Liver and Biliary Tract Tumors
What is it?
Tumors of the liver and biliary tract are carcinomas that develop primitively in the liver and group into hepatocarcinoma and cholangiocarcinoma.
Hepatocarcinoma or hepatocellular carcinoma arises from hepatocytes. Hepatocarcinoma is the most frequent primary malignant neoplasm of the liver.
Cholangiocarcinoma, unlike the other, originates from the bile ducts, also called cholangiocytes, and can develop:
- within the liver (intrahepatic cholangiocarcinoma);
- at the perilaryngeal level;
- outside the organ (extrahepatic cholangiocarcinoma);
- at the level of the gallbladder.
Causes and risk factors
The main causes of hepatocellular carcinoma are hepatitis B or C and cirrhosis of the liver; the occurrence on healthy liver is much rarer. The proportion of hepatocarcinomas related to hepatic steatosis (NASH) has been increasing in recent years.
Less is known about the causes correlated with the development of cholangiocarcinoma. There are certain diseases or predisposing factors, such as:
- Cairoli's syndrome;
- presence of intrahepatic gallstones;
- exposure to certain chemicals and toxins;
- parasitic infections (parasitoses) of the liver that are quite rare in the Western World, but present in countries such as Thailand, Taiwan, China, Eastern Russia, Korea, and Vietnam.
Which are the symptoms?
Symptoms identifying the presence of a primary oncologic disease generally develop when they reach certain sizes and are often common to other diseases both benign and malignant. The most common symptoms are:
- weight loss;
- cachexia;
- dyspepsia;
- pain in the upper abdomen radiating sometimes to the shoulder;
- jaundice;
- dark urine;
- diarrhea
- hyperpyrexia.
How is it diagnosed?
The diagnostic-therapeutic procedure for liver tumors is individualized and is defined by a multidisciplinary team (liver surgeon, oncologist, medical hepatologist, interventional radiologist, anatomical pathologist, radiation oncologist, and nuclear physician) during a specific weekly meeting.
Depending on the decision of the multidisciplinary team, the patient may undergo various imaging techniques (abdominal ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography, liver angiography and/or cholangiography, or endoscopy). It may also be indicated to proceed with a liver biopsy and laparoscopy aimed at analyzing the suspected tissue and providing a definitive diagnosis.
Suggested exams
How is it treated?
Regarding hepatocarcinoma, available treatments differ according to:
- liver function;
- general clinical conditions;
- extent of neoplasm.
Particular importance regarding this condition is being given in recent years by an often combined approach of sequential treatments allowing for choosing a therapeutic approach tailored to the characteristics of each patient after collegial evaluation.
Cholangiocarcinoma is a neoplasm of complex management both because of the high risk of morbidity associated with therapeutic procedures and because of the multiplicity of diagnostic and therapeutic strategies that are constantly changing. Treatments are defined in relation to the stage of disease and are applied by different specialists within a multidisciplinary team.
Central role in this pathology is given to surgery, which is the main curative approach. Regarding systemic treatments, recent years have seen a revolution related to a precision medicine approach thanks to the extensive assessment of tumor DNA.
Where do we treat it?
Are you interested in receiving the treatment?