American Medical Association Family Medical Guide - American Medical Association [521]
Diagnosis
If your doctor thinks that you may have liver cancer, he or she will perform a physical examination and feel your abdomen for lumps in the liver or nearby organs or changes in the shape or size of organs. He or she also will feel your abdomen for an abnormal buildup of fluid and will examine your skin and eyes to look for jaundice. You may have blood tests to detect any problems and to evaluate liver function.
Your doctor may examine your liver using an imaging procedure such as a CT scan (see page 112), ultrasound (see page 111), MRI (see page 113), or angiogram (see page 110). In some cases, doctors remove a sample of tissue from the liver for examination under a microscope to look for cancer cells (biopsy). Depending on the size of the sample required for examination, a liver biopsy can be done using a small needle (aspiration biopsy), a thicker needle (core biopsy), or a laparoscope (a viewing tube that is inserted into a small incision in the abdomen). In rare cases, a biopsy is done through a large incision in the abdomen.
Treatment
Treatment of liver cancer usually depends on the condition of the liver, the number of tumors and their size and location, and whether the cancer has spread outside the liver. A doctor also considers the person’s age and general health. Doctors usually recommend surgery to remove tumors that originate in the liver or a single tumor that has spread to the liver from elsewhere. (Liver transplants are recommended only for tumors that originate in the liver, not for metastases.)
If a tumor cannot be removed surgically—usually because a person has a liver disease such as cirrhosis, the tumor is not easily accessible, or a person has other health problems—a number of treatment options may be considered to help control the cancer and extend the person’s life. Treatment options include applying heat to the tumors to destroy them with radiofrequency waves, lasers, or microwaves; injecting ethanol (a type of alcohol) into the liver tumor to kill cancer cells; freezing the cancer cells (cryosurgery) to destroy them; or injecting or infusing anticancer drugs directly into the tumor.
For tumors that are found in both lobes of the liver, that have spread to the liver from the colon and are confined to the liver, or that have spread to other parts of the body, chemotherapy (see page 23) may help slow the growth of the tumors.
Wilson’s Disease
Wilson’s disease is an inherited disorder in which excessive amounts of copper accumulate in the liver or brain. Copper, a mineral present in most foods, is essential to the body in small amounts. In healthy people the unneeded copper is excreted but, in people who have Wilson’s disease, the liver cannot release copper as it normally does, causing copper to accumulate in the liver and damage liver tissue. Over time, the damage to the liver causes it to release the copper directly into the bloodstream, which carries the mineral throughout the body. The excess copper can eventually damage the kidneys, brain, and eyes. If not treated, Wilson’s disease can cause severe brain damage, liver failure, and death. Although a person is born with the disorder and copper begins to accumulate immediately after birth, the symptoms usually don’t appear until late adolescence.
Because the gene for the disorder is recessive, to be affected, a person needs to inherit a copy of the defective gene from both parents. If you or your partner has a family member with Wilson’s disease, you may want to talk to a genetic counselor (see page 952) about being tested before you have children to see if you are at risk of passing the disease to your children. The test would look for the precise genetic mutation that runs in your family. There is no test yet available