Treatment for Liver Neoplasms

There were over 60,000 new cases of primary and secondary liver cancer in 2018. Primary liver cancer constitutes 75% of all cases in the United States. In 2018, this group contributed to a total of 9,950 deaths in the United States. Overall, liver cancer is the fifth most common cause of death as of 2018 in Canada. The most common histological subtypes are hepatocellular carcinoma (HCC), which accounted for 52.3% of all cases in 2018. The second most common subtype was cholangiocarcinoma (38.5%). In the next two leading rank, colorectal carcinoma and carcinoid accounted for 14.6% and 11.2%, respectively.

Liver neoplasms are an important cause of morbidity and mortality worldwide. They may be benign or malignant, and they may present with a wide spectrum of imaging and pathological findings.

Cancerous liver lesions (including hepatocellular carcinomas (HCC) and cholangiocarcinomas (CC) as well as other non-carcinomas) are closely linked to both Hepatitis B virus and fatty liver disease.

Signs of liver neoplasms usually occur late in the course of the disease; however, they can be a cause for concern. A large liver mass, palpable hepatomegaly and abdominal discomfort is common. In addition, liver cirrhosis can be inferred when there is excessive appetite or weight loss. Liver metastasis is not usually the initial presentation – however, abdominal pain and liver enlargement can accompany this presentation. Hepatocellular carcinoma may present with an initial presentation of jaundice and right upper quadrant tenderness in 25% of cases. As discussed in more detail, a biopsy should be performed if there is an elevated level of liver enzymes suggestive of liver disease.

The main obstacle to an effective treatment of hepatic malignancies is inadequate diagnostic criteria. To overcome these problems, the concept of curative tumor therapy should be revived.

The majority of patients are managed with surgical removal of a mass, radiation therapy, or a blend of the two. Rarely are patients treated with chemotherapy, embolization, or targeted therapy.

Recent findings indicate an association between tumor growth velocity and the aggressiveness of treatment responses in patients who are treated for liver cancer. Patients with fast-growing tumors can be identified on preoperative imaging and may benefit from more aggressive therapy.

Hepatitis B virus infection, which is associated with cirrhosis, and liver neoplasms often coexist, increasing the risk of developing serious complications, such as cirrhosis or hepatocellular carcinoma.

There are three major aspects in the treatment of liver tumors: (1) minimizing or eliminating the spread of the cancer cells; (2) removing, or destroying the remaining tumor cells; and (3) reducing the progression of metastases. For a better understanding of the current treatment of liver tumors, we have developed an [Open data, Open access] database. To enable the reader to check the information provided in the table below, the data provided herein are from the Mayo Clinic website for liver cancer.\n

The findings suggest a high level of patient acceptance of treatment and support for improvement in HRQOL. Because of the small sample size, the authors feel that confirmation awaits larger, matched, comparative studies, but these findings support the potential for benefit in HRQOL from treatment for patients with liver neoplasms.

The most commonly used treatments are mainly palliative for both the tumor and the patient. Treatments used are non-curative by intent: the main goal is to obtain symptom control (pain control and anemia control, e.g., in the case of anemia of chronically low iron intake) or quality of life, or (for a few tumors) the potential to eradicate tumors.