Tumours

Benign liver lesions
Benign liver lesions can also be detected in the liver. Most of these tumours do not require therapy unless thy cause complaints. If not treated, some benign lesions in the liver can turn into malignant lesion. In cases where there is a high risk of malignant development, the lesion can be resected during an operation. Below is a list of the various benign liver tumours.

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Focal Nodular Hyperplasia

Focal Nodular Hyperplasia is a benign tumour type in the liver that arises from cells in the liver and the biliary duct and has typical imaging characteristics. FNH occurs in 3 out of 1000 people, and is seen more often in women than men.

Since FNH is a benign tumour type, treatment is not necessary, as patients do not experience any symptoms. When patients experience pain, surgical removal of the tumour can be considered. The prognosis of patients with FNH is good and no link with cancer has been shown.

Haemangioma

A haemangioma is the most common benign tumour in the liver. Haemangioma are tumours originating from blood vessels and can occur on multiple sites within the liver (in 20% of the cases there is more than one haemangioma in the liver). The size of the tumour varies from several millimetres to more than 10 centimetres.

In the Netherlands, haemangioma are present in approximately 1-2% of the adult population. It is mostly found by coincidence, for example during an ultrasound of the abdomen. Haemangioma do not require treatment, unless the patient has complaints of the haemangioma or if it progresses rapidly. Most of the time haemangioma do not cause discomfort to patients. When there is sudden abdominal pain however accurate intervention is necessary, because this may indicate that the haemangioma is bleeding. Sometimes a preventive operation is therefore necessary. Complications of a haemangioma are rare.

Adenoma

The liver adenoma is a rare liver disease with a prevalence of 3 out of 100.000 females. Some liver adenomas are sensitive for hormones. Liver adenomas are also associated with long-use of contraceptives or anabolic steroids. Small adenomas (less than 6 cm) are usually not accompanied by any symptoms or complaints. Large adenomas can cause pain symptoms in the upper right part of the abdomen.

In 5% of cases, a benign adenoma can transform into a malignant lesion. In cases where additional examination cannot differentiate between a benign or malignant lesion, a preventive surgical treatment is the best option. More aggressive treatment options are chosen, if there is an underlying liver disease such as hepatitis or liver cirrhosis. Considering the higher chance of malignancy in these cases, surgical treatment is the first choice for treatment. There is also a high risk of bleeding in the adenoma and in cases where bleeding occurs, surgical intervention is necessary.

Cyst

A cyst is a cavity filled with fluid. Cysts are benign lesions that can grow up to 10 cm. It is possible to detect multiple cystic lesions in the liver. Usually, treatment is not necessary. In case of complaints caused by the cystic lesion, drainage of the cyst can be performed. In some cases, surgical treatment is an option. During the procedure, the cyst is partly resected or removed in total.


Malignant liver tumours
Most frequently occurring malignant tumours in the liver are metastases from the colon. The liver is the first location where metastases from primary tumours of the colon can be detected. Other malignant tumours originated from the liver are hepatocellular carcinoma and cholangiocarcinoma. Below is a list of the different types of malignant tumours.

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Hepatocellular carcinoma (liver cell cancer)

Hepatocellular carcinoma (HCC) is a malignant tumour that and is rare in the Western world, however, it is the most frequently occurring type of primary malignant liver tumour worldwide causing 1.25 million deaths each year.

Patients that suffer from liver cirrhosis or a chronic inflammation caused by hepatitis B or C, have an increased risk of developing HCC. More than 80% of patients with HCC suffer from liver cirrhosis. Patients with an increased risk should therefore be screened for HCC. HCC is often diagnosed in patients with known liver cirrhosis that are screened. Imaging techniques such as ultrasound and computed tomography (CT) play an important role in the diagnosis.

The treatment modalities depend on the stage of the tumour at the time of diagnosis. The treatment consists, if possible, of surgical removal or ablation (radiofrequent ablation or laser therapy). In a subset of patients, liver transplantation is the best option. When surgery is not possible, the therapy is aimed at comfort (palliation). Other possible treatment modalities are chemotherapy, radiotherapy and tumour embolization.

After diagnosis, the prognosis depends on a number of factors. These include aggressiveness of the tumour as well as the size and the amount of tumours. In addition, the health and the liver function of the patient are also important determinants. Surgical treatment is only possible in patients with a good liver function and a limited number of tumours. Thereby, it is important to realize that in term, tumours will often develop on other locations in the cirrhotic liver. Due to these two reasons, local tumour ablation is increasingly preferred as treatment, as this procedure causes less damage to the liver.

Cholangiocarcinoma

Cholangiocarcinoma is a primary malignant tumour of the liver that is derived from bile duct cells. In contrast to HCC, cholangiocarcinoma is not related to liver cirrhosis. The causes of this rare disease are not known. Symptoms that can occur are: anorexia, fatigue, decreased appetite and jaundice and abdominal pain is experienced in some rare cases. Curative treatment is possible and exists of surgical resection. During the surgery, the part of the liver with the bile ducts that is affected by the tumour is resected. Surgical resection is not possible in all patients. Only patients were the disease is discovered in the early course of the disease are eligible for surgery. Unfortunately, in most cases the disease is discovered in a late stage of the disease when metastases are developed. In these cases, treatment is focused on symptom relief, such as placing a drain to enable the drainage of bile (Percutaneous transhepatic echolangiostomy drain). Radiotherapy and chemotherapy can also reduce symptoms in patients.

Gallbladder carcinoma

Gallbladder carcinoma is a rare type of cancer and is more frequently detected in female compared to male patients (2 out of 100.000). The most important prognostic factor for developing a gallbladder cancer is gallstones. Occasionally, the tumour is detected as an incidental finding during a cholecystectomy procedure (removal of the gallbladder). There are no specific complaints that indicate gallbladder carcinoma.

Often, in a late course of the disease, there are complaints of weight loss, abdominal pain and jaundice. Usually, curative treatment is not possible when symptoms already exist. Surgery is the most widely used treatment option. The stage of the tumour is of utmost importance for surgical success. Jaundice is treated by placement of a drain in the bile ducts in order to enable the drainage of bile (Percutaneous transhepatic echolangiostomy drain).

Sarcoma

Sarcoma is a malignant form of tumour of the connective tissue, fatty tissue or muscle tissue. Sarcoma is a very rare type of tumour and most frequently located in the legs, the arms, chest and abdominal wall and the head and neck area. In cases where the sarcoma is detected in the liver, this is usually a metastasis from a primary located elsewhere. Primary sarcoma of the liver does exist, however very rare. Surgical resection is the treatment of option.

Metastasen

Metastases from other primary tumours are the most frequently detected malignant tumours in the liver. Usually, the primary tumour is located in the bowels. However, the stomach, pancreas, breast, lungs and connective tissue are other frequent primaries for metastases in the liver.

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