Cancer and liver cirrhosis: implications on prognosis and management

Abstract

Liver cirrhosis, the end-stage of every chronic liver disease, is not only the major risk factor for the development of hepatocellular carcinoma but also a limiting factor for anticancer therapy of liver and non-hepatic malignancies. Liver cirrhosis may limit surgical and interventional approaches to cancer treatment, influence pharmacokinetics of anticancer drugs, increase side effects of chemotherapy, render patients susceptible for hepatotoxicity, and ultimately result in a competitive risk for morbidity and mortality. In this review, we provide a concise overview about the impact of liver cirrhosis on the management and prognosis of patients with primary liver cancer or non-hepatic malignancies.

Keywords: hepatocellular carcinoma; intrahepatic cholangiocarcinoma; liver cirrhosis; non-hepatic cancer; viral reactivation.

Figure 1

Proposal of a simplified treatment algorithm in patients with cancer and liver cirrhosis. ¹ Both tumour- and liver-related prognosis should be taken into account. ² Liver transplantation is not a standard treatment for intrahepatic cholangiocarcinoma. BSC, best supportive care; CHT, chemotherapy; CI, contraindication; CSPH, clinically