About 42,030 cases in the United States in 2019, but worldwide this may be the most common tumor; 31,780 deaths in 2019 in the United States. Male:female = 4:1; tumor usually develops in cirrhotic liver in persons in fifth or sixth decade. High incidence (and increasing) in Asia and Africa is related to etiologic relationship between this cancer and hepatitis B and C infections. Effective vaccines for hepatitis B prevention and successful chemotherapy of hepatitis C should reduce the incidence. Aflatoxin exposure contributes to etiology and leaves a molecular signature, a mutation in codon 249 of the gene for p53. Mutations in TERT (telomerase reverse transcriptase) promoter and CTNNB1 (beta-catenin gene) are common.
A pt with known liver disease develops an abnormality on ultrasound or rising α fetoprotein (AFP) or des-gamma-carboxy prothrombin (DCP) due to absence of vitamin K; abnormal liver function tests; cachexia, abdominal pain, fever.
Jaundice, asthenia, itching, tremors, disorientation, hepatomegaly, splenomegaly, ascites, peripheral edema.
| TREATMENT | ||
Hepatocellular CarcinomaSurgical resection or liver transplantation is therapeutic option but rarely successful. Radiofrequency ablation, transcatheter arterial embolization (TACE), and 90 Yttrium can cause regression of small tumors. Sorafenib or lenvatinib may produce partial responses lasting a few months. |
Screening populations at risk has given conflicting results. Hepatitis B vaccine prevents the disease. Interferon α (IFN-α) may prevent liver cancer in persons with chronic active hepatitis C disease and possibly in those with hepatitis B. Combination therapy with a viral protease inhibitor (e.g., ledipasvir) and a viral polymerase inhibitor (e.g., sofosbuvir) for 12-24 weeks cures most pts with chronic hepatitis C.