What is a hepatocellular carcinoma (HCC)?
Hepatocellular carcinoma (HCC) is a cancer of the liver. It usually arises in patients with pre-existing liver disease.
How may it present?
It may present in a number of ways including:
- finding of a lump in the abdomen,
- as an incidental finding on scans of the liver
- worsening liver function
- during surveillance scans in patients with liver disease
Caption: The yellow spots within the liver are liver cancer deposits. Source: Yale Rosen by CC BY-SA licence.
How is it diagnosed?
The diagnosis of this usually relies on the use of CT or MRI scans and blood tests. Contrast (dye) is injected into a vein in the arm during these scans. This dye is brought by the blood stream into the liver and creates a characteristic appearance on the scan (the tumour “lights up” rapidly followed by rapid “dimming” with contrast). This characteristic appearance is due to the abundant blood supply of this type of tumour and is in itself adequate for its diagnosis. This may be supported by the finding of a raised blood test tumour marker, alpha feto protein (AFP). Generally, biopsy of the lesion is not necessary for diagnosis for the fear of causing cancer spread during this procedure.
How do we treat it?
The “management” (treatment) of liver cancer depends on many factors, including the:
- patient’s liver function;
- the tumour size;
- the tumour location (especially in relation to major blood vessels of the liver);
- the number of tumours; and finally,
- whether the tumour can potentially be surgically removed or not.
In general, liver transplantation is limited to those who have small tumours and poor liver function. Surgical removal of the tumour (Liver resection) is possible for those with larger tumours, but is limited by tumour number and location, as well as the patient’s liver function. Other treatments may include burning of the tumour (radiofrequency or microwave ablation), disruption of its blood supply (TACE) and chemotherapy. In advanced cases, the aim of treatment is directed at symptoms rather than tumour control.
Due to the above complexities and the many different treatments modalities available, liver cancer is best managed by a Multi-Disciplinary Team approach. CESA surgeons are associated with different multidisciplinary teams and can draw on such expertise as required.
Colorectal Liver Metastases
What are colorectal liver metastases?
Colorectal liver metastases are spread of colon cancer (“bowel cancer") to the liver. The liver is the most common area of spread of bowel cancer. Usually, such spread is found out on initial scans after the diagnosis of colon cancer. Sometimes it may be found on follow-up months or years after the initial diagnosis of colon cancer. It may also be found as a “lesion” in the liver which on further investigation is found to be spread from colon cancer (see liver lesion)
The diagnosis of this usually relies on the use of CT or MRI scans and blood tests. Contrast (dye) is injected into a vein in the arm during these scans. Because of the differences in the amount of blood vessels between the tumour and the surrounding liver, the tumour becomes more obvious with such dye.
How do we treat it?
The treatment of colorectal liver metastases should not be considered alone. It should be considered as part of the treatment of the colon cancer. Therefore, careful coordination between the colorectal surgeon, the liver surgeon as well as the medical oncologist is required. The order of bowel surgery, liver surgery and chemotherapy is different depending on circumstances. Sometimes, liver surgery is not possible in which case chemotherapy may be required.
Therefore, management of colorectal liver metastases should be in the context of a Multidisciplinary Team environment. The surgeons at CESA are associated with multidisciplinary teams and are well placed to help in the management of colorectal cancer and liver metastases.