|
|
| Line 1: |
Line 1: |
| {{Infobox disease
| | #redirect:[[Liver tumor]] |
| | Name = Liver cancer
| |
| | Image = CT cholangioca.jpg
| |
| | Caption = [[CT scan]] of a [[liver]] with [[cholangiocarcinoma]]
| |
| | DiseasesDB =
| |
| | ICD10 = C22.9
| |
| | ICD9 = {{ICD9|155.2}}
| |
| | ICDO =
| |
| | OMIM =
| |
| | MedlinePlus =
| |
| | eMedicineSubj =
| |
| | eMedicineTopic =
| |
| | MeshID = D008113
| |
| }}
| |
| <!-- Definition and symptoms -->
| |
| '''Liver cancer''' or '''hepatic cancer''' (from the [[Greek language|Greek]] ''hēpar'', meaning liver) is a [[cancer]] that originates in the [[liver]]. Liver tumors are discovered on medical imaging equipment (often by accident) or present themselves symptomatically as an abdominal mass, [[abdominal pain]], [[jaundice|yellow skin]], nausea or liver dysfunction.
| |
| | |
| <!-- Cause and diagnosis-->
| |
| The leading cause of liver cancer is [[cirrhosis]] due to either [[hepatitis B]], [[hepatitis C]], or [[alcohol]].<ref name=GBD2013>{{cite journal|last1=GBD 2013 Mortality and Causes of Death|first1=Collaborators|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet|date=17 December 2014|pmid=25530442|doi=10.1016/S0140-6736(14)61682-2}}</ref> In 2013, 300,000 deaths from liver cancer were due to hepatitis B , 343,000 to hepatitis C and 92,000 to alcohol.<ref name=GBD2013/> Liver cancers are not the same as liver [[metastases]], which start in another part of the body and spread to the liver. Liver cancers are formed from either the liver itself or from structures within the liver, including blood vessels or the [[bile duct]].
| |
| | |
| <!-- Epidemiology -->
| |
| Primary liver cancer is globally the sixth most frequent cancer, and the second leading cause of cancer death.<ref name=WCR2014Epi>{{cite book|title=World Cancer Report 2014|date=2014|publisher=World Health Organization|isbn=9283204298|pages=Chapter 1.1}}</ref> In 2012 it occurred in 782,000 people and resulted in 746,000 deaths.<ref name=WCR2014Epi/> Higher rates of liver cancer occur where hepatitis B and C are common, including [[Eastern Asia|East-Asia]] and [[sub-Saharan Africa]].<ref name="pmid21296855">{{cite journal|last=Jemal|first=A|author2=Bray, F |author3=Center, MM |author4=Ferlay, J |author5=Ward, E |author6= Forman, D |title=Global cancer statistics.|journal=CA: a cancer journal for clinicians|date=Mar–Apr 2011|volume=61|issue=2|pages=69–90|pmid=21296855|doi=10.3322/caac.20107}}</ref> [[Five year survival rates]] are 17% in the United States.<ref>{{cite web|title=SEER Stat Fact Sheets: Liver and Intrahepatic Bile Duct Cancer|url=http://seer.cancer.gov/statfacts/html/livibd.html|website=NCI|accessdate=18 June 2014}}</ref>
| |
| | |
| ==Classification==
| |
| | |
| The most frequent liver cancer, accounting for approximately 75% of all primary liver cancers, is [[hepatocellular carcinoma]] (HCC) (also named ''hepatoma'', which is a misnomer because [[adenoma]]s are usually benign). HCC is a cancer formed by liver cells, known as [[hepatocyte]]s, that become malignant. Another type of cancer formed by liver cells is [[hepatoblastoma]], which is specifically formed by immature liver cells.<ref name="doi10.1016/j.mpsur.2008.12.005">{{cite journal|first=Ahmed, I; Lobo D.N.|title=Malignant tumours of the liver|journal=Surgery (Oxford)|date=January 2009|volume=27|issue=1|pages=30–37|doi=10.1016/j.mpsur.2008.12.005|last1=Ahmed|last2=Lobo|first2=Dileep N.