What Are Benign Liver Tumors?
A benign liver tumor is a noncancerous development that occurs in the liver. Tumors are defined as abnormal proliferation or aggregations. A neoplasm is categorized as a malignant tumor when it shows signs of uncontrolled development and invasion. A tumor is categorized as benign when it shows no signs of cancer. There exist three primary classifications of benign liver tumors. The three types of liver lesions discussed are
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Adenomas: Adenomas are noncancerous (benign) masses that develop in the epithelial tissue that lines the organs and structures on which they are located.
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Hemangiomas: Hemangiomas are usually benign, harmless vascular growth made up of cells from blood vessels.
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Focal Nodular Hyperplasia(FNH): A benign tumor or lesion that develops in the liver.
Among these options, adenomas are the sole entities that possess the potential to progress into a malignant neoplasm. Cancer transformation resulting from a liver adenoma is an infrequent phenomenon, typically observed in cases where the adenoma has attained significant dimensions.
What Are the Etiological Factors Contributing to the Development of Benign Liver Tumors?
The etiology of liver hemangiomas and FNH remains unknown. The precise etiology of liver adenomas remains uncertain; nonetheless, a notable correlation has been observed between the occurrence of adenomas and the utilization of oral contraceptives. Due to this rationale, adenomas are predominantly detected in women during the reproductive age range.
How Do Benign Liver Tumors Manifest?
Symptoms are uncommon among benign liver tumors. Generally, symptoms only appear once the mass is large enough to press on other organs. When this occurs, it may induce upper abdominal pain, especially on the right side. If the tumor presses on the stomach, it can cause a feeling of satiety after consumption, limiting the amount of food one can consume. One may experience unintentional weight loss if this continues long enough. Bleeding in the liver is an unusual complication of large adenomas. Typically, this causes immediate, severe discomfort in the upper right abdomen. This can be fatal, and patients suspected of having a rupture should be evaluated promptly by a physician.
What Are the Various Diagnostic Tests?
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Hepatic Function Testing: A sequence of specialized hematological examinations that can ascertain the optimal functioning of the liver.
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Sonography: Ultrasound of the abdomen, often known as sonography. High-frequency sound waves are employed in a diagnostic imaging approach to generate an image of the interior organs. Ultrasound imaging is employed to visualize internal organs within the abdominal cavity, including the liver, spleen, and kidneys, and evaluate blood circulation within different vessels.
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CT Scan: CT scan, often known as a CAT scan. The utilization of X-rays and computer technology in conjunction to generate horizontal or axial images, commonly referred to as slices, of the human body is a diagnostic imaging technique. A CT scan provides high-resolution images of many anatomical structures, such as bones, muscles, adipose tissue, and organs. CT scans provide a higher level of detail compared to standard X-rays.
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Liver Biopsy: A liver biopsy is a diagnostic procedure involving the extraction of tiny liver tissue samples, typically performed to assess the presence of cancerous cells. Two methods are used to acquire a tissue sample.
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Needle Biopsy: A needle biopsy involves administering a local anesthetic to numb the skin at the site of a minor incision. The procedure involves inserting a needle through the skin and into the liver, resulting in the acquisition of a tissue sample. Ultrasound or CT guidance is utilized for this purpose.
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Open Biopsies: Open biopsies are typically performed as a component of a separate surgical intervention. The surgeon has the option to perform a surgical procedure to extract a tiny portion of liver tissue for the tissue sample, or a core biopsy may be performed. The procedure known as a core biopsy entails the insertion of a miniature hollow needle into the liver. The needle is inserted into the cellular layers to extract a sample or core. A core biopsy is commonly conducted using imaging techniques.
What Are the Treatment Options for Benign Liver Tumors?
Most tumors can be monitored and followed using imaging studies if they are not causing any symptoms. Tumors that induce symptoms like the ones listed above must be removed. This is usually accomplished through surgery.
Non-surgical liver tumor treatment is too extensive. Neoadjuvant chemotherapy can make 15 to 30 percent of unresectable CRC metastases resectable. Hepatic resection should follow the final treatment round by six to eight weeks.
Surgical Interventions
For primary and secondary liver tumors, resection is the best long-term treatment. Depending on tumor location and size, resection can range from minimal, covering only the tumor, to extensive, involving most of the liver.
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Liver surgery equipment is developing rapidly. Based on effectiveness, the surgeon can transect the hepatic parenchyma using several electrosurgical devices. Modern hepatic parenchyma resection tools, like ultrasonic knives, save vascular structures and reduce blood loss.
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The Habib knife, a multi-needle radiofrequency instrument, coagulates liver tissue to ensure safe dissection (surgical removal). These methods are expensive, which is their major drawback.
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The crash and clamp technique uses forceps to separate hepatic parenchyma and selectively ligature vascular structures, the easiest and most cost-effective way to resect it.
Which Surgical Method to Use?
The introduction of laparoscopic surgery has transformed benign liver tumor treatment. A skilled operator can conduct laparoscopic liver resection safely. Comprehensive hepatectomy removes any part of the liver and replaces restricted hepatectomy, which only removes the anterior parts.
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Laparoscopy: Liver surgery is less invasive than laparoscopy, which is good for those who need it. This method reduces pain and improves aesthetics. Since laparoscopy was introduced, there has been a worrying and unsafe trend toward removing BLT. Some studies have found an excessively high prevalence of diagnostic or protective operations. No matter the approach, patient safety is the top goal in surgery.
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Open Surgery: Open surgery is still best, especially when tumors are near blood arteries or protrude near the skin. Skilled specialists should perform major laparoscopic hepatectomy.
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Radiofrequency Ablation: Recently, locoregional liver tumor treatment with radiofrequency ablation (RFA) and cryotherapy has grown quickly. RFA is the most common liver cancer treatment. Deep-seated single tumors, minor tumors in other liver regions left after resection, and recurrence in a spared lobe can be treated with this approach. It can also supplement extensive liver resection if lesions cannot be removed in the spared liver. RFA can be performed percutaneously with ultrasound or CT guidance, but challenging cases require laparotomy or laparoscopic control ablation.
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Transarterial Chemoablation: Transarterial chemoablation (TACE) works best for unresectable liver tumors without vascular infiltration, metastases to other organs, and well-preserved liver function. This approach's primary advantage is its applicability for bridging therapy before liver transplantation. This approach controls tumors well with minimum morbidity. However, radioembolization is expensive and limited.
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Portal Vein Embolization: Portal vein embolization (PVE) increases the liver remnant size following surgery. This procedure redirects portal blood to future liver residual segments, causing hypertrophy. PVE is safe, has low side effects, and can boost curative resection eligibility. Hepatic resection should follow the final treatment round by six to eight weeks.
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Liver Transplantation: The goal of liver transplantation is to replace a damaged liver with a healthy one. Given their prognosis and transplantation complexity, benign liver tumors seldom require a liver transplant. Liver function is also maintained. Transplantation should be discussed in the context of surgical intervention to prevent problems or relieve symptoms. Solid tumors must be either a single, large tumor that cannot be surgically removed and is causing significant symptoms or many benign tumors that are causing major, untreatable consequences like recurrent bleeding or adenomatosis cancer.
Conclusion
The detection of localized lesions in the liver at an advanced stage suggests that screening approaches have limited effectiveness. As a result, it is only sometimes feasible for all patients to obtain therapy promptly. Patients are referred to more specialized facilities for further evaluation when uncertainty arises. Nevertheless, the initial results of both hepatic lesion excision and radiofrequency ablation exhibit promise, with a comparatively low incidence of sequelae.
