It is a malignant tumor developed at the expense either of liver cells (hepatocellular carcinoma) or bile duct cells (cholangiocarcinoma) or blood vessels (angiosarcoma).

The primary liver cancer was rare in Europe and America, but its frequency is increasing rapidly (5000 cases per year in France) because of the hepatitis C epidemic and is more common in Africa and Asia.

- Hepatocellular carcinoma, or hepatocellular carcinoma (HCC) is the most common liver tumors, and it occurs in 20% of a healthy liver, liver more frequently diagnosed with a pre-existing liver disease (cirrhosis, chronic hepatitis) . Unlike Europe, where alcoholic cirrhosis is the main cause of this type of tumor, in the countries of Africa and Asia, HCC is often linked to hepatitis B and C, sometimes to the pollution of food, including aflatoxin.

- Cholangiocarcinoma, much rarer, is especially common in Southeast Asia, where it criminalizes the role of certain parasites.

- The angiosarcoma, the rarest of all primary tumors of the liver, is sometimes linked to chronic poisoning (vinyl chloride, arsenic).

SYMPTOMS AND SIGNS

Hepatocellular carcinoma results in a large liver detectable by palpation and by a pseudo-infectious fever. It causes mild pain, localized in the upper abdomen, which is often the first symptom of the disease. It may also result in the aggravation of cirrhosis is already known and more often discovered during routine surveillance of this disease.

DIAGNOSIS AND EVOLUTION

The diagnosis is based on ultrasound, CT scan and ultrasound-guided liver biopsy.

The detection of alpha-feto-protein in the blood diagnosis says: this protein, absent from the serum of healthy adults or patients with other liver diseases, is present in two out of three patients with HCC

The risk of metastases, mainly lung and bone, is important.

TREATMENT

It involves the surgical removal of the tumor whenever possible, by partial hepatectomy. Exceptionally, a liver transplant can be considered. In ways not covered by surgery, treatment involves general or local chemotherapy (injecting the product directly into the tumor through a catheter into the hepatic artery) or tumor destruction by alcohol (local injection alcohol) or heat (radiofrequency).

PREVENTION AND PROGNOSIS

The prevention of primary tumors of the liver based on the fight against alcoholism in the early vaccination against hepatitis B, treatment of chronic hepatitis B and C and the eviction of infected blood donors. Early diagnosis of hepatocellular carcinoma occurring in a cirrhotic disease should lead to improved prognosis, which is currently severe.

Secondary liver cancer

It is the most common cancer of the liver in temperate countries, it may declare at any other cancer, but it is more common in cancers of the digestive system (colon, stomach, pancreas, bile ducts) and in gynecologic cancers (uterine, breast). A secondary liver cancer is called synchronous when discovered at the same time as the primary cancer, metachronous if diagnosed after treatment of primary cancer.

SYMPTOMS AND SIGNS

The secondary liver cancer can result in impaired general condition or jaundice. Clinical examination may reveal an enlarged liver palpated nodule (“liver brown”), painful or not.

DIAGNOSIS AND TREATMENT

The diagnosis is based on ultrasound, CT scan and biopsy, necessary to confirm the liver.

The treatment is surgical, if possible (removal of the tumor). In the diffuse forms, we use the local or systemic chemotherapy (injection of a catheter into the hepatic artery).

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