Primary carcinoma of the liver: Review of the literature and an analysis of twelve additional cases

Abstract

Twelve additional cases of primary carcinoma of the liver are added to the 2,205 cases found in a review of the literature. The 16 reduplications of Charache as recorded by Warvi were excluded from this total. Our autopsy rate of 1.11 per cent, although in a small series, is considered possibly significant when compared to similar series. Comparison of findings in a selected small group of patients such as ours with those of larger groups of various races, sex, age, and economic status prohibits positive valid conclusions; but it is of interest to note similarities and differences, which eventually may lead to delineation of more specific factors in the development of this disease. We believe that our cases support the impression of other investigators that the relative frequency of occurrence of primary carcinoma of the liver seems to be increasing in the United States. To be remembered, however, is the fact that the life expectancy of the general population, especially in this country, has increased considerably in recent years. Since fewer people now succumb to diseases which formerly resulted in the early death of many, this factor may have influenced the prevalence of primary liver carcinoma. In general, our findings relative to symptoms, physical signs, laboratory data and extrahepatic metastases parallel those of other authors. The pathologic finding of cirrhosis of the liver was noted in only 3 of our 12 patients; whereas in similar small series, as well as larger ones, other reports indicate the presence of cirrhosis in a considerably higher percentage of patients with primary carcinoma of the liver. The reason for this difference is not known. Perhaps the explanation lies in the fact that the nutritional background was good in all but 2 of our patients, and a history of excessive consumption of alcohol was found in only 4. In our 12 cases, no definite predisposing factors such as race, occupation, nutrition, alcoholism, occupation, and parasitic infestation can be cited as of definite etiologic significance in the development of this disease. Although our cases may be considered by some to lend support to the theory of racial susceptibility, satisfactory data with reference to this factor are lacking. We believe that other unknown factors related to economic and social status or the mode of living may be of special significance in the pathogenesis of primary carcinoma of the liver.