PRIMARY LIVER CANCER: CLINICAL ASPECTS, PROGNOSTIC FACTORS AND PREDICTIVE RESPONSE TO THERAPY

Primary liver cancer (PLC) is the fifth and seventh most common cancer in men and women, respectively. The 85% of all PLC cases are hepatocellular carcinomas (HCCs). The 80% of all HCC results from cirrhosis, while the 20% develop in patients with no chronic hepatic disease, mostly from severe forms of non-alcoholic fatty liver disease. The Barcelona Clinic Liver Cancer is the most accepted staging system. Tumor stage and degree of hepatic dysfunction determine the treatment of HCC. Good long-term survival and 5-year survival rates (70-50%) are enabled by liver transplantation and surgical resection with radical intent. In addition, especially in early-stage nodules, loco regional treatment can also accomplish positive results. Intra-hepatic cholangiocarcinoma (ICC), is the second most common PLC. It arises from the bile ducts of the second-order and usually presents as a mass inside the liver. ICC can be diagnosed with CT and MRI imaging techniques showing location of the tumor, the possible multifocality of the lesion, the presence of venous or arterial invasion, and the presence of lymph node involvement or distant metastases. Three types of ICC can be described according to the type of macroscopic growth: mass forming, periductal infiltrating, and intraductal growing. The treatment of choice is radical surgical resection, the only treatment showing a long-term survival for patients. A major hepatectomy is often required to achieve radical resection. This therapeutic choice has acceptable mortality and morbidity rates. Other PLCs (e.g., epithelioid hemangioendothelioma, fibrolamellar hepatocellular carcinoma, hepatoblastoma, sarcoma and lymphomas, combined HCC and ICC) are very uncommon, and surgery remains the treatment of choice.