}}</ref> It is a rare malignant tumor that primarily develops in children, and accounts for approximately 1% of all cancers in children and 79% of all primary liver cancers under the age of 15. Most hepatoblastomas form in the right lobe.<ref name="pmid15598339">{{cite journal|last=Emre|first=S|author2=McKenna, GJ |title=Liver tumors in children.|journal=Pediatric transplantation|date=December 2004|volume=8|issue=6|pages=632–8|pmid=15598339|doi=10.1111/j.1399-3046.2004.00268.x}}</ref>
| |
| | |
| Liver cancer can also form from other structures within the liver such as the [[bile duct]], [[blood vessel]]s and [[immune cells]]. Cancer of the bile duct ([[cholangiocarcinoma]] and cholangiocellular [[cystadenocarcinoma]]) account for approximately 6% of primary liver cancers.<ref name="doi10.1016/j.mpsur.2008.12.005"/> There is also a variant type of HCC that consists of both HCC and cholangiocarcinoma.<ref>{{cite journal|last=Khan|first=SA|author2=Davidson, BR; Goldin, RD; Heaton, N; Karani, J; Pereira, SP; Rosenberg, WM; Tait, P; Taylor-Robinson, SD; Thillainayagam, AV; Thomas, HC; Wasan, H; British Society of, Gastroenterology|title=Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update|journal=Gut|date=December 2012|volume=61|issue=12|pages=1657–69|pmid=22895392|doi=10.1136/gutjnl-2011-301748}}</ref> Tumors of the blood vessels ([[angiosarcoma]] and [[hemangioendothelioma]], [[embryonal sarcoma]] and [[fibrosarcoma]] are produced from a type of connective tissue known as [[mesenchyme]]. Cancers produced from muscle in the liver are [[leiomyosarcoma]] and [[rhabdomyosarcoma]]. Other less common liver cancers include [[carcinosarcoma]]s, [[teratoma]]s, [[yolk sac tumour]]s, [[carcinoid tumour]]s and [[lymphoma]]s.<ref name="doi10.1016/j.mpsur.2008.12.005"/> Lymphomas usually have diffuse infiltration to liver, but It may also form a liver mass in rare occasions.
| |
| | |
| Many cancers found within the liver are not true liver cancers, but are cancers from other sites in the body that have spread to the liver (known as [[metastasis|metastases]]). Frequently, the site of origin is the [[gastrointestinal tract]] (such as [[colon cancer]] and [[Carcinoid syndrome|carcinoid tumors]] mainly of the [[Vermiform appendix|appendix]]), but also from [[breast cancer]], [[ovarian cancer]], [[lung cancer]], [[renal cancer]], [[prostate cancer]].
| |
| | |
| ==Signs and symptoms==
| |
| Because liver cancer is an [[umbrella term]] for many types of cancer, the signs and symptoms depend on what type of cancer is present. Cholangiocarcinoma is associated with [[sweating]], [[jaundice]], [[abdominal pain]], [[weight loss]] and [[hepatomegaly|liver enlargement]].<ref>{{EMedicine|article|277393|Cholangiocarcinoma}}</ref> Hepatocellular carcinoma is associated with [[abdominal mass]], [[abdominal pain]], [[emesis]], [[anemia]], [[back pain]], [[jaundice]], [[itching]], [[weight loss]] and [[fever]].<ref>{{cite web |url=http://www.childrenshospital.org/az/Site1015/mainpageS1015P0.html |title=Liver tumors in Children |publisher=Boston Children's Hospital}}</ref>
| |
| | |
| == Causes ==
| |
| | |
| ===Viral infection===
| |
| [[File:Hepatitis-B virions.jpg|thumb|left|This [[electron micrograph]] shows [[hepatitis B]] virus "Dane particles", or virions.]]
