Liver Tumors

What are Liver Tumors?

Liver tumors are abnormal growths that develop from the tissues of the liver. The liver is an important organ of the body that helps with digestion and detoxification.

Are liver tumors condition a medical emergency?

Some liver tumors may lead to medical emergencies. Early detection and management of cancerous liver tumors are important in the prevention of complications and death.

Types

Liver tumors may be of the following types:

• Benign (noncancerous) Liver Tumors:
  • Hepatic hemangioma
  • Hepatic adenoma
  • Focal nodular hyperplasia
  • Hepatic hamartoma
  • Nodular regenerative hyperplasia
• Malignant (cancerous) Liver Tumors:
  • Hepatocellular carcinoma
  • Hepatoblastoma
  • Cholangiocarcinoma
  • cholangiocellular cystadenocarcinoma
  • Hepatic leiomyosarcoma
  • Hepatic rhabdomyosarcoma
  • Metastatic liver cancer: Spread from tumors of adjacent or distant organs

Causes 

Some causes of liver tumors are as follows:

• Benign tumors:
  • Estrogen therapy
  • Corticosteroid therapy
  • Genetic predisposition
• Malignant tumors:
  • Cirrhosis of the liver
  • Hepatitis B and C viral infections
  • Exposure to aflatoxins 

Risk factors

Some risk factors associated with the development of liver tumors include:

• Obesity
• Diabetes
• Smoking
• Excessive alcohol consumption
• Hemochromatosis
• Androgenic steroids
• Primary sclerosing cholangitis
• Alpha 1 antitrypsin deficiency
• Thorotrast radioactive contrast
• Parasitic liver fluke infections

Symptoms & signs

Hepatocellular carcinoma may be asymptomatic and may only be found during investigations for other conditions or they may present with the following symptoms and signs:

• Abdominal pain [mostly right-sided]
• Weight loss
• Nausea
• Vomiting
• Large mass on the upper right side of the abdomen
• Fever
• Yellowing of the skin and eyes
• Persistent itching

Advanced stages of the disease may present with:

• Low blood pressure
• Fast heart rate
• Shock
• Ascites [increased abdominal girth and filling up of the abdomen with fluid]
• Neurological dysfunction [hepatic encephalopathy]

Investigations

Some investigations that may be done for fatty liver tumors include:

• Laboratory tests:
  • CBP and ESR
  • Coagulation profile and blood typing
  • Liver and renal function tests
  • Complete metabolic panel
  • Viral serology
  • Complete urine examination with urine bilirubin levels
  • Serum transferrin levels
  • Serum alpha 1 antitrypsin levels
  • Alpha fetal protein levels
• Imaging tests:
  • Abdominal Ultrasound
  • Triple phase CT scan
  • MRI
  • Procedures:
  • Liver biopsy

Diagnosis

A diagnosis is established based on medical history, clinical evaluation, and the results of the investigations done.

Course & Stages

Several systems are used for the staging of cancerous liver tumors, some of which are useful for the planning of treatment. Staging is done based on the size of the tumor, the morphology of the tumor, levels of bilirubin, levels of alpha fetal protein, portal venous pressure and thrombosis, etc.

Treatment options

The treatment of fatty liver tumors depends on the type and stage of the tumor. Asymptomatic noncancerous tumors are managed with careful monitoring, and surgical intervention may be done if they turn symptomatic. Cancerous liver tumors are treated with medical and surgical interventions and radiotherapy. Some individuals may require liver transplantation.

Medical management

Medical management of cancerous liver tumors may include:

• Chemotherapy: With agents such as doxorubicin, 5-Fluorouracil, and cisplatin; it is done either as a palliative treatment or is reserved for those in whom surgical intervention cannot be done.
• Immunomodulators

Interventional including surgery and indications for surgery

Interventional management of liver tumors may include the following:

• Transcatheter Arterial Chemoembolization [TACE]
• Resection of the tumor
• Liver Transplantation

Radiation

Radiotherapy in the form of brachytherapy, which is a low dose local application of radiation over 10 to 12 days, may be done.

Role of Diet/ Exercise/ Lifestyle changes/ Preventive measures

Some measures that may be taken to reduce the risk of Liver Tumors may include:

• Eating a healthy diet and maintaining an ideal body weight
• Avoiding smoking
• Avoiding consumption of alcohol in moderation
• Keeping diabetes under control
• Getting vaccinated for Hepatitis B
• Cessation of estrogen therapy or androgenic steroids

Complications

Some complications of Liver Tumors include:

• Liver failure
• Neurological dysfunction
• Severe malnutrition
• Severe bleeding
• Metastasis to distant organs such as the lungs

Prognosis

The prognosis of liver tumors depends on the type and the stage of the tumor. Noncancerous tumors have a good prognosis and may need to be treated only when they are symptomatic. Cancerous liver tumors have a poor prognosis and a high rate of recurrence even after treatment.

When to contact the doctor or hospital? / How to identify the emergency or complications?

It is advisable to seek medical attention if the signs and symptoms of liver tumors are noticed.

Indications for hospitalization if required

Hospitalization may be required for the surgical management of liver tumors.

Screening methods

Screening via imaging should be done in individuals who have received liver transplantation to check for recurrence of the disease.

Suggested clinical specialist/ Departments to consult for this condition

Liver Tumors will be treated by specialists from the Department of Hepatology, Gastroenterology and Surgical Gastroenterology.