Hepatocellular Carcinoma and Diseases

DoctorPatient_Sept18Hepatocellular carcinoma treatment involves a combination of surgery and chemotherapy. One of the most common cancers worldwide is liver cancer. Also known as, hepatocellular cancer, this malignancy has been increasing in many populations especially in Asians and Africans. Liver cancer usually starts off as a mass known as an adenoma. Hepatocellular adenoma is not considered cancerous unless it grows to a size of more than 6-8 cm. Hepatocellular adenoma is very rare in North America. One risk factor for development of an adenoma includes the use of birth control pills. Only about one in 1, 000,000 women develop a hepatic adenoma after taking the birth control pill. In most cases, the hepatocellular adenoma disappears spontaneously once the female stops taking the pill.

Other individuals who are at risk for hepatic cancer (adenomas) include diabetics and those who have a very rare disorder known as hemachromatosis. Males who abuse anabolic steroids can also develop hepatic adenomas that can turn cancerous rapidly. In all the above cases, hepatic adenomas usually occur after 5-7 years. Females should avoid pregnancy if they have been found to have a hepatic adenoma. The exact cause of hepatocellular diseases is not understood but it is felt that these cancers may be linked to excess hormonal activity.

In all cases of adenoma, the biggest risk is not cancer but bleeding. As the adenomas grow large, they do have a tendency to bleed and sometimes they will rupture, resulting in massive loss of blood. The rare patient with a hepatic adenoma will also develop pain just below the right rib cage, vague discomfort, itching or yellowing discoloration of the skin. In women, the hepatic adenomas often present with sudden bleeding during pregnancy and often the results are catastrophic for both the mother and fetus. Women who have a history of adenomas should avoid the birth control pill. Any time an athlete is found to have a hepatic adenoma; the anabolic steroid should be immediately discontinued. In some unfortunate individuals, the risk of cancer continues even though the pills have been stopped.

Some specific liver tests can help make a diagnosis of a hepatocellular cancer. The size and features of the hepatic adenoma is usually assessed with either a CT scan or an MRI.

In most cases, the small hepatic adenomas are observed as they do spontaneously disappear. Adenomas larger than 6-8 cms are removed surgically as they can bleed. The risk of cancer increases with size of the adenoma. In an individual who has a small hepatic adenoma, annual ultrasound and assessment of blood work is mandatory. Most hepatic adenomas can be safely removed with surgery. If the adenoma has transformed itself into a hepatocellular malignancy, then the prognosis is very different. The patient must be thoroughly worked up and staged prior to any surgery. Unfortunately the majority of patients with have malignant liver cancers are not candidates for surgery. in most people, by the time the diagnosis of hepatocellular disease is made, the cancer has spread beyond the liver. Besides surgery, other hepatocellular carcinoma treatment includes delivering drugs directly to the cancer (chemoembolization) and localized radiation (brachytherapy).

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