| |
| Viral infection with either [[hepatitis C]] virus (HCV) or [[Hepatitis B]] virus (HBV) is the chief cause of liver cancer in the world today, accounting for 80% of [[hepatocellular carcinoma]] (HCC).<ref name="pmid23344543">{{cite journal|last=Arzumanyan|first=A|author2=Reis, HM |author3=Feitelson, MA |title=Pathogenic mechanisms in HBV- and HCV-associated hepatocellular carcinoma.|journal=Nature reviews. Cancer|date=February 2013|volume=13|issue=2|pages=123–35|pmid=23344543|doi=10.1038/nrc3449}}</ref><ref>{{cite journal|last=Rosen|first=HR|title=Clinical practice. Chronic hepatitis C infection.|journal=The New England Journal of Medicine|date=Jun 23, 2011|volume=364|issue=25|pages=2429–38|pmid=21696309|doi=10.1056/NEJMcp1006613}}</ref><ref name=AdultNCI>{{cite web|title=General Information About Adult Primary Liver Cancer|url=http://www.cancer.gov/cancertopics/pdq/treatment/adult-primary-liver/HealthProfessional|publisher=National Cancer Institute|accessdate=13 January 2013}}</ref> The viruses cause HCC because massive [[inflammation]], [[fibrosis]] and eventual [[cirrhosis]] occurs within the liver. HCC usually arises after cirrhosis, with an annual incidence of 1.7% in cirrhotic HCV-infected individuals.<ref name="pmid23323249">{{cite journal|last=Jeong|first=SW|author2=Jang, JY |author3=Chung, RT |title=Hepatitis C virus and hepatocarcinogenesis.|journal=Clinical and molecular hepatology|date=December 2012|volume=18|issue=4|pages=347–56|pmid=23323249|doi=10.3350/cmh.2012.18.4.347}}</ref> Around 5-10% of individuals that become infected with HBV become chronic carriers, and around 30% of these acquire chronic liver disease, which can lead to HCC.<ref name="pmid23344543"/> HBV infection is also linked to [[cholangiocarcinoma]].<ref>{{cite journal|last=Ralphs|first=S|author2=Khan, SA |title=The role of the hepatitis viruses in cholangiocarcinoma.|journal=Journal of viral hepatitis|date=May 2013|volume=20|issue=5|pages=297–305|pmid=23565610|doi=10.1111/jvh.12093}}</ref> The role of viruses other than HCV or HBV in liver cancer is much less clear, although there is some evidence that co-infection of HBV and [[hepatitis D]] virus may increase the risk of HCC.<ref>{{cite journal|last=Kew|first=MC|title=Hepatitis viruses (other than hepatitis B and C viruses) as causes of hepatocellular carcinoma: an update.|journal=Journal of viral hepatitis|date=March 2013|volume=20|issue=3|pages=149–57|pmid=23383653|doi=10.1111/jvh.12043}}</ref>
| |
| | |
| Many [[mutation|genetic]] and [[epigenetics|epigenetic]] changes are formed in liver cells during HCV and HBV infection, which is a major factor in the production of the liver tumours. The viruses induce malignant changes in cells by altering [[gene methylation]], affecting gene expression and promoting or repressing cellular [[signal transduction pathway]]s. By doing this the viruses can prevent cells from undergoing a programmed form of cell death ([[apoptosis]]) and promote viral replication and persistence.<ref name="pmid23344543"/><ref name="pmid23323249"/>
| |
| | |
| ===Cirrhosis===
| |
| [[File:Cirrhosis high mag.jpg|thumb|High magnification [[micrograph]] of a liver with cirrhosis. [[Trichrome]] stain. The most common cause of cirrhosis in the Western world is [[alcohol abuse]] - the cause of cirrhosis in this case.]]
| |
| In addition to virus-related [[cirrhosis]] described above, other causes of cirrhosis can lead to HCC. Alcohol intake correlates with risk of HCC, and the risk is far greater in individuals with an alcohol-induced cirrhotic liver. There are a few disorders that are known cause cirrhosis and lead to cancer, including hereditary [[hemochromatosis]] and [[primary biliary cirrhosis]].<ref>{{cite journal|last=Fattovich|first=G|author2=Stroffolini, T |author3=Zagni, I |author4= Donato, F |title=Hepatocellular carcinoma in cirrhosis: incidence and risk factors.|journal=Gastroenterology|date=November 2004|volume=127|issue=5 Suppl 1|pages=S35–50|pmid=15508101|doi=10.1053/j.gastro.2004.09.014}}</ref>
| |
| | |
| ===Aflatoxin===
| |
| | |
