Hepatobiliary disease: liver tumours

Summary

Liver tumours may present with clinical symptoms but are increasingly presenting at a pre-clinical stage due to surveillance in patients with cirrhosis. This has led to a significant change in the ‘natural history’ of liver tumours and provides an opportunity to alter prognosis in what has been a uniformly dismal diagnosis.

Definition and classification

Liver tumours may be benign or malignant, primary or secondary. The two ‘common’ primary tumours are hepatocellular carcinoma (HCC) or cholangiocarcinoma. Rarer tumours include haemangiosarcoma and hepatoblastoma. Secondary tumours are the most common cause of liver malignancy and may arise from any organ but most commonly from the stomach, colon, pancreas, breast and ovary. Benign tumours of the liver include haemangiomas, focal nodular hyperplasia and hepatic adenomas.

Incidence

In patients with cirrhosis and chronic viral hepatitis HCC occurs at a rate of 1–4% per year. Incidence is higher in males and those over the age of 40. HCC is a common malignancy in China, South-East Asia and Sub-Saharan Africa. The incidence of HCC is increasing in Europe and the USA due to hepatitis C virus infection. The incidence of cholangiocarcinoma is increasing rapidly in developed countries.

Aetiology

Almost all HCCs arise from a background of cirrhosis. All causes of cirrhosis may cause HCC but viral hepatitis, haemochromatosis and alcohol are the most important aetiologies. Exposure to aflatoxin increases the risk of HCC particularly in populations where hepatitis B virus infection is common. In developed countries the risk factors for cholangiocarcinoma are primary sclerosing cholangitis and inflammatory bowel disease. In tropical countries the tumour is associated with chronic liver fluke infection.