PRIMARY CARCINOMA OF THE LIVER: CLINICAL AND RADIOLOGIC MANIFESTATIONS

Despite increased surgical aggressiveness toward hepatomas, the diffuse multicentric growth pattern often limits operability. There still remains a sizable number of localized tumors which escape diagnosis until metastases occur.

With advances in chemotherapy, the number of patients undergoing some form of treatment (radiotherapy, surgery or chemotherapy) has increased five-fold in the past 20 years. However, the over-all 5 year survival rate still falls below 1 per cent in most series.²⁹ Earlier diagnosis in the group of patients with a solitary lesion might ultimately result in a higher survival rate.

With suggestive clinical and laboratory information and the described preliminary roentgenographic findings, one should suspect primary liver carcinoma.

Selective celiac and/or superior mesentery angiography is the most definitive diagnostic procedure. The occurrence of a vascular mass with tumor vessels, a prolonged vascular blush, stretching and displacement of the hepatic vessels, and arteriovenous shunting should strongly suggest the diagnosis of hepatoma. However, in the cirrhotic patient the diagnosis of primary carcinoma of the liver must be strongly considered even when an avascular mass is demonstrated.

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