October, Liver Cancer Awareness Month, is back: An entire month that research institutes, scientific societies, and patient associations dedicate to information and awareness of liver cancer. 

Hepatocarcinoma, the most frequent primary cancer of the liver, is the second leading cause of death from malignancy worldwide and mainly develops in patients already affected by cirrhosis or hepatitis B and C. 

Cholangiocarcinoma, or biliary tract cancer, is a rare disease often detected in advanced stages. For this reason, access to information about liver cancer is crucial. Liver Cancer Awareness Month, with its outreach activities, allows specialists and associations to reach a large part of the population.

Hepatocarcinoma: The Most Frequent Cancer of the Liver

Hepatocarcinoma is the sixth most prevalent cancer worldwide and develops due to abnormal development of liver tissue cells. Alcohol abuse, resulting in the development of cirrhosis, hepatitis B and hepatitis C, and metabolic syndrome, are the main risk factors for the development of this cancer. Patients already affected by these diseases are encouraged to have regular hepatological check-ups, aiming to diagnose the possible presence of hepatocarcinoma early.

Symptoms of hepatocarcinoma, such as weight loss, fatigue, abdominal pain, and jaundice, often occur when the tumor is in an advanced state, thus resulting in late diagnosis. Hepatocarcinoma, however, is a condition that requires immediate intervention: In the early stages, the liver is still able to perform its functions regularly, and the tumor can be treated effectively with surgery, with a good chance of recovery for the patient. 

Cholangiocarcinoma: A Rare Tumor

Cholangiocarcinoma, while having a significantly lower incidence than hepatocarcinoma, is the second most frequent primary tumor of the liver. It is a rare tumor that affects 1.2 percent of all cancers in the male gender and 1.7 percent in the female gender. It arises from the uncontrolled development of bile duct cells between the liver and intestine. It can affect the inside of the liver (in this case, we will speak of intrahepatic cholangiocarcinoma) or the outside (extrahepatic and gallbladder cholangiocarcinoma).

The prognosis of cholangiocarcinoma is five years from the diagnosis for about 15% of the patients, and the continuously increasing incidence data and the high rate of late diagnosis make the situation even more severe. 

Diagnosing cholangiocarcinoma is complex both because of a lack of specific criteria for diagnosis and because patients do not present with symptoms immediately attributable to the disease. In the early stages, the tumor remains silent, and the symptoms that occur as the disorder progresses are rather general and include: 

  • Abdominal pain
  • Nausea
  • Weight loss
  • Malaise 

Only in more advanced cases of extrahepatic cholangiocarcinoma most patients manifest jaundice, but it is generally not accompanied by painful symptoms. 

Unlike hepatocarcinoma, the underlying causes of cholangiocarcinoma are still being studied. Again, however, risk factors, in addition to smoking, age, and exposure to external agents (dioxins, asbestos, radon), include: 

  • Primary sclerosing cholangitis
  • Gallstones
  • Cirrhosis
  • Hepatitis B and C
  • Chronic bowel disease

From this point of view, it is crucial to monitor patients affected by diseases included among the risk factors for cholangiocarcinoma and who should undergo periodic check-ups at their referral center.

Referral Centers: Critical for Prevention and Treatment

Liver cancer referral centers play a vital role in controlling the disease as they ensure a multidisciplinary approach for the patient, thanks to teams of physicians having different specialties. In addition, for cholangiocarcinoma, it is essential to get molecular profiling, allowing the identification of possible alterations that can be targets for new biological drugs. 

Liver tumors must be diagnosed and treated by taking into account the different aspects of the pathology and involving hepatologists, surgeons, oncologists, radiation oncologists, and interventional radiologists

The forms of liver cancer are different, and the patient must be cared for comprehensively by a multidisciplinary team of specialists capable of managing the various aspects of the pathology.