HEPATOMA IN CIRRHOSIS

Impaired T cell function and decreased natural killer activity in patients with liver cirrhosis and their significance in the development of hepatocellular carcinoma

It is well known that the incidence of hepatocellular carcinoma (HCC) in patients with liver cirrhosis (LC) is very high. We investigated the immunological state in patients with LC and HCC. T cell population of peripheral blood lymphocytes (PBL) and blast transformation of PBL by phytohaemagglutinin (PHA) were significantly decreased in patients with LC. Natural killer activity against HeLa cell was also significantly decreased in these patients. These results suggest that immunological surveillance is impaired in patients with LC and this may be one of the aetiological factors in genesis of hepatocellular carcinoma in patients with LC.

Hepatocellular carcinoma and hepatic cirrhosis in the west of Scotland: a 25-year necropsy review

A two-fold increase in the incidence of hepatocellular carcinoma in the west of Scotland is reported on the basis of a 25-year retrospective necropsy review (313 cases). This increase is not accompanied by a corresponding increase in the incidence of hepatic cirrhosis. The relationship between hepatocellular carcinoma and hepatic cirrhosis is discussed in the light of these findings.

New approaches to the causation and prevention of cancers of epithelial surfaces

Environmental rather than genetic factors appear to be responsible for the causation of cancers involving epithelial surfaces, especially oropharyngeal cancers, cancers of the gastro-intestinal tract, cancers of the liver and gall-bladder, cancers of the cervix uteri and lung cancers. Epithelial surfaces which have mucus-bearing cells are particularly prone, because if these mucus cells are surrounded by an alkaline milieu over a prolonged period, the mucous of the epithelial cells is rendered fluid and is removed from the cells, of which it forms an integral part. This leads to proliferative changes with metaplasia, cell-atypia and a very significant increase in mitotic activity. Such changes are a prelude to carcinogenesis. In the case of many oropharyngeal cancers in Asia and Africa it is the alkaline slaked lime in the betel quid which is responsible; in the case of gastric cancers it is the reflux of the alkaline duodenal contents into the stomach; in the case of colon it is the absence of roughage, cellulose and vegetable fibres from the diet; in the case of the cervix uteri it is the frequency of coitus which gives rise to a highly alkaline seminal fluid; and in the case of cancer lung it is the alkaline cigarette smoke.

A clinicopathological review of 100 cases of primary malignant tumours of the liver

One hundred cases of primary malignant tumour of the liver coming to necropsy in the period 1900-1969 have been reviewed. The overall tumour incidence was 0.46% of all necropsies. The overall tumour incidence in hepatic cirrhosis was 12.3%, but the corresponding male and female incidences were 17.5 and 4.4% respectively. There was no significantly increased tumour incidence in haemochromatosis. An increasing incidence of primary malignant tumours of the liver has been noted since 1940 and appears to be due to a corresponding increase in incidence of hepatic cirrhosis. Hepatocellular carcinomas outnumbered cholangiocarcinomas by 8 to 1, were more common in males than females (6 to 1), and in 77% of cases occurred in cirrhotic livers. Tumours supervened as a complication of macronodular or predominantly macronodular cirrhotic patterns.

The variable course of primary hepatocellular carcinoma

Analysis of the clinical course in 85 patients with histologically proved primary hepatocellular carcinoma showed that 73 followed the classic pattern of the disease with a rapid onset and a quick demise. Howeoer, in I2 patients the course was longer in that the duration of illness was over 2 years. This was largely accounted for by the duration of symptoms prior to diagnosis. No clinical differences could be discerned between these 12 patients and the other 73, and survival once diagnosis had been made was no different. The frequency of an underlying cirrhosis in the whole series was 58 per cent. The course of these patients differed in no way from those without cirrhosis except that the age hepatocellular carcinoma presented was older. One patient who received no specific therapy lived for 4 years from the time of diagnosis, and in each of the treatment groups there were occasional patients surviving for several years.

Hepatic artery infusion chemotherapy in hepatoma

Three patients with inoperable malignant hepatomas were treated by intra-arterial infusion of fluorouracil. In each case the treatment gave relief of symptoms: there was striking relief of pain in two cases.Preoperative angiography is essential, but the technical problems are relatively minor.The response of the tumours to chemotherapy is sufficiently encouraging to justify greater efforts for early diagnosis.

Primary carcinoma of the liver in Alberta

A survey was made to determine the incidence and to elucidate the manifestations of primary carcinoma of the liver in Alberta. The findings were compared with other reported series. Ninety-six cases were identified: 69 hepatomas, 25 cholangiomas and two cholangiohepatomas. Seventy-four of the patients were male and 22 were female, a male preponderance of greater than 3:1. Ages ranged from 7 days to 92 years, but the majority of the patients (58%) were in the seventh and eighth decades. The incidence of associated cirrhosis (38.5%) was lower than that noted in most series.Hepatomegaly, abdominal pain, weight loss and ascites were the outstanding clinical features. Gastrointestinal hemorrhage was frequent and second only to hepatic failure as the immediate cause of death. An abdominal mass and pleural effusion occurred in higher frequency than that cited in the literature. Associated disorders included peptic ulceration and cholelithiasis.Surgical biopsy was superior to needle biopsy in establishing the diagnosis. Laboratory tests and routine radiographs may be of diagnostic aid.