Digestive System Surgery: Liver Cancer (Hepatocellular Tumor)

• Hepatocellular Tumor takes the 95% proportion of Primary Liver Cancer
• If it grows rapidly, severe abdominal pain due to bleeding.
• Targeted to chronic hepatitis or cirrhosis of liver
• Evaluation of liver function affects to treatment method

Hepatocellular Tumor takes the 95% proportion of Primary Liver Cancer.

There are Metastatic Liver Cancer, which Bowel Cancer or Stomach Cancer advanced then transferred to Liver, and Primary Liver Cancer which is developed from Liver itself. They are completely different diseases so that their characteristics and treatment methods are also different. Primary Liver Cancer is then grouped into several groups such as Hepatocellular Cancer or Hepatic Duct Cellular Cancer. About 95% of Primary Liver Cancer is Hepatocellular Cancer. Here we will explain about hepatocellular cancer which constitute nearly all primary liver cancer developed from Liver.

Hepatocellular cancer has a unique characteristic for which other cancer does not have. They are;

• Almost all of them are developed from liver with chronic hepatitis or cirrhosis of liver.
• Once cancer is developed, recurrence is repeated.

There are other characteristics like high risk group of cancer development is clear and distinctive so that test objective person is easy to squeeze down. Also, as several treatments are necessary so that liver function is the concerned point regarding the selection of treatment.

If it grows rapidly, severe abdominal pain due to bleeding.

Symptoms are stomach pain and/or jaundice, but they do not appear until disease advances much deeper then it becomes the late stage. On relatively early stage, no symptoms appeared, so that it is necessary to have periodical medical test mentioned as below. Also, Hepatocellular Tumor suddenly develops much bleeding on or inside of abdomen, if it grows rapidly (Liver Cancer Rapture). In this case, sudden acute abdominal pain appears.

Targeted to chronic hepatitis or cirrhosis of liver.

Almost all hepatocellular cancer is developed on chronic hepatitis or cirrhosis of liver. So that person who has high risk of developing hepatocellular cancer is the person in chronic hepatitis or cirrhosis of liver. Whatever the cause is, it is requested to have image test for persons having chronic hepatitis or cirrhosis of liver, in more than few times a year. Image Tests are, abdominal ultrasonography, CT exam and MRI exam are the mains. Each of these tests has merit and demerit, so that it is considered as desirable to combine these test.

In addition to these image test, measurement of AFP, AFP Lectin (L3) Cutoff, RIVKA II are conducted. However, tumor marker does not necessarily give abnormal value all the time, comprehensive diagnosis for image test and tumor marker is needed. With these test, as almost all hepatocellular cancer can be diagnosed unlike other cancers, histopathological work-up, to pick up tissue directly and observe it using microscope which is different from other cancer, will not conducted in general. But when it is unable to diagnose, histopathological work-up may conducted.

Evaluation of liver function affects to treatment method.

When treatment is performed to hepatocellular cancer, not only spreading of the cancer but also liver function is the main issue. Spreading of disease focus is diagnosed by image test, but liver function will be comprehensively diagnosed by the existence of ascites fluid and with or without the symptom of liver encephalopathy

Treatment methods are, surgery, Ablation Coagulation Therapy, transcatheter arterial chemoembolization/ hepatic arterial infusion, Radiation Therapy, molecularly-target drug. Outlines of selection criteria for the treatment are listed as below.

Treatment Method	Expansion of focus	Liver Function
Surgery	Max. diameter less 3 cm plus less 3 pieces, or Diameter 5cm plus one piece	Limited to goodness sample for liver function *Stipulate cut off area by liver function
Ablation Coagulation Therapy	Max. diameter less 3 cm plus less 3 pieces, or Diameter 5cm plus one piece	Possible to Liver Function moderately poor case
Transcatheter Arterial Chemoembolization / Hepatic Arterial Infusion
Radiation Treatment
molecular target drug

1. * It is just a rough selection criteria.
2. * There is the case just combined with these treatment methods.
3. * Liver Transplantation is considered when the size becomes max. diameter is less than 3cm and numbers are less three pieces, or diameter 5cm, one piece only.
4. * In case in terminal condition of the cancer or spreading of focus of disease is minor but liver function is extremely bad, palliative medical treatment is performed.