Hepatic Neoplasms

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | Referral

Definition

Hepatic neoplasms refer to tumours originating in or metastasising to the liver. These may be benign (e.g., haemangiomas, adenomas) or malignant (e.g., hepatocellular carcinoma, metastatic liver cancer).

Aetiology

  • Primary hepatic neoplasms:
    • Hepatocellular carcinoma (HCC): most common primary liver cancer.
    • Cholangiocarcinoma: cancer of the bile ducts.
    • Hepatic adenoma: benign tumour often linked to oestrogen use.
    • Haemangioma: the most common benign liver tumour.
  • Secondary (metastatic) liver tumours:
    • Commonly from colorectal, breast, lung, or pancreatic cancers.

Pathophysiology

The mechanisms vary depending on the tumour type:

  • Hepatocellular carcinoma (HCC): chronic inflammation and fibrosis (e.g., from hepatitis B/C or cirrhosis) lead to dysplasia and eventual malignant transformation.
  • Metastatic liver tumours: spread occurs via haematogenous dissemination, typically through the portal vein.

Risk factors

  • Chronic hepatitis B or C infection.
  • Liver cirrhosis (e.g., from alcohol misuse or non-alcoholic fatty liver disease).
  • Exposure to aflatoxins (common in developing countries).
  • Metabolic conditions (e.g., haemochromatosis, alpha-1 antitrypsin deficiency).
  • Use of oral contraceptives (associated with hepatic adenomas).
  • Family history of liver cancer or related genetic conditions.

Signs and symptoms

Symptoms:

  • Right upper quadrant pain or discomfort.
  • Fatigue and malaise.
  • Unexplained weight loss and anorexia.
  • Jaundice (in advanced cases).
  • Abdominal distension (due to ascites).

Signs:

  • Palpable liver mass or hepatomegaly.
  • Jaundice and scleral icterus.
  • Signs of chronic liver disease (e.g., spider naevi, palmar erythema).
  • Ascites (fluid accumulation in the peritoneal cavity).

Investigations

  • Blood tests:
    • Alpha-fetoprotein (AFP): elevated in HCC.
    • Liver function tests (LFTs): may show raised bilirubin, ALP, and GGT.
    • Clotting profile: prolonged in advanced liver disease.
  • Imaging:
    • Ultrasound: first-line for detecting liver masses.
    • CT or MRI: for detailed characterisation and staging of lesions.
  • Biopsy: only if imaging and clinical findings are inconclusive.

Management

1. Curative Options (if applicable):

  • Surgical resection: indicated for resectable primary or solitary secondary tumours in patients with good liver function.
  • Liver transplantation: for selected patients with small, unresectable HCC (e.g., meeting Milan criteria).

2. Localised Treatments (as per specialist):

  • Ablative therapies: radiofrequency ablation (RFA) or microwave ablation (MWA) for small tumours.
  • Transarterial therapies: transarterial chemoembolisation (TACE) or radioembolisation (TARE) for intermediate-stage HCC.

3. Systemic Therapy (as per specialist input):

  • Targeted therapy: Sorafenib or lenvatinib for advanced HCC.
  • Immunotherapy: Checkpoint inhibitors (e.g., atezolizumab) for selected cases.
  • Chemotherapy: For metastatic liver tumours (e.g., colorectal metastases).

4. Palliative Care:

  • Symptom control (e.g., pain management, relief of ascites).
  • Management of complications (e.g., jaundice, encephalopathy).

Referral

  • Urgent referral: if liver masses are detected on imaging or AFP is elevated.
  • Specialist hepatology team: for further evaluation and management planning.
  • Oncology referral: for systemic or palliative therapies.
GastroenterologymypanotesHepatic Neoplasms