Hepatocellular carcinoma. A 5 year institutional experience

Liver cancer is the most common of all malignancies worldwide, its incidence reaching almost epidemic proportions in some countries. However, its significance in North America has generally been underemphasized. In a 5 year period, hepatocellular carcinoma was diagnosed in 35 adult patients in our institution. Preexisting liver inflammation was present in 27 of the patients (77 percent). Although most patients had symptoms, they included only poorly defined pain or cachexia in most cases, and 10 patients (29 percent) were totally asymptomatic at the time of diagnosis. Five patients presented with hemoperitoneum due to intraabdominal tumor rupture. Examinations useful in confirming the diagnosis included alpha-fetoprotein determination, liver scan, and computerized tomographic scanning. Eight patients (23 percent) had associated visceral or other malignancies. The outlook was poor, with a mean survival of 5 months, and only two patients survived more than 1 year. Hepatocellular carcinoma is uncommon but not at all rare in the Pacific Northwest. It arises from chronic liver inflammation, is diagnosed late, and has a grim prognosis. Prevention of various forms of chronic liver inflammation, and mass serial screening of populations at high risk for the development of hepatocellular malignancy will probably have the greatest role in reducing the lethality of this disease.