| [[Aflatoxin]] exposure can lead to the development of HCC. The aflatoxins are a group of chemicals produced by the fungi ''[[Aspergillus flavus]]'' (the name comes from ''A. flavus'' toxin) and ''[[Aspergillus parasiticus|A. parasiticus]]''. Food contamination by the fungi leads to ingestion of the chemicals, which are very toxic to the liver. Common foodstuffs contaminated with the toxins are cereals, peanuts and other vegetables. Contamination of food is common in Africa, South-East Asia and China. Concurrent HBV infection and aflatoxin exposure increases the risk of liver cancer to over three times that seen in HBV infected individuals without aflatoxin exposure. The mechanism by which aflatoxins cause cancer is through genetic [[mutation]] of a gene required for the prevention of cancer: [[p53]].<ref>{{cite journal|last=Kensler|first=TW|author2=Roebuck, BD |author3=Wogan, GN |author4= Groopman, JD |title=Aflatoxin: a 50-year odyssey of mechanistic and translational toxicology|journal=Toxicological sciences : an official journal of the Society of Toxicology|date=March 2011|volume=120 Suppl 1|pages=S28–48|pmid=20881231|pmc=3043084|doi=10.1093/toxsci/kfq283}}</ref><ref name="pmid19091458">{{cite journal|last=Chuang|first=SC|author2=La Vecchia, C; Boffetta, P|title=Liver cancer: descriptive epidemiology and risk factors other than HBV and HCV infection|journal=Cancer letters|date=Dec 1, 2009|volume=286|issue=1|pages=9–14|pmid=19091458|doi=10.1016/j.canlet.2008.10.040}}</ref>
| |
| | |
| ===Other causes in adults===
| |
| * High grade dysplastic nodules are precancerous lesions of the liver. Within 2 years, there is a risk of cancer arising from these nodules of 30-40%.<ref>{{cite journal|last=Di Tommaso|first=L|author2=Sangiovanni, A |author3=Borzio, M |author4=Park, YN |author5=Farinati, F |author6= Roncalli, M |title=Advanced precancerous lesions in the liver.|journal=Best practice & research. Clinical gastroenterology|date=April 2013|volume=27|issue=2|pages=269–84|pmid=23809245|doi=10.1016/j.bpg.2013.03.015}}</ref>
| |
| *[[Obesity]] has emerged as an important risk factor as it can lead to [[steatohepatitis]].<ref name=AdultNCI/><ref name="pmid19091458"/>
| |
| *[[Diabetes]] increases the risk of HCC.<ref name="pmid19091458"/>
| |
| *Smoking increases the risk of HCC compared to non-smokers and previous smokers.<ref name="pmid19091458"/>
| |
| *There is around 5-10% lifetime risk of cholangiocarcinoma in people with [[primary sclerosing cholangitis]].<ref name="pmid22982100"/>
| |
| *[[Liver fluke]] infection increases the risk of cholangiocarcinoma, and is the reason [[Thailand]] has particularly high rates of this cancer.<ref name="pmid21296855"/>
| |
| | |
| ===Risk factors in children===
| |
| Increased risk of liver cancer in children can be caused by [[Beckwith-Wiedemann Syndrome]] (associated with hepatoblastoma),<ref>{{cite journal|last=DeBaun|first=MR|author2=Tucker, MA |title=Risk of cancer during the first four years of life in children from The Beckwith-Wiedemann Syndrome Registry.|journal=The Journal of pediatrics|date=March 1998|volume=132|issue=3 Pt 1|pages=398–400|pmid=9544889|doi=10.1016/S0022-3476(98)70008-3}}</ref><ref name="pmid22692949"/> [[familial adenomatous polyposis]] (associated with hepatoblastoma),<ref name="pmid22692949">{{cite journal|last=Spector|first=LG|author2=Birch, J |title=The epidemiology of hepatoblastoma.|journal=Pediatric blood & cancer|date=November 2012|volume=59|issue=5|pages=776–9|pmid=22692949|doi=10.1002/pbc.24215}}</ref> [[low birth weight]] (associated with hepatoblastoma),<ref name="pmid15598339"/> Progressive familial intrahepatic cholestasis (associated with HCC)<ref>{{cite journal|last=Davit-Spraul|first=A|author2=Gonzales, E |author3=Baussan, C |author4= Jacquemin, E |title=Progressive familial intrahepatic cholestasis|journal=Orphanet journal of rare diseases|date=Jan 8, 2009|volume=4|pages=1|pmid=19133130|pmc=2647530|doi=10.1186/1750-1172-4-1}}</ref> and [[Trisomy 18]] (associated with hepatoblastoma).<ref name="pmid22692949"/>
| |
| | |
| ==Diagnosis==
| |
| Many imaging modalities are used to aid in the diagnosis of primary liver cancer. For HCC these include [[Medical ultrasonography|sonography]] (ultrasound), [[computed tomography]] (CT) and [[magnetic resonance imaging]] (MRI). When imaging the liver with ultrasound, a mass greater than 2 cm has more than 95% chance of being HCC. The majority of cholangiocarcimas occur in the [[hilum (anatomy)|hilar]] region of the liver, and often present as bile duct obstruction. If the cause of obstruction is suspected to be malignant, [[endoscopic retrograde cholangiopancreatography]] (ERCP), ultrasound, CT, MRI and [[magnetic resonance cholangiopancreatography]] (MRCP) are used.<ref>{{cite journal|last=Ariff|first=B|author2=Lloyd, CR |author3=Khan, S |author4=Shariff, M |author5=Thillainayagam, AV |author6=Bansi, DS |author7=Khan, SA |author8=Taylor-Robinson, SD |author9= Lim, AK |title=Imaging of liver cancer|journal=World journal of gastroenterology : WJG|date=Mar 21, 2009|volume=15|issue=11|pages=1289–300|pmid=19294758|pmc=2658841|doi=10.3748/wjg.15.1289}}</ref>
