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What is liver disease?

The liver is an organ located in the upper right quadrant of the abdomen, protected by the rib cage. The liver has a wide range of functions, including production of proteins (e.g., albumin, coagulation factors), cholesterol, bile acid which is necessary for digestion, and metabolism of medications. Liver disease is a broad term that refers to any disturbance of liver function. Liver damage can be a result of multiple factors, which lead to development of liver cirrhosis (scarring of the liver) [Figure 1 and 2]. Three of the most common factors include :

  • Excession alcohol consumption (Alcoholism)
  • Hepatitis B and Hepatitis C (Infection)
  • Fatty liver from long standing obesity (Steatohepatitis)

Once liver cirrhosis has developed, parenchymal damage to the liver is irreversible. Liver cirrhosis significantly increases the likelihood of harboring liver cancer. People with progressive liver cirrhosis will also end up with liver failure if the cause of liver damage is not adequately managed. Symptoms of advanced liver disease include :

  • Fatique (tiredness)
  • Accumulation of fluid in the abdomen (ascites)
  • Jaundice (a yellow discoloration of the skin)
  • Gastrointestinal bleeding (vomiting blood or having bloody bowel movements)
  • Visible enlargement of veins in the abdominal wall

Treatment depends on the type of liver disease presented. With many types (benign or malignant) and severity of liver diseases, some can be treated with medications or outpatient procedures, while others may require surgery or liver transplantation. Consultation with a liver surgeon who works in a multidisciplinary fashion with medical oncologist, radiation oncologist, interventional radiologist, and hepatologist is key to determine the best treatment options for any liver tumors/masses. Minimally invasive operative techniques (Robotic/Laparoscopic) yield the best outcomes with faster recovery when performed by an experienced liver surgeon.

Hepantic Adenoma

Hepatic adenoma also known as hepatocellular adenoma is a common benign liver mass, which occurs mostly in women of childbearing age. Hepatic adenoma is strongly associated with the use of oral contraceptive pills and other estrogens. Nearly 20-25% of cases present with right upper quadrant discomfort ± right shoulder pain and up to 30% of patients experience bleeding from the adenoma. Hepatic adenoma can be single or multiple and the size can range from 1-20 cm in diameter. Once the mass reaches 4-5 cm in diameter, the risk of malignant transformation into hepatocellular carcinoma increases. Surgical resection (preferably via minimally invasive approach) is therefore recommended for hepatic adenoma > 4-5 cm.

Liver Cyst

Liver cyst occurs in about 5% of the general population, however only about 5-10% of people with liver cyst develop symptoms. Liver cyst can be single or multiple. The typical symptoms are right upper abdominal fullness, discomfort, pain, and early satiety. Most liver cyst contains clear fluid, however some patients bleed into the cyst, which causes sudden right upper quadrant pain and right shoulder discomfort. The bleeding is usually self limiting and the pain improves over several days. Treatment of symptomatic liver cyst is to remove a large portion of the cyst wall, which can be done laparoscopically via a small incision in the umbilicus (belly button). Most patients can be discharged on the same day. A small number of patients require an overnight stay, mostly related to their existing preoperative medical issues. Postoperative recovery is about one week. Simply aspirating the fluid from the cyst using a small needle or catheter is not effective because the cyst fills up again within a few days.

Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma (also called primary liver cancer) accounts for most liver cancers, more spesifically in patients with liver cirrhosis from any causes. This type of cancer occurs more often in men than women between 50 and 60 years old. Treatment options for hepatocellular carcinoma depending of tumor location, size, proximity to major vascular/biliary structures, and future liver remnant are liver resection, liver ablation, transarterial injection of chemoembolization or radioactive agents, and liver transplantation.

Intrahepatic Cholangiocarcinoma

Intrahepatic cholangiocarcinoma is a type of aggressive liver cancer that is originating from bile duct branches inside the liver. The first line of treatment for this type of cancer is liver resection to remove a part of liver that harbors the malignancy, without leaving any tumor behind. If the tumor or the patient is deemed unsuitable for liver resection, other treatment options include liver ablation and transarterial injection of chemoembolization or radioactive agents.

Metastatic Cancer To The Liver

Liver is the most common location for tumor spread (metastasis) from other organs. Common cancers that metastasize to the liver are colon & rectal cancer, pancreatic neuroendocrine tumor, soft tissue sarcoma, breast cancer, stomach cancer, esophageal cancer, melanoma, ovarian cancer and uterine cancer. Approximately 50% of patients with colon & rectal cancer develop liver metastasis in their lifetime. Liver metastasis can be discovered at the same time (synchronous) or at a later time (metachronous) of the colon & rectal cancer diagnosis. Even though cancer has spread to the liver, the condition is often still curable with liver resection and or liver ablation, in addition to systemic chemotherapy. There is a particular work-up that needs to be followed prior to resecting/ablating part of the liver involved with the cancer. If the tumor or the patient is deemed unsuitable for liver resection, other treatment options include liver ablation and transarterial injection of chemoembolization or radioactive agents.

Other Liver Cancers

There are several less commonly seen liver cancers such as primary liver carcinosarcoma, angiosarcoma, fibrosarcoma, leiomyosarcoma, teratoma, and fibrolamellar carcinoma. Treatment options for these types of liver cancer depend of tumor location, size, proximity to major vascular/biliary structures and future liver remnant are liver resection, liver ablation, transarterial injection of chemoembolization or radioactive agents, and liver transplantation.

For questions and evaluation for any liver mass (malignant or benign), please schedule an appointment with The Southeastern Center for Digestive Disorders & Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery contact us today. Our expert team of surgeons service patients throughout Tampa and the state of Florida.

Figure 1. Normal Liver

Figure 2. Cirrhotic Liver

Figure 3. Hepatic Adenoma

Figure 4. Hepatic Adenoma with Bleeding

Figure 5 & 6. Liver Cyst

Figure 7. Hepatocellular Carcinoma

Figure 8. Hepatocellular carcinoma >10 cm

Figure 9. Intrahepatic Cholangiocarcinoma

Figure 10. Metastatic cancer (Pancreatic Neuroendocrine Tumor) To The Liver

Figure 11. Metastatic Colon Cancer To The Liver

Figure 12. Liver Sarcoma

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