Cirrhosis and liver cancer are two major liver pathologies encountered in the alcoholic individuals. Both conditions are life threatening conditions. Initially they may present with similar features, but it is very important to understand the basic differences between the two in a clinical standpoint, as well as on the side of the patient because cancer is bad news. This article describes the clinical features, symptoms, causes, investigation and diagnosis, and prognosis of cirrhosis and liver cancer, and outlines the differences between cirrhosis and liver cancer and also the course of treatment they require.
Cirrhosis means irreversible liver damage. Under the microscope, cirrhotic liver has damaged warped liver architecture with excessive fibrosis and nodular regeneration. Chronic alcohol abuse, autoimmune diseases, genetic disorders (Wilson’s disease, hemochromatosis, alfa antitrypsin deficiency), drugs (amiodarone, methyldopa and methotrexate), Budd-Chiari syndrome, hepatitis B and hepatitis C are a few well known cause of cirrhosis. Cirrhosis may be asymptomatic, a simple elevation of liver enzymes or decompensated liver failure. White nails, Terry’s nails (white proximal half and red distal half), clubbing of nails, jaundice, parotid swelling, male breast enlargement, palmar redness, hand contractures (Dupuytren’s), bilateral pitting ankle edema, small testes (testicular atrophy), and enlarged liver (in early disease) are the common clinical features of hepatic cirrhosis.
With chronic liver disease, a whole lot of complications can manifest themselves. Clotting abnormalities (because liver produces most of the clotting factors), encephalopathy (due to impaired ammonia metabolism), low blood sugar (due to poor glycogen metabolism in liver), spontaneous bacterial peritonitis, and portal hypertension are a few examples. Encephalopathy presents with coma, confusion, day-night reversal, flapping hand tremors, poor stereognosis (spatial awareness). Portal hypertension leads to esophageal varices (hematemesis and melena), enlarged spleen and Caput medusa.
Full blood count, blood urea, serum creatinine, liver enzymes including gamma GT, direct and indirect bilirubin, serum albumin, bleeding time, clotting time, virology for hepatitis, autoantibodies, alfafetoprotein, caeruloplasmin, alfaantitrypsin, and ultrasound scan of the abdomen are the routine investigations. The patient should be admitted to hospital in case of first detection for assessment and in decompensated liver disease. General management includes, daily weight chart, blood pressure and heart rate monitoring, urine output, serum electrolytes, abdominal girth, QHT, examining for pleural effusion, tender abdomen due to peritonitis. Diet should be low salt and low protein. Antibiotics may be given to flush out ammonia forming gut bacteria in case of liver failure and to treat bacterial peritonitis. Diuretic remove fluid. Ascitic tap removes excessive fluid collection in the peritoneal cavity. Interferones, ribavirin, and penicillamine have their roles according to the clinical presentation.
The commonest types of hepatocellular carcinoma are not actually from the liver but from breast, bronchus, and gastrointestinal tract. They are in essence metastatic deposits. Primary tumors arising from the liver may be benign or malignant. Cancer in the liver may present with fever, malaise, anorexia, nausea, vomiting, jaundice, liver enlargement, and general features of chronic liver disease. Tests done in chronic liver disease and chest x ray, CT abdomen, and bone marrow biopsy may be done in case of a hepatocellular carcinoma, as well. Viral hepatitis, cirrhosis, aflatoxin, and parasites may cause liver cancers. Surgical resection of solid tumors, chemotherapy, and radiotherapy are the treatment options available. Hepatocellular carcinoma is a deadly disease with >95% 5 year mortality.
What is the difference between Cirrhosis and Liver Cancer?
• Cirrhosis is liver fibrosis and regeneration while liver cancer is an abnormal uncontrolled growth in the liver.
• Cirrhosis affects the liver completely while cancers are initially localized.
• Cirrhotic changes are uniformly spread across the liver while cancers spread as small nodular growths.
• Cirrhosis is a cause of liver cancers.
• Cirrhotic parts cannot be excised, but cancers can be removed by partial liver resection.
• Cirrhosis has an excellent prognosis if managed properly while liver cancer has very bad prognosis.
1. Difference Between Cirrhosis and Hepatitis