Hepatomas are a type of tumor that originates in the liver. These growths represent a significant health concern globally due to their aggressive nature and the complex challenges they present in diagnosis and management.
What Are Hepatomas
Hepatomas are malignant tumors that begin in the liver cells. Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, is a type of hepatoma. Unlike cancers that spread to the liver from other parts of the body, HCC originates directly within the liver’s primary cells, known as hepatocytes.
HCC is a highly prevalent cancer, accounting for over 80% of primary liver cancer cases worldwide. It is considered the sixth most common cancer globally and the third leading cause of cancer-related deaths. These tumors can significantly impair the liver’s ability to perform its many functions, such as filtering toxins, producing proteins, and aiding digestion.
Factors Contributing to Hepatoma Development
Several underlying conditions and external factors significantly increase the likelihood of developing hepatomas. Chronic viral hepatitis, specifically infections with Hepatitis B virus (HBV) and Hepatitis C virus (HCV), represents a major cause, contributing to over 70% of HCC cases. These viruses cause ongoing inflammation and damage to liver cells, which can progress to cirrhosis over time.
Cirrhosis, a severe scarring of the liver tissue, is a primary risk factor for HCC regardless of its cause. Conditions like alcohol-related liver disease and non-alcoholic fatty liver disease (NAFLD), which can advance to non-alcoholic steatohepatitis (NASH) and then cirrhosis, also contribute. Hemochromatosis, a genetic disorder causing excessive iron buildup in the liver, similarly leads to liver damage and increased risk.
Exposure to certain environmental toxins, such as aflatoxins produced by specific fungi, can also increase the risk of hepatomas. These toxins can contaminate food crops and are particularly prevalent in some regions. Metabolic syndrome, characterized by conditions like obesity, type 2 diabetes, and insulin resistance, drives NAFLD and, subsequently, hepatoma development, especially in Western countries.
Recognizing and Diagnosing Hepatomas
Recognizing hepatomas can be challenging because early symptoms are often subtle and non-specific. Individuals might experience unexplained weight loss, persistent fatigue, or a general feeling of being unwell. As the tumor progresses, more noticeable signs may appear, including abdominal pain or swelling, particularly in the upper right quadrant, and jaundice, which is a yellowing of the skin and eyes.
The diagnostic process typically begins with blood tests, such as checking levels of alpha-fetoprotein (AFP), a protein that can be elevated in many HCC patients. Imaging techniques play a central role, with ultrasound used as an initial screening tool, followed by more detailed assessments with computed tomography (CT) scans or magnetic resonance imaging (MRI). These scans help visualize the liver and identify suspicious masses. A definitive diagnosis requires a liver biopsy, examining a tissue sample under a microscope to confirm cancer cells.
Approaches to Treating Hepatomas
Treatment for hepatomas is highly individualized, depending on the cancer’s stage, the patient’s overall liver function, and their general health. For early-stage tumors and patients with good liver function, surgical options offer a chance for cure. Surgical resection involves removing the tumor along with a margin of healthy liver tissue. A liver transplant may be considered for select patients, especially those with smaller tumors and underlying cirrhosis.
Locoregional therapies deliver treatment directly to the tumor while minimizing impact on healthy liver tissue. Tumor ablation techniques, such as radiofrequency ablation (RFA) or microwave ablation, use heat to destroy cancer cells. Transarterial chemoembolization (TACE) involves injecting chemotherapy drugs directly into the artery supplying the tumor, followed by a blocking agent to cut off blood flow. Radioembolization (TARE) uses radioactive microspheres delivered through the same arterial route to irradiate the tumor internally.
For more advanced cases or when locoregional therapies are not suitable, systemic therapies are employed. Targeted therapies focus on specific molecular pathways involved in cancer growth, while immunotherapies harness the body’s own immune system to fight the cancer cells. Chemotherapy, though less commonly used as a primary treatment for HCC compared to other cancers, may still be part of a comprehensive plan. Supportive care is also provided to manage symptoms and improve the patient’s quality of life.