Liver cancer is a malignant neoplasm originating from hepatocytes or bile ducts. Depending on the histological structure, hepatocellular carcinoma (HCC) is the most common form, accounting for about 75-85% of all primary malignant liver tumors, and cholangiocarcinoma. The disease is characterized by a highly aggressive course with early metastasis to regional lymph nodes and distant organs. The pathogenesis of the disease is associated with chronic inflammation, regenerative hyperplasia and dysregulation of apoptosis mechanisms. Key factors in its development are liver cirrhosis, chronic viral hepatitis B and C, and the accumulation of toxic substances.
History of the disease and interesting historical facts
The first mention of malignant neoplasms of the liver dates back to ancient Egyptian medical papyri dating back to 1600 BC. However, systematic study of the disease began only in the 19th century. In 1844, Rudolf Virchow first described the morphological features of hepatocellular carcinoma. “Understanding the molecular mechanisms of liver cancer development has expanded significantly since the discovery of the role of HBV infection in the 1960s,” notes a study in the Journal of Hepatology, 2019. Interestingly, the greatest progress in treatment has been achieved over the past 20 years due to the development of targeted therapy.
Epidemiology
According to the International Agency for Research on Cancer (IARC) in 2020, liver cancer is the sixth most common cancer and the fourth most common cause of death. Global incidence is approximately 906,000 new cases annually. Prevalence varies significantly across regions of the world:
- High incidence rates are observed in Asian and African countries (up to 30 cases per 100,000 population)
- Moderate levels are typical for Europe and North America (5-10 cases per 100,000)
- The incidence ratio between men and women is 2.4:1
Genetic predisposition to this disease
The genetic component plays a significant role in the development of hepatocellular carcinoma. Key mutations affect the following genes:
- TP53 is the most frequently mutated gene (up to 30% cases)
- CTNNB1 (β-catenin gene) - changes are found in 20-40% tumors
- AXIN1 – mutations occur in 10-15% cases
- TERT - promoter mutations are found in almost all patients
“The presence of specific mutations correlates with disease prognosis and response to therapy,” emphasizes the work in Nature Reviews Cancer, 2021.
Risk factors for the development of this disease
The main risk factors include:
- Chronic viral hepatitis B and C
- Liver cirrhosis of various etiologies
- Alcoholic liver disease
- Metabolic syndrome and non-alcoholic fatty liver disease
- Aflatoxins are mycotoxins that contaminate food products.
- Diseases associated with iron and copper metabolism disorders
Diagnosis of this disease
The clinical picture in the early stages is often asymptomatic. The main manifestations include:
- Pain in the right hypochondrium
- Weight loss
- Ascites
- Jaundice
- Hepatic encephalopathy
The diagnostic algorithm includes:
- Lab tests: AFP, liver function tests
- Ultrasound of abdominal organs
- CT/MRI with contrast
- Liver biopsy
Treatment
The therapeutic strategy depends on the stage of the disease:
- Surgical treatment: liver resection, transplantation
- Local methods: radiofrequency ablation, transarterial chemoembolization
- Systemic therapy: targeted drugs, immunotherapy
- Palliative care
List of drugs used to treat this disease
- Sorafenib
- Lenvatinib
- Regorafenib
- Cabozantinib
- Ramucirumab
Disease monitoring
Regular monitoring includes:
- Every 3 months: AFP, ultrasound
- Every 6 months: CT/MRI
- Evaluation of the functional state of the liver
The prognosis remains poor with a 5-year survival rate of 10-20%.
Age-related features of the disease
The disease is most often diagnosed at the age of 55-65 years. In young patients, the course is more aggressive, but surgical treatment is better tolerated. In older patients, the risk of complications during therapy is higher.
Questions and Answers
- What tests should be taken for early diagnosis? Annual alpha-fetoprotein testing and liver ultrasound are recommended for at-risk groups.
- Is it possible to completely cure liver cancer? With early diagnosis and the possibility of surgical treatment, full recovery is possible.
- How does alcohol affect the risk of disease? Long-term alcohol abuse increases the risk of developing hepatocellular carcinoma by 5 times.
Advice from Dr. Oleg Korzhikov
Patients often ask how to prevent the disease from developing. I recommend:
- Have your liver checked regularly if you have risk factors
- Treat viral hepatitis promptly
- Follow a diet that limits fats and simple carbohydrates
- Perform an ultrasound of the liver annually after 40 years of age
“The main thing is not to ignore even minor symptoms from the liver,” emphasizes Dr. Korzhikov.
