Primary Neoplasms of the Liver

Abstract

Overview Primary liver cancer is the second leading cause of cancer death in men and the sixth leading cause among women. Hepatocellular carcinoma (HCC) constitutes 70–85% of primary hepatic neoplasms, followed by intrahepatic cholangiocarcinoma (ICC) (10–15%) and other less common hepatic malignancies (5%) such as hepatic angiosarcoma, epithelioid hemangioendothelioma, or hepatic lymphoma. Primary hepatic malignancies are generally associated with poor survival, and only a limited evidence of systemic therapy have been available, prevention, surveillance, early diagnosis, and multidisciplinary treatment approach are important factors to maximize treatment outcomes. In addition, most of the primary hepatic neoplasms are associated with chronic liver disease or cirrhosis, and the decreased hepatic functional reserve often precludes aggressive treatment for tumors. Therefore, for treatment selection, one should consider two intrinsic conflicting factors, curability and safety of treatment. Currently, several clinical staging systems and treatment algorithms are available to adequately select therapeutic options for HCC. The choice of therapy is individualized based on the tumor burden, degree of underlying liver disease, patient performance status, and the overall possibility of side effects or complications balanced with acceptable results. Selection of treatment should be determined in a multidisciplinary approach with the local expertise. The most curative treatment options including surgical resection, radiofrequency ablation, and orthotopic liver transplantation (OLT) should be the first priority as long as such treatments are approved. For the other hepatic malignancies, only limited clinical evidence is available and surgical resection or OLT is considered as the first‐line treatment.