Adult primary liver cancer is a type of tumor that originates in liver cells during adulthood. It is also known as hepatocellular carcinoma. This form of liver cancer differs from cancers that spread to the liver from other parts of the body. Symptoms may include a firm lump under the right rib cage due to liver swelling, discomfort in the upper right abdomen, pain near the right shoulder blade, or jaundice (yellowing of the skin). Blood tests often reveal elevated levels of alpha-fetoprotein (AFP) and alkaline phosphatase, and sometimes the only indication of the tumor is a sudden decline in liver function.While surgery can potentially cure hepatocellular carcinoma, it is a viable option only for a small percentage of patients with localized disease. Imaging tests can identify metastatic disease, tumors in both liver lobes, or insufficient liver tissue, potentially eliminating the need for exploratory surgery. Liver transplantation offers another potential cure but is suitable for only about 5% of patients with a hepatoma.Non-surgical treatments are best pursued within clinical trials, which assess the effectiveness of various approaches such as systemic or infusional chemotherapy, artery ligation or embolization, ethanol injections, cryoablation (freezing the tumor), and radiolabeled antibodies, often combined with surgical resection. The prognosis depends on the amount of liver replaced by the tumor and how much liver function is compromised.Hepatocellular carcinoma is the most prevalent cancer in certain regions globally and, although still relatively rare in the United States, its incidence is increasing, mainly due to the spread of hepatitis B and C. Individuals with liver conditions such as cirrhosis or the iron-storage disease hemochromatosis also face a higher risk of developing hepatoma. Worldwide, hepatitis B and C are the leading causes of hepatocellular carcinoma. Those with both hepatitis B and C who consume more than 80 grams of alcohol daily are at even greater risk. A family history of hepatocellular carcinoma further increases the risk.Cirrhosis is linked to hepatocellular carcinoma in 50% to 80% of cases, and 5% of individuals with cirrhosis eventually develop this type of cancer. In some parts of the world, aflatoxin, a toxic mold byproduct found in high levels in food, is implicated in causing primary liver cancer. Additionally, workers exposed to vinyl chloride before safety regulations were implemented often developed liver sarcomas, particularly angiosarcomas, which are distinct from hepatomas.
