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Cancer in Pregnancy: Hepatocellular Carcinoma in Pregnancy

Introduction
Hepatocellular carcinoma (HCC) in pregnancy is very rare. Lau et al reviewed the published literature between 1957 and 1993 of this association and found 28 cases1. They also reported an association between high parity 1, HBsAg carriers 1,3, oral contraceptives 1,2 and HCC appearances. Focused medical history and the level of serum AFP may be helpful as screening tools 1.

Diagnosis
Most patients complain of right upper quadrant pain or distention and weight loss. An irregular liver mass together with excessively high serum a-fetoprotein (AFP) level suggest HCC 4. AFP may also be used for screening HCC in pregnant women at high risk. Liver sonography and/or magnetic resonance imaging together with fine liver aspiration of the liver are used for definite diagnosis during pregnancy 1,5.

Treatment
These imaging methods and measures are also used for staging. Partial hepatectomy is the treatment of choice2 if the anatomical and surgical considerations and tumor spread enable an aggressive approach.

Prognosis
Although a shorter median survival for pregnant women with HCC has been suggested 1 we believe that the small number of published cases precludes any firm conclusions. Two case reports of HCC diagnosed in the second trimester reported favorable outcomes for both mother and child 2,6.

References

  1. Lau WY, Leung WT, Ho S, Lam SK, Johnson PJ, Williams R, Li AK. Hepatocellular carcinoma during pregnancy and its comparison with other pregnancy associated malignancies. Cancer 75:2669-75, 1995.
  2. Gisi P, Floyd R. Hepatocellular carcinoma in pregnancy. A case report. J Reprod Med 1999 Jan;44(1):65-7.
  3. T'Sang-T'ang Hsien, Hong-Chih Hou et al. Term delivery after hepatocellular carcinoma resection in previous pregnancy. Acta Obstet Gynecol Scand 1996;75:77-8.
  4. To WK, Ghosh A. Primary liver carcinoma complicating pregnancy. Aust. and N.Z. J. of Obstet & Gynecol 33:325-6, 1993.
  5. Entezami M, Becker R, Ebert A, Pritze W, Weitzel H. Case report: Hepatocellular carcinoma as a rare case of an excessive increase of a-fetoprotein during pregnancy. Gyncol Oncol 62:405-7, 1996.
  6. To WK, Ghosh A. Primary liver carcinoma complicating pregnancy. Aust NZ J Ostet Gynecol 1993 Aug;33(3):325-6.
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