Liver tumor

Liver tumors can be benign and malignant.
Malignant tumors can be primary or secondary, that is, they are metastases of a tumor from another organ (most often from the colon, but can also originate from carcinoma of the breast, kidney or lungs).

In Europe and the United States, a single tumor mass in the liver is more likely to be a metastatic carcinoma than a primary tumor of the liver.
Liver cancer is the third leading cause of death due to a tumor.

The main risk factors for liver cancer are:

  • Virus of hepatitis B and C
  • Alcohol consumption and fatty liver that can lead to cirrhosis of the liver
  • Smoke
  • Diabetes
  • Consumption of food contaminated with aflatoxins

Contents

Benign liver tumors

Hemangioma

A hemangioma or angioma of the liver is a tumor of the endothelial cells that form the inner wall of blood vessels.
It consists of a tangle of small blood vessels or capillaries and usually does not cause pain or other symptoms; in rare cases, it can take on large proportions and press against nearby organs; then it can cause symptoms and consequences.
Hemangiomas are the most common benign tumors in the liver in adults and children. As a rule, they are found more frequently in the right lobe of the liver than in the left.
Liver hemangiomas can occur as part of a clinical syndrome, such as Klippel-Trenaunay-Weber syndrome, Osler-Rendu-Weber disease, and von Hippel-Lindau syndrome.
Cavernous hemangiomas can reach a diameter of 8-10 cm.

These tumors can grow under the influence of the contraceptive pill and regress if they are stopped.
These benign tumors can also grow during pregnancy.
Liver haemangiomas can be found in 10% of children at one year of age, but usually resolve in the first two years of life.

Symptoms of hemangioma
They are usually small and asymptomatic and are discovered accidentally during an instrumental examination of the liver or laparoscopy.
The most commonly described symptoms are pain in the upper right quadrant and swelling of the abdomen.
Physical examination is normal, but hepatomegaly (liver enlargement) and/or arterial flow noise above the upper right quadrant may be present.

Less common symptoms include:

  • a large abdominal tumor mass;
  • Anorexia;
  • feeling of satiety after low food intake;
  • large tumors can press on the stomach, causing nausea and vomiting.

A rupture occurs rarely, but can occur spontaneously as a result of trauma or a biopsy.
Instrumental diagnostic techniques include echography, CT, magnetic resonance imaging, arteriography of the liver, and digital subtraction angiography.

Treatment of hemangioma As a rule, no treatment is necessary, but if the hepatic angioma
causes symptoms, the doctor may suggest various treatment options.
Surgical removal of the hemangioma or part of the liver is the preferred form of treatment.
Other less invasive therapies include arterial embolization, radiofrequency ablation, and liver radiation.
A liver transplant is only required in rare cases.

Liver adenoma

Liver adenomas are rare benign tumors. About 90% of cases occur in women, especially at the age of 15-45 years.
Liver adenomas are more common in women of fertile age and are often caused by the use of the birth control pill.
Other factors that increase the risk of developing liver adenoma include anabolic steroids, beta-thalassemia, tyrosinemia, type 1 diabetes, and glycogen storage diseases (types 1 and 3).
Liver adenomas are common in glycogen storage diseases.
The risk of malignant development is not known, but can account for 13% of cases.

Symptoms of liver adenoma
Liver adenomas are often asymptomatic and are discovered accidentally during instrumental examinations carried out for other reasons.
With an increase in size, a palpable mass may form, with right-sided flank pain and abdominal pain in the upper area (above the navel).
With rupture of the adenoma, there may be acute abdominal pain with severe abdominal bleeding, which leads to shock.
Other rare symptoms also include occlusive jaundice.

Diagnosis of liver adenoma

As a rule, the functioning of the liver is not affected, but aminotransferases may be slightly elevated or characteristic signs of occlusive jaundice may appear.
Appropriate diagnostic tests are:

  • Ultrasound
  • CT
  • Magnetic resonance tomography.

Patients with liver adenomas who complain of severe abdominal pain or are hemodynamically unstable should immediately undergo a diagnostic abdominal examination for imaging (for example, a CT).

The examinations must clarify whether the tumor is limited to the liver or has spread to the lymph nodes and other organs in order to choose the most appropriate therapy.

Therapy of liver adenoma
Patients should stop taking oral contraceptives or anabolic steroids.
Pregnancy should be avoided until the tumor is removed because of the risk of complications for mother and child.
Symptomatic tumors must be surgically removed.
Asymptomatic liver adenomas, reaching a size of 4 cm, must be surgically removed because of the risk of spontaneous bleeding and the possible malignant development associated with large tumors.
Patients who have not yet had their liver adenoma removed must undergo annual ultrasound check-ups.

Focal nodular hyperplasia

Focal nodular hyperplasia is the second most common liver tumor.
It is characterized by the formation of nodes inside the organ.
Focal nodular hyperplasia is a benign liver tumor that is often discovered by chance thanks to another X-ray examination.
This tumor does not degenerate malignantly and is more common in women.
Focal nodular hyperplasia is rarely symptomatic and usually no surgical intervention is required.
However, sometimes symptoms may occur and the tumor may grow rapidly.
In this case, surgical resection is required.
To visualize a nodular hyperplasia, a Doppler sonography is sufficient. However, the doctor may also prescribe a CT scan or magnetic resonance imaging for control.
In some cases, ruptures and bleeding have occurred. Because of these risks, some specialists believe that it is better to remove the tumor, while others believe that monitoring by means of apparatus testing is sufficient.

Other benign liver tumors
There are other tumors that occur less frequently:

  • Fibroma
  • Lipoma
  • Leiomyoma
  • Cystadenoma

Symptoms of liver tumor

A child with a benign or malignant liver tumor does not necessarily have symptoms.
In the initial stages, the liver tumor is asymptomatic, so the first symptoms appear only at an advanced stage.
With growth, both in the child and in the tumor, various symptoms can develop:

  • Formation of an abdominal node
  • Bloated abdomen or ascites (due to fluid in the abdomen)
  • Pain on the right side of the abdomen, where the liver is located
  • Back pain or pain in the right shoulder
  • Fever
  • Decrease in appetite and weight loss (usually only in the fourth and final stage)
  • Vomit
  • Jaundice (yellowing of the eyes and skin)
  • Dark urine
  • Skin itching

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