| |
| | |
| [[Tumor marker]]s, chemicals sometimes found in the blood of people with cancer, can be helpful in diagnosing and monitoring the course of liver cancers. High levels of [[alpha-fetoprotein]] (AFP) in the blood can be found in many cases of HCC and intrahepatic cholangiocarcinoma. Cholangiocarcinoma can be detected with these commonly used tumor markers: [[CA19-9|carbohydrate antigen 19-9]] (CA 19-9), [[carcinoembryonic antigen]] (CEA) and cancer antigen 125 ([[CA125]]). These tumour markers are found in primary liver cancers, as well as in other cancers and certain other disorders.<ref>{{cite journal|last=Malaguarnera|first=G|author2=Paladina, I |author3=Giordano, M |author4=Malaguarnera, M |author5=Bertino, G |author6= Berretta, M |title=Serum markers of intrahepatic cholangiocarcinoma|journal=Disease markers|year=2013|volume=34|issue=4|pages=219–28|pmid=23396291|doi=10.3233/DMA-130964|doi_brokendate=2015-01-14}}</ref><ref>{{cite journal|last=Zhao, Y; Qiang, J; Li, C|title=Tumor markers for hepatocellular carcinoma (Review)|journal=Molecular and Clinical Oncology|year=2013|volume=1|issue=4|pages=593–598|doi=10.3892/mco.2013.119|pmid=24649215|pmc=3915636|first1=Guan-Cheng|last2=Ju|first2=Q|last3=Li|first3=G. C.}}</ref>
| |
| | |
| ==Prevention==
| |
| Prevention of cancers can be separated into primary, secondary and tertiary prevention. Primary prevention preemptively reduces exposure to a risk factor for liver cancer. One of the most successful primary liver cancer preventions is [[hepatitis B vaccine|vaccination against hepatitis B]]. Vaccination for [[hepatitis C]] virus is currently unavailable. Other forms of primary prevention are aimed at limiting transmission of these viruses by promotion of safe injection practice, screening of [[blood donation]] products and screening of high risk asymptomatic individuals. [[Aflatoxin]] exposure can be avoided by post-harvest intervention to discourage mold, which has been effective in [[west Africa]]. Reducing [[alcohol abuse]], [[obesity]], and [[diabetes]] would also reduce rates of liver cancer. Diet control in [[hemochromatosis]] could decrease the risk of [[iron overload]], decreasing the risk of cancer.<ref name="pmid22873223">{{cite journal|last=Hoshida|first=Y|author2=Fuchs, BC |author3=Tanabe, KK |title=Prevention of hepatocellular carcinoma: potential targets, experimental models, and clinical challenges.|journal=Current cancer drug targets|date=Nov 1, 2012|volume=12|issue=9|pages=1129–59|pmid=22873223|doi=10.2174/156800912803987977}}</ref>
| |
| | |
| Secondary prevention includes both cure of the agent involved in the formation of cancer ([[carcinogenesis]]) and the prevention of carcinogenesis if this is not possible. Cure of virus-infected individuals is not possible, but treatment with antiviral drugs such as interferon can decrease the risk of liver cancer. [[Chlorophyllin]] may have potential in reducing the effects of aflatoxin.<ref name="pmid22873223"/>
| |
| | |
| Tertiary prevention includes treatments to prevent the recurrence of liver cancer. These include the use of chemotherapy drugs, and antiviral drugs.<ref name="pmid22873223"/>
| |
| | |
| ==Treatment==
| |
| | |
| ===Hepatocellular carcinoma===
| |
| [[File:Big Liver Tumor.JPG|thumb| Left lobe liver tumor in a 50-year-old male, operated in [[King Saud Medical Complex]], [[Riyadh]], [[Saudi Arabia]]]]
| |
| [[Segmental resection|Surgical resection]] is often the treatment of choice for non-cirrhotic livers. Increased risk of complications such as liver failure can occur with resection of cirrhotic livers. [[5-year survival rate]]s after resection has massively improved over the last few decades and can now exceed 50%. Recurrence rates after resection due to the spread of the initial tumor or formation of new tumors exceeds 70%.<ref name="pmid21374666">{{cite journal|last=Bruix|first=J|author2=Sherman, M; American Association for the Study of Liver, Diseases|title=Management of hepatocellular carcinoma: an update|journal=Hepatology (Baltimore, Md.)|date=March 2011|volume=53|issue=3|pages=1020–2|pmid=21374666|doi=10.1002/hep.24199}}</ref> [[Liver transplantation]] can also be used in cases of HCC where this form of treatment can be tolerated and the tumor fits specific criteria (such as the [[Milan criteria]]). Less than 30-40% of individuals with HCC are eligible for surgery and transplant because the cancer is often detected late stage. Also, HCC can progress during the waiting time for liver transplants, which can prevent transplant due to the strict criteria.
