Malignant liver tumours can be primary or secondary. The most common primary malignant liver tumours are hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC), while the colorectal and neuroendocrine liver metastases account for the majority of secondary tumours.
HCC tends to arise in patients with cirrhosis secondary to hepatitis or alcohol. Diagnosis is usually made on a raised α-fetoprotein and CT and MRI. Treatment options include hepatic resection, transplantation, percutaneous ablation and transarterial chemo-embolization. Treatment is dependent on the Child's status of the patient, extent of liver disease and the presence of metastatic disease.
IHC accounts for 10% of cholangiocarcinomas. Risk factors include primary sclerosing cholangitis and choledochal cysts. Liver resection offers the only chance for cure in these patients.
Secondary liver tumours account for 95% of hepatic malignancies, the most common being colorectal liver metastases (CRLM). CRLM are detected during surveillance following surgery for the primary tumour. Liver resection is potentially curative, and more patients are being subjected to liver resection following down-staging of the disease with neoadjuvant chemotherapy.
Surgery offers a potential cure for liver tumours. Recent medical advances have made treatment of malignant liver tumours safer and potentially curative.