There are a variety of tumors, benign and malignant, that may be detected in the liver. These can be asymptomatic or cause symptoms such as right upper quadrant abdominal pain or jaundice. They are usually detected with diagnostic imaging such as an ultrasound or CT scan. Once identified, successful management requires diagnosis which can be accomplished with a variety of imaging techniques as well as a biopsy. Benign tumors such as simple cysts, hemangiomas, hamartomas, and focal nodular hyperplasia can be managed without surgery unless they cause symptoms such as pain. Hepatic adenomas often need to be removed because of the risk of rupture, bleeding and malignancy.
Malignant tumors may be “primary” hepatocellular cancer, starting in the liver, or result from spread from cancers starting in other organs (and are called “metastatic” or “secondary”). In most instances patients with metastatic liver cancer have had cancers previously diagnosed in other parts of their body such as the colon or lung. Primary liver cancer is rare in the United States although it is the most common cause of cancer in the world. Patients with known cirrhosis from hepatitis are at increased risk for developing this tumor.
The treatment of liver tumors depends on an accurate diagnosis and thorough assessment of both the patient’s overall medical condition and the appropriate treatment options available to them. Surgical resection, long considered the “gold standard” of treating liver tumors, is usually first considered. To be a candidate for liver surgery the patient must be in good overall medical condition and have a tumor that can be completely removed without exposing the patient to excessive risk of complications such as hemorrhage or liver failure after surgery.
Patients with healthy livers may undergo removal of as much as 75-80% of their liver which will then grow back (“regenerate”) within a few months after surgery. Patients with cirrhosis or liver damage from chemotherapy may not tolerate removal of large portions of their liver as is commonly done with major liver resections. Such patients may be better served by one or more of the following modalities. Cryotherapy is a procedure in which a tumor is supercooled with liquid nitrogen and then left in place in the liver where it dissolves and is absorbed by the surrounding tissues. Chemoembolization is a procedure performed by an interventional radiologist in which chemotherapeutic particles are injected into the blood vessels supplying the tumor to destroy the tumor. Radiofrequency ablation (“RFA”), performed by a radiologist or surgeon, involves placing a probe into the tumor and then heating it with radiowave energy. Stereotactic radiosurgery (often with a Cyberknife®) involves the precise, non-invasive destruction of the tumor with high dose radiation therapy. Percutaneous alcohol injection, performed by a radiologist, may be rarely used if none of the above options are appropriate. Liver transplantation is an excellent option for carefully selected patients with localized primary hepatocellular cancers that fit certain criteria for size and multiplicity.