  Caring for transhepatic catheters

§  Hospice

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COMMON SITES OF LIVER CANCER

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