II. Epidemiology
- Most common internal cancer worldwide
- Highest Incidence where Hepatitis B is endemic
- Southeast Asia
- Sub-Saharan Africa
- Less common in the United States
- Incidence in men 2-4 times more common than women
- Incidence peaks in ages 50-70 years old
III. Risk Factors
- Chronic Active Hepatitis B
- Highest risk if congenitally acquired
- Hepatitis C Infection
- Cirrhosis
- Hemochromatosis
- Alpha-1-Antitrypsin Deficiency
- Tyrosinosis
- Anabolic Steroid use
- Fungal metabolite ingestion (aflatoxin)
IV. Symptoms
- Weight loss
- Right Upper Quadrant Abdominal Pain
V. Signs
- Tender, hard, palpable liver mass
- Ascites (25%)
- Peritoneal friction rub
- Hepatic bruit
VI. Labs
-
Liver Function Tests
- Alkaline Phosphatase elevated
- 5'-nucleotidase elevated
-
Tumor Marker: Serum Alpha-fetoprotein >20 ng/ml
- Test Sensitivity: 64%
- Test Specificity: 91%
VII. Radiology
- Liver Ultrasound
- Test Sensitivity: 59% to 74%
- Test Specificity: 94%
- Triphasic Liver CT (arterial contrast images)
- Detects tumors <2 cm in diameter
VIII. Diagnosis: Liver biopsy
- Percutaneous
- Surgical (Laparoscopy or Laparotomy)
IX. Management
- Curative Measures
- Curative resection in only 5%
- Liver Transplantation for small tumors without spread
- Palliation
- Radiation Therapy
- Selective arterial embolization
- Chemotherapy not beneficial
- Radiofrequency Ablation (nonresectable tumor)
- Small trials suggest prolonged survival or cure
- Wong (2001) Am J Surg 182:552-7 [PubMed]
X. Prevention
- Hepatitis B Vaccination for global Immunity