Liver tumors (also known as hepatic tumors) are abnormal growth of liver cells on or in the liver. Several distinct types of tumors can develop in the liver because the liver is made up of various cell types. Liver tumors can be classified as benign (non-cancerous) or malignant (cancerous) growths. They may be discovered on medical imaging (even for a different reason than the cancer itself), and the diagnosis is often confirmed with liver biopsy.

Classification

thumb|Liver tumor types by relative incidence in adults in the United States

Liver tumors can be broadly classified as benign or malignant:

Benign

There are several types of benign liver tumors. They are caused by either abnormal growth of neoplastic cells or in response to liver injury, known as regenerative nodules.

Hemangiomas

Cavernous hemangiomas (also called hepatic hemangioma or liver hemangioma) are the most common type of benign liver tumor, found in of people. These hemangiomas get their blood supply from the hepatic artery and its branches.

Focal nodular hyperplasia

Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver. They are most common in women using contraceptives or hormone replacement therapies containing estrogen, women who are pregnant, or people mis-using steroids. Transformation to hepatocellular carcinoma is more common in men.

Liver Cell Adenomatosis

Liver cell adenomatosis (also called hepatic adenomatosis) is a related but distinct diagnosis from hepatocellular adenoma.

Pseudotumors:

Pseudotumors differ from liver tumors in that they are not a proliferation of abnormal cells but are "local variations" of tissue type.

  • Other forms of primary forms of liver cancer include cholangiocarcinoma, mixed tumors, sarcoma, and hepatoblastoma.

Diagnosis

Upon discovery of a liver tumor, the main issue in the workup is to determine whether the tumor is benign or malignant. Many imaging modalities are used to aid in the diagnosis of malignant liver tumors. These include sonography (ultrasound), computed tomography (CT) and magnetic resonance imaging (MRI).

Tumor markers, chemicals sometimes found in the blood of people with cancer, can be helpful in diagnosing and monitoring the course of liver cancers. High levels of alpha-fetoprotein (AFP) in the blood can be found in many cases of HCC and intrahepatic cholangiocarcinoma. Cholangiocarcinoma can be detected with these commonly used tumor markers: carbohydrate antigen 19-9 (CA 19–9), carcinoembryonic antigen (CEA) and cancer antigen 125 (CA125). These tumour markers are found in primary liver cancers, as well as in other cancers and certain other disorders.

Ultrasound

Ultrasonography of liver tumors involves two stages: detection and characterization. Tumor detection is based on the performance of the method and should include morphometric information (three axes dimensions, volume) and topographic information (number, location specifying liver segment and lobe/lobes). The specification of these data is important for staging liver tumors and prognosis. Tumor characterization is a complex process based on a sum of criteria leading towards tumor nature definition. Often, other diagnostic procedures, especially interventional ones are no longer necessary. Tumor characterization using the ultrasound method will be based on the following elements: consistency (solid, liquid, mixed), echogenicity, structure appearance (homogeneous or heterogeneous), delineation from adjacent liver parenchyma (capsular, imprecise), elasticity, posterior acoustic enhancement effect, the relation with neighboring organs or structures (displacement, invasion), vasculature (presence and characteristics on Doppler ultrasonography and contrast-enhanced ultrasound (CEUS).

Computed tomography

thumb|350px|Selected images from a biphasic CT of Focal Nodular Hyperplasia in the left hepatic lobe (arrow). These masses have characteristic early arterial enhancement (6a) with contrast wash out on the portal venous phase images (6b) from the mass making these lesions difficult to identify on portal venous phase images alone.

When evaluating hepatic masses by abdominal computed tomography (CT), it can be advantageous to have both late arterial and portal venous phase images since some tumors enhance briskly during the arterial phase (hepatocellular carcinoma, hepatic adenoma, follicular nodular hyperplasia (FNH), and hypervascular metastasis), but maybe occult or difficult to characterize on portal venous phase imaging alone. However, it should be stressed that the addition of late arterial phase images is only indicated if one of these tumors is suspected, or if there is a need for further characterization of a hepatic mass, since the large majority of patients will not benefit from the addition of this phase. In addition, if there is a need to definitively characterize a hepatic mass, MRI is generally more sensitive and specific, with no associated radiation dose.

References

  • Liver cancer at Mayo Clinic

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