 Primary Liver Cancer in the setting of a normal non-cirrhotic liver
 Cut section of the tumor shown above |
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What is Primary Liver Cancer?
These are cancers that arise de novo within the liver and do not come from some other organ. If they have traveled from another organ they are called Secondary or Metastatic Liver cancers. Liver cancers commonly referred to as hepatocellular carcinoma (HCC). It begins in the hepatocytes which is the main cell type of liver. Hepatocellular carcinoma is the fifth most common solid tumor in the world, with worldwide prevalence highest in Southeast Asia and Africa. The incidence of HCC in the United States is much lower than the rest of the world and most cases are seen in people with liver cirrhosis.
The treatment of HCC involves consideration of the tumor as well as the underlying condition of the liver. More than 80% of HCC develop in cirrhotic livers and the remaining 20% arise in livers without evidence of cirrhosis. In the absence of cirrhosis, if the lesion lends itself to resection, aggressive surgical therapy is the norm. For patients with advanced cirrhosis, liver transplantation for HCC makes theoretical sense, as it removes the tumor as well as the underlying cirrhosis. In early stages of cirrhosis the management may include aggressive surgical resection. However in sharp contrast, if they have advanced cirrhosis they are best served by liver transplantation, as they stand the risk of decompensating after surgical resection. A small percentage of the Asian population in the USA tend to be carriers for hepatitis and often do not manifest any detrimental effects of the virus on their livers. This patient population is at a much higher risk for developing primary liver cancers and should undergo regular screening with their gastroenterologists/ hepatologists. Once again, if they develop tumors they should be resected if possible.
What is Secondary liver cancer or liver metastases?
By definition, liver metastasis is cancer that has spread to the liver from somewhere else in the body. Liver is the most common site for cancers to spread to after the lymph nodes. Most of these originate from cancers of the colon, rectum, pancreas, stomach, esophagus, breast, lung, melanoma and some other less common sites. In the past liver metastases were often considered advanced disease and frequently sent for palliative care. However, today the paradigm has shifted completely. Depending on where they originate from, aggressive surgical resection and sometimes coupled with chemotherapy will lead to significant improvement and long term survival in this patient population. We at the John Wayne Cancer Institute have traditionally had a very aggressive approach to metastatic disease and offer both Laparoscopic and Standard Open Surgery depending on size, location and number of metastases. (metastasis= single, metastases= multiple)
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