Hepatoma: Definition, Causes and Treatment

Hepatoma otherwise known as Hepatocellular carcinoma is a malignant tumor of the liver. It is the most common type of primary liver cancer in adults and is currently the most common cause of death in people with cirrhosis.

Hepatoma occurs most often in the setting of chronic liver inflammation and is most closely linked to chronic viral hepatitis infection (hepatitis B or C) or exposure to toxins like alcohol, aflatoxin, or pyrrolizidine alkaloids.

The risk of getting Hepatoma is increased by certain diseases, such as hemochromatosis and alpha 1-antitrypsin deficiency. Metabolic syndrome and NASH are also increasingly recognized as risk factors for Hepatoma.

Causes and risk factors of Hepatoma/ Hepatocellular carcinoma

Hepatoma can occur as a result of:

1. Chronic viral hepatitis

This is the most common and estimated cause of 80% of cases globally.

  • Chronic hepatitis B has about 50% cases.
  • And Chronic hepatitis C is about 25% of cases.

2. Toxins

Hepatoma can occur as a result of exposure to toxins such as

  • Alcohol
  • Aflatoxin
  • Iron overload state (hemochromatosis)
  • Pyrrolizidine alkaloids

3. Congenital disorders

Congenital liver disorders are associated with an increased chance of developing Hepatoma. Children with biliary atresia, infantile cholestasis, glycogen-storage diseases, and other cirrhotic diseases of the liver are predisposed to developing Hepatoma or HCC in childhood

  • Alpha 1-antitrypsin deficiency
  • Wilson’s disease is controversial because while some theorize the risk increases, other case studies suggest the opposite where Wilson’s disease may actually confer protection.
  • Haemophilia, although statistically associated with a higher risk of Hepatoma or Hepatocellular carcinoma (HCC), is due to coincident chronic viral hepatitis infection related to repeated blood transfusions over a lifetime.

Certain benign liver tumors, such as hepatocellular adenoma, may sometimes be associated with coexisting malignant HCC or Hepatoma.

Certain subtypes of hepatocellular adenoma, particularly those with β-catenin activation mutation, are particularly associated with an increased risk of Hepatoma or HCC.

4. Diabetes mellitus

The risk of hepatocellular carcinoma in type 2 diabetics is high and also dependent on the duration of diabetes and treatment protocol.

The circulating insulin concentration is a suspected contributor to this increased risk, such that diabetics with poor insulin control or on treatments that elevate their insulin output, has a far greater risk of hepatocellular carcinoma or Hepatoma than diabetics on treatments that reduce circulating insulin concentration.

Signs and symptoms

Hepatoma in most cases occurs in people who already have signs and symptoms of chronic liver disease. And may present with worsening symptoms or without symptoms at the time of cancer detection. Such signs and symptoms may include:

  • Losing weight unintentionally.
  • Loss of appetite.
  • Upper abdominal pain.
  • Nausea and vomiting.
  • General weakness and fatigue.
  • Yellow discoloration of your skin and the whites of your eyes (jaundice)
  • White, chalky stools.
  • Abdominal swelling due to fluid in the abdominal cavity,
  • Easy bruising from blood clotting.

Diagnosis

The improvement in medical imaging has enhanced the methods of diagnosis of Hepatoma or HCC.

The evaluation of both asymptomatic patients and those with symptoms of liver disease involves both blood testing and imaging.

Usually, a biopsy of a tumor was required to prove an HCC diagnosis.

However, imaging most especially the MRI may be conclusive enough to obviate histopathological confirmation.

Because initial diagnosis commonly occurs at an advanced stage of disease, Hepatoma remains associated with a high mortality rate.

On ultrasound, Hepatoma or HCC often appears as a small coarse hypoechoic lesion with poorly defined margins and irregular internal echoes.

The tumor sometimes appears heterogeneous with fibrosis, fatty change, and calcifications when it grows. This heterogeneity may have a close resemblance to cirrhosis and the surrounding liver parenchyma.

Since hepatitis B and C are some of the main causes of hepatocellular carcinoma/ Hepatoma, prevention of infection is key to then prevent HCC.

Therefore, childhood vaccination against hepatitis B could reduce the risk of liver cancer in the future.

In the case of patients with cirrhosis, alcohol consumption is to be avoided. Also, screening for hemochromatosis may be beneficial for some patients. Whether screening those with chronic liver disease for HCC improves outcomes is unclear.

Treatment

As with any cancer, the treatment and prognosis of HCC vary depending on the specifics of tumor histology, size, how far the cancer has spread, and overall health.

Curative intention:

When the cancer is limited to one or more areas within the liver, surgically removing the malignant cells can be curative.

This can be achieved by resectioning of the affected portion of the liver (known as partial hepatectomy) or in some cases by orthotopic liver transplantation of the entire organ.

“Bridging” intention:

For a limited disease that qualifies for potential liver transplantation, the person may undergo targeted treatment of some or all of the known tumors while waiting for a donor to become available.

“Downstaging” intention:

When the disease has not spread beyond the liver but is too advanced to qualify for curative treatment.

The person may be treated with targeted therapies in order to reduce the size or number of active tumors, with the goal of once again qualifying for a liver transplant after this treatment.

Palliative intention:

Can be applicable when there is a spread of cancer beyond the liver or in persons who may not tolerate surgery, or treatment intended to decrease symptoms of the disease and maximize the duration of survival.

Application of Radiofrequency ablation (RFA):

This uses high-frequency radio waves to destroy tumors by local heating.

The electrodes are inserted into the liver tumor under ultrasound image guidance using percutaneous, laparoscopic, or open surgical approaches.

Application of Cryoablation:

This is a technique used to destroy tissue using cold temperature.

The tumor is not removed and the destroyed cancer is left to be reabsorbed by the body. Initial results in properly selected patients with unresectable liver tumors are equivalent to those of resection.

Cryosurgery involves the placement of a stainless steel probe into the center of the tumor. Liquid nitrogen is circulated through the end of this device.

Selective internal radiation therapy (SIRT):

This can be used to destroy the tumor from within (thus minimizing exposure to healthy tissue).

Similar to TACE, this is a procedure in which an interventional radiologist selectively injects the artery or arteries supplying the tumor with a chemotherapeutic agent.

The agent is typically Yttrium-90 (Y-90) incorporated into embolic microspheres that lodge in the tumor vasculature, causing ischemia and delivering their radiation dose directly to the lesion.

This technique allows for a higher, local dose of radiation to be delivered directly to the tumor while sparing normal healthy tissue.

Use of High Intensity-Focused Ultrasound (HIFU):

As opposed to diagnostic ultrasound this is an experimental technique that uses high-powered ultrasound waves to destroy tumor tissue.

That’s all.

Egbujor Victor Chinedu
He Is Just A Pro Blogger Who Invests his time in Blogging and Web Designing ... Student, Writer...

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