| |
| | |
| Percutaneous ablation is the only non-surgical treatment that can offer cure. There are many forms of percutaneous ablation, which consist of either injecting chemicals into the liver ([[ethanol]] or [[acetic acid]]) or producing extremes of temperature using [[radio frequency ablation]], [[microwave ablation|microwave]]s, [[laser ablation|laser]]s or [[cryotherapy]]. Of these, radio frequency ablation has one of the best reputations in HCC, but the limitations include inability to treat tumors close to other organs and blood vessels due to heat generation and the heat sync effect, respectively.<ref name='"pmid24071575"'>{{cite journal|last=Wang|first=ZG|author2=Zhang, GF |author3=Wu, JC |author4= Jia, MK |title=Adjuvant therapy for hepatocellular carcinoma: Current situation and prospect.|journal=Drug discoveries & therapeutics|date=August 2013|volume=7|issue=4|pages=137–143|pmid=24071575|doi=10.5582/ddt.2013.v7.4.137}}</ref><ref name='"pmid22300468"'>{{cite journal|last=de Lope|first=CR|author2=Tremosini, S |author3=Forner, A |author4=Reig, M |author5= Bruix, J |title=Management of HCC.|journal=Journal of hepatology|year=2012|volume=56 Suppl 1|pages=S75–87|pmid=22300468|doi=10.1016/S0168-8278(12)60009-9}}</ref>
| |
| | |
| Systemic [[chemotherapy|chemotherapeutics]] are not routinely used in HCC, although local chemotherapy may be used in a procedure known as [[transarterial chemoembolization]]. In this procedure, cytotoxic drugs such as [[doxorubicin]] or [[cisplatin]] with [[lipiodol]] are administered and the arteries supplying the liver are blocked by gelatin sponge or other particles. Because most systemic drugs have no efficacy in the treatment of HCC, research into the molecular pathways involved in the production of liver cancer produced [[sorafenib]], a [[targeted therapy]] drug that prevents cell proliferation and [[angiogenesis|blood cell growth]]. This drug provides a survival benefit for advanced HCC.<ref name='"pmid22300468"'/>
| |
| | |
| [[Radiotherapy]] is not often used in HCC because the liver is not tolerant to radiation. Although with modern technology it is possible to provide well targeted radiation to the tumor, minimizing the dose to the rest of the liver. Dual treatments of radiotherapy plus chemoembolization, local chemotherapy, systemic chemotherapy or targeted therapy drugs may show benefit over radiotherapy alone.<ref>{{cite journal|last=Feng|first=M|author2=Ben-Josef, E |title=Radiation therapy for hepatocellular carcinoma.|journal=Seminars in radiation oncology|date=October 2011|volume=21|issue=4|pages=271–7|pmid=21939856|doi=10.1016/j.semradonc.2011.05.002}}</ref>
| |
| | |
| [[File:photodynamic therapy.jpg|thumb|left|A surgeon performing photodynamic therapy.]] | |
| | |
| ===Cholangiocarcinoma===
| |
| Resection is an option in cholangiocarcinoma, but less than 30% of cases of cholangiocarcinoma are resectable at diagnosis. After surgery, recurrence rates are up to 60%.<ref name="pmid23608009">{{cite journal|last=Ulstrup|first=T|author2=Pedersen, FM |title=[Photodynamic therapy of cholangiocarcinomas].|journal=Ugeskrift for laeger|date=Feb 25, 2013|volume=175|issue=9|pages=579–82|pmid=23608009}}</ref><ref name="pmid23337933">{{cite journal|last=Kuhlmann|first=JB|author2=Blum, HE |title=Locoregional therapy for cholangiocarcinoma.|journal=Current opinion in gastroenterology|date=May 2013|volume=29|issue=3|pages=324–8|pmid=23337933|doi=10.1097/MOG.0b013e32835d9dea}}</ref> Liver transplant may be used where partial resection is not an option, and adjuvant [[chemoradiation]] may benefit some cases.<ref name="pmid22982100">{{cite journal|last=Razumilava|first=N|author2=Gores, GJ |title=Classification, diagnosis, and management of cholangiocarcinoma.|journal=Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association|date=January 2013|volume=11|issue=1|pages=13–21.e1; quiz e3–4|pmid=22982100|doi=10.1016/j.cgh.2012.09.009}}</ref>
