Hepatocellular Liver Cancer

Definition
Hepatocellular carcinoma is the most common primary malignancy of the liver.

Rationale

Cirrhosis is probably the most important risk factor for hepatocellular carcinoma. Causes of cirrhosis include chronic hepatitis B and C , chronic alcoholism and less commonly primary biliary cirrhosis, autoimmune chronic active hepatitis, hemochromatosis, and Wilson’s disease . Aflatoxin B (also metabolized by fungi in food) for the pathogenesis of cirrhosis and is found mainly in African countries.

Symptoms – Diagnosis

Symptoms of the disease include abdominal pain, fatigue, anorexia, weight loss, unexplained fever, and abdominal distention from ascites fluid. Clinical findings that raise the suspicion of the disease include swelling of the liver and spleen, while laboratory findings may include high hematocrit and hypoglycemia.
The rapid and unexplained deterioration of the clinical picture of a patient with a history of cirrhosis should always raise the suspicion of developing liver cancer.
An increase in the value of α1-fetal globin (α-fetoprotein) is observed in up to 70% of patients and the diagnosis is established if a focal liver lesion is detected by computed tomography or under ultrasound and biopsy.
An α-fetoprotein value above 50 ng / ml is almost pathognomonic for the presence of hepatocellular carcinoma.

Treatment

In most cases surgical resection is impossible while chemoembolization and the use of radiofrequency often have good results for early stage disease. Chemotherapy does not have a proven effect on advanced disease while recent advances at the molecular level have shown that targeted therapy has very good results. Immunotherapy ( atezolizumab / bevacizumab ) and monotherapy with antiangiogenic drugs such as sorafenib are the first treatment options in metastatic disease.