Treatment Options for Liver Cancer

Fibrolamellar Hepatocellular Carcinoma

There are several different subtypes of hepatocellular carcinoma that can be differentiated by examining the liver cancer cells under a microscope. The most important subtype or variant is known as fibrolamellar hepatocellular carcinoma . This form is a distinct clinical variant of hepatocellular carcinoma that usually occurs in young patients between ages 20 to 40. The fibrolamellar variant of hepatocellular carcinoma differs from the "classical" form of hepatocellular carcinoma in several important aspects including:

  • Most patients with fibrolamellar hepatocellular carcinoma do not have underlying cirrhosis of the liver.
  • Hepatitis B infection is very uncommon in patients with fibrolamellar hepatocellular carcinoma.
  • The serum levels of alpha-fetoprotein are usually not elevated in patients with fibrolamellar hepatocellular carcinoma.

There have been conflicting studies published in the medical literature regarding the issue of whether patients with fibrolamellar hepatocellular carcinoma have a better prognosis for survival than patients with the classic form of hepatocellular carcinoma. Whereas some studies have reported longer survival rates for patients with fibrolamellar hepatocellular carcinoma, other studies have reported no survival advantage. In general, the prognosis for patients with fibrolamellar hepatocellular carcinoma is influenced by several important variables including:

  • Stage of the disease
  • Number of liver tumors present
  • Whether or not the tumor has spread to the lymph nodes or other parts of the body. In about 30% of patients with fibrolamellar hepatocellular carcinoma, the tumor has already spread to the lymph nodes or other areas by the time the disease has been diagnosed.

The treatment options for patients with fibrolamellar hepatocellular carcinoma are, in general, the same as for patients with the classic form hepatocellular carcinoma. Since most patients with fibrolamellar hepatocellular carcinoma are diagnosed with localized, resectable disease, surgical resection and liver transplantation are considered to be the primary treatment options. Some published studies suggest that surgical resection offers a survival advantage as compared to liver transplantation, however, this is still the subject of controversy in the medical community.