| |
| | |
| 60% of cholangiocarcinomas form in the [[Hilum (anatomy)|perihilar]] region and [[photodynamic therapy]] can be used to improve [[quality of life]] and survival time in these unresectable cases. Photodynamic therapy is a novel treatment that utilitizes light activated molecules to treat the tumor. The compounds are activated in the tumor region by laser light, which causes the release of toxic reactive oxygen species, killing tumor cells.<ref name="pmid23608009"/><ref>{{cite journal|last=Ortner|first=MA|title=Photodynamic therapy for cholangiocarcinoma|journal=Lasers in surgery and medicine|date=September 2011|volume=43|issue=7|pages=776–80|pmid=22057505|doi=10.1002/lsm.21106|doi_brokendate=2015-01-14}}</ref>
| |
| | |
| Systemic chemotherapies such as [[gemcitabine]] and [[cisplatin]] are sometimes used in inoperable cases of cholangiocarcinoma.<ref name="pmid22982100"/>
| |
| | |
| [[Radio frequency ablation]], [[transarterial chemoembolization]] and internal radiotherapy ([[brachytherapy]]) all show promise in the treatment of cholangiocarcinoma.<ref name="pmid23337933"/>
| |
| | |
| [[Radiotherapy]] may be used in the adjuvant setting or for palliative treatment of cholangiocarcinoma.<ref>{{cite journal|last=Valero V|first=3rd|author2=Cosgrove, D |author3=Herman, JM |author4= Pawlik, TM |title=Management of perihilar cholangiocarcinoma in the era of multimodal therapy.|journal=Expert review of gastroenterology & hepatology|date=August 2012|volume=6|issue=4|pages=481–95|pmid=22928900|doi=10.1586/egh.12.20}}</ref>
| |
| | |
| ===Hepatoblastoma===
| |
| | |
| Removing the tumor by either [[Segmental resection|surgical resection]] or [[liver transplant]] can be used in the treatment of hepatoblastoma. In some cases surgery can offer a cure. Chemotherapy may be used before and after surgery and transplant.<ref>{{cite journal|last=Meyers|first=RL|author2=Czauderna, P |author3=Otte, JB |title=Surgical treatment of hepatoblastoma.|journal=Pediatric blood & cancer|date=November 2012|volume=59|issue=5|pages=800–8|pmid=22887704|doi=10.1002/pbc.24220}}</ref>
| |
| | |
| [[Chemotherapy]], including [[cisplatin]], [[vincristine]], [[cyclophosphamide]], and [[doxorubicin]] are used for the systemic treatment of hepatoblastoma. Out of these drugs, cisplatin seems to be the most effective.<ref>{{cite journal|last=Perilongo|first=G|author2=Malogolowkin, M |author3=Feusner, J |title=Hepatoblastoma clinical research: lessons learned and future challenges.|journal=Pediatric blood & cancer|date=November 2012|volume=59|issue=5|pages=818–21|pmid=22678761|doi=10.1002/pbc.24217}}</ref>
| |
| | |
| ==Epidemiology==
| |
| [[File:Liver cancer world map - Death - WHO2004.svg|thumb|250px|[[Age adjustment|Age-standardized]] death from liver cancer per 100,000 inhabitants in 2004.<ref>{{cite web |url=http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2009 |work=World Health Organization |accessdate=Nov 11, 2009}}</ref>{{refbegin|3}}
| |
| {{legend|#b3b3b3|no data}}
| |
| {{legend|#ffff65|<7.5}}
| |
| {{legend|#fff200|7.5–15}}
| |
| {{legend|#ffdc00|15–22.5}}
| |
| {{legend|#ffc600|22.5–30}}
| |
| {{legend|#ffb000|30–37.5}}
| |
| {{legend|#ff9a00|37.5–45}}
| |
| {{legend|#ff8400|45–52.5}}
| |
| {{legend|#ff6e00|52.5–60}}
| |
| {{legend|#ff5800|60–67.5}}
| |
| {{legend|#ff4200|67.5–75}}
| |
| {{legend|#ff2c00|75–110}}
| |
| {{legend|#cb0000|>110}}
| |
| {{refend}}]]
| |
