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Cancer of the liver.

In the past 30 years, the number of deaths caused by cancer of the liver has gone down in the United States. Primary liver cancer accounts for less than one per cent of all cancers in this country. However, in other parts of the world, such as Africa, Southeast Asia, and China, it is a major health problem, causing up to 15% of the cancer cases seen in those areas. This difference is thought to be due to the much higher percentage of carriers of hepatitis B virus -- from 10 to 20 per cent, compared to 0.5% in whites in the United States.

Patients with chronic hepatitis B virus antigen in their body are more likely to develop cancer of the liver than non-carriers. Their relatives and pe rsonal contacts should be tested for hepatitis B antigen or antibodies. If they are not present, they should be urged to receive the hepatitis B vaccine to protect them from both the virus and possible liver cancer.

Certain toxins and chemicals cause liver cancer. In Africa, aflatoxin, a product of mold found in badly stored peanuts and other food, has been recognized as a cause of liver cancer. Prolonged exposure to polyvinyl chlorid e, used in manufacturing plastics, causes angiosarcoma, a rare form of cancer of blood vessels in the liver. Iron overload cirrhosis (hemochromatosis) and alcoholic cirrhosis have been associated with the development of primary liver cancer in rare instances. Two congenital disorders, alpha 1 antitrypsin deficiency and tyrosinemia, may lead to primary liver cancer.

Benign tumors may also appear on the liver. Most common are adenomas, which occur particularly in women. They are often associated with long-term use of oral contraceptives. The tumor may shrink in size when the contraceptives are discontinued. Although adenomas do not spread like cancerous tumors, they may become very large and cause great pain. They may also rupture and cause internal bleeding that can be fatal. Simple liver cysts and collections of vein s called hemanglomas are commonly seen in the liver.

The liver can also be the site of secondary tumors that have spread from cancers elsewhere. Because the liver filters blood from all parts of the body, it "catches" cancer cells. An enlarged liver full of cancer cells may be an early sign of cancer in other organs. Long-term survival has been possible when the initial cancer has been properly identified and treated. Secondary cancer should not be confused with primary cancer of the liver.

Diagnosis

Primary liver cancer is hard to detect at the beginning. The first symptom is usually pain that goes from the abdomen to the back and shoulder. Weight loss is common. Sometimes patients have episodes of severe pain, fever and nausea. Rapidly deteriorating health, weakness, liver tenderness and jaundice m ay led a doctor to suspect liver cancer.

Measuring levels of alphafetal protein, a substance produced by liver tumors and found in the blood, aids in diagnosis and can help monitor the effect of treatment. Radioactive liver scan, ultrasound test of liver, and CAT scan have been use to detect abnormalities in the liver and abdomen. Liver biopsy is very useful in establishing the diagnosis. It may be necessary to examine the arteries and veins of the liver and gastrointestinal tract through angiography, especially if surgery is considered.

Treatment

Surgery is the preferred treatment for primary liver cancer, especially when cancer is limited to one lobe. If the cancer cannot be removed, chemotherapy and/or radiotherapy may be useful. Recent studies with monoclonal antibodies have shown promise in reducing the size of the tumor. Some cases have been reported in which antibodies to ferratin, an iron protein found in liver tumors, have reduced the size of tumors. The success rate was about 3 of 100 cases. Much investigation is proceeding in these fields.

Liver transplantations have been performed in patients with primary liver cancer. In some instances, cancer has recurred.
COPYRIGHT 1991 American Liver Foundation
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Publication:Pamphlet by: American Liver Foundation
Article Type:pamphlet
Date:Sep 23, 1991
Words:653
Previous Article:Breakthrough on cirrhosis.
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