LIVER TUMOURS

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Benign Liver Tumours

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What does the liver actually do?

The liver is a major organ that lies in the abdomen just beneath the ribs on the right side. It weighs around 1500 g and its major functions include

  1. Production of bile, which breaks down your food components into nutrients for absorption

  2. Converts the absorbed nutrients into various forms of energy

  3. Produces many hormones and vital proteins essential for the body

  4. Cleans up toxins present in your blood arising from metabolism and medications

  5. Helps control metabolism of fat and production of cholesterol

  6. Production of proteins essential for blood clotting

Liver Tumours

There are basically two types of tumors

  1. Benign or the non-cancerous tumors

  1. Malignant or Cancerous tumors

Benign Liver Tumours

Benign liver tumours are relatively common and are mostly without symptoms. They are usually found incidentally when an abdominal scan is done for other reasons. The common benign liver tumours include

Hemangioma

  • The most common benign liver tumour in adults and children. The vast majority of hepatic haemangiomas are asymptomatic and most often discovered incidentally during imaging investigations for unrelated health concerns. They are more common in the right lobe of the liver than in the left lobe. Large cavernous haemangiomas may reach 8-10 cm in diameter.

  • They are thought to be congenital and may enlarge under the influence of oral contraceptives.  However, they usually regress when oral contraceptives are stopped. They can also grow during pregnancy

  • Usually they are asymptomatic, right upper abdomen pain / fullness is the most common symptom. The other symptoms may include jaundice, abdominal mass or early satiety due to pressure symptoms on the stomach

  • Rupture is rare but may occur spontaneously, following trauma or at the time of attempted biopsy

Hepatic Adenoma

  • Hepatic adenomas are rare, benign tumours. Approximately 90% of cases occur in females, mostly aged 15-45 years. They occur most often in women of childbearing age and are strongly associated with the use of oral contraceptives.

  • Usually asymptomatic but may cause slight abdominal pain in the upper abdomen and also bloating.

  • They can undergo cancerous transformation and also have the risk of rupture and present as an emergency.

Focal Nodular Hyperplasia

  • Focal nodular hyperplasia is the second most common tumour of the liver.

  • It is a benign condition of the liver that is often discovered incidentally on radiological investigation. It is more common in women.

  • It is not prone to cancerous change

  • It is rarely symptomatic and surgical intervention is almost never required. However, symptomatic focal nodular hyperplasia does occur, may have rapid growth and may require resection

Diagnosis of Benign Liver tumors

Blood Tests

Blood tests are almost always normal in patients with benign liver tumours.

Ultrasound scan abdomen

These tumours have characteristic appearance on ultrasound scans. Most of the time, small tumours without symptoms can be followed up with ultrasound scans

CT scans and MRI scans

These tests would add more information than from an ultrasound abdomen, they would let your doctor know the exact location, size and charateristics of the tumour. They will also help your doctor in differentiating between the various types of tumours.

Liver Biopsy

Here a fine needle in passed into your liver under local anesthesia under ultrasound guidance and tissue samples are taken from suspected tumours or abnormal areas, This test carries a small risk of bleeding from the liver and thus is usually done only when really needed. .

Management of Benign Liver Tumours:

Most of the benign liver tumours can be observed and followed up as long as they are small and don’t cause any symptoms or discomfort

Enlarging or Giant Hemoangiomas and those that significant symptoms due to their shear size need to be removed. Those tumours, if they are in a location that predisposes them to bleed, they need to be removed as well.

Hepatic adenomas may regress once oral contraceptives are stopped. They have a risk of rupture, bleed or cancerous change. Hence they need to be followed up closely. If they cause symptoms or if they are enlarging, they need to be removed.

Most of these focal nodular hyperplasias can be followed because they rarely cause problems.

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