| Globally, {{As of|2010|lc=y}}, liver cancer resulted in 754,000 deaths, up from 460,000 in 1990, making it the third leading cause of cancer death after lung and stomach.<ref name=Loz2012/> In 2012, it represented 7% of cancer diagnoses in men, the 5th most diagnosed cancer that year.<ref>{{cite book |title = World Cancer Report 2014 |publisher = International Agency for Research on Cancer, World Health Organization |date = 2014 |isbn = 978-92-832-0432-9}}</ref> Of these deaths 340,000 were secondary to hepatitis B, 196,000 were secondary to hepatitis C, and 150,000 were secondary to alcohol.<ref name=Loz2012>{{cite journal|last=Lozano|first=R|title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010|journal=Lancet|date=Dec 15, 2012|volume=380|issue=9859|pages=2095–128|pmid=23245604|doi=10.1016/S0140-6736(12)61728-0|last2=Naghavi|first2=M|last3=Foreman|first3=K|last4=Lim|first4=S|last5=Shibuya|first5=K|last6=Aboyans|first6=V|last7=Abraham|first7=J|last8=Adair|first8=T|last9=Aggarwal|first9=R|last10=Ahn|first10=S. Y.|last11=Alvarado|first11=M|last12=Anderson|first12=H. R.|last13=Anderson|first13=L. M.|last14=Andrews|first14=K. G.|last15=Atkinson|first15=C|last16=Baddour|first16=L. M.|last17=Barker-Collo|first17=S|last18=Bartels|first18=D. H.|last19=Bell|first19=M. L.|last20=Benjamin|first20=E. J.|last21=Bennett|first21=D|last22=Bhalla|first22=K|last23=Bikbov|first23=B|last24=Bin Abdulhak|first24=A|last25=Birbeck|first25=G|last26=Blyth|first26=F|last27=Bolliger|first27=I|last28=Boufous|first28=S|last29=Bucello|first29=C|last30=Burch|first30=M|display-authors=29}}</ref> HCC, the most common form of liver cancer, shows a striking geographical distribution. China has 50% of HCC cases globally, and more than 80% of total cases occur in sub-Saharan Africa or in East-Asia due to [[hepatitis B]] virus.<ref name="pmid21296855"/><ref>{{cite journal|last=El-Serag|first=HB|author2=Rudolph, KL |title=Hepatocellular carcinoma: epidemiology and molecular carcinogenesis.|journal=Gastroenterology|date=June 2007|volume=132|issue=7|pages=2557–76|pmid=17570226|doi=10.1053/j.gastro.2007.04.061}}</ref> Cholangiocarcinoma also has a significant geographical distribution, with Thailand showing the highest rates worldwide due to the presence of liver fluke.<ref name="pmid21296855"/><ref>{{cite journal|last=Khan|first=SA|author2=Toledano, MB |author3=Taylor-Robinson, SD |title=Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma.|journal=HPB : the official journal of the International Hepato Pancreato Biliary Association|year=2008|volume=10|issue=2|pages=77–82|pmid=18773060|doi=10.1080/13651820801992641}}</ref>
| |
| | |
| ===UK===
| |
| Liver cancer is the eighteenth most common cancer in the UK (around 4,300 people were diagnosed with liver cancer in the UK in 2011), and it is the twelfth most common cause of cancer death (around 4,500 people died of the disease in 2012).<ref>{{cite web|title=Liver cancer statistics|url=http://www.cancerresearchuk.org/cancer-info/cancerstats/types/liver/|website=Cancer Research UK|accessdate=28 October 2014}}</ref>
| |
| | |
| == Research ==
| |
| Hepcortespenlisimut-L (see [[Cancer vaccine]]) is an immunotherapy that is going through a phase 3 clinical trial for HCC.<ref> Immunitor Phase 3 trial of hepcortespenlisimut-L, Liver Cancer Immunotherapy https://clinicaltrials.gov/ct2/show/NCT02232490 </ref>
| |
| | |
| ==References==
| |
| {{reflist|2}}
| |
| | |
| ==External links==
| |
| {{Commons category}}
| |
| *[http://pathology2.jhu.edu/liver/ The Liver Cancer Web Page] at [[Johns Hopkins University]]
| |
| *[http://www.mayoclinic.com/health/liver-cancer/DS00399/ Liver cancer] at [[Mayo Clinic]]
| |
| *Clinically reviewed [http://www.cancerhelp.org.uk/type/liver-cancer/ liver cancer information]
| |
| | |
| {{Digestive system neoplasia}}
| |
| | |
| {{Authority control}}
| |
| {{DEFAULTSORT:Liver Cancer}}
| |
| [[Category:Hepatology]]
| |
| [[Category:Digestive system neoplasia]]
| |
| [[Category:Diseases of liver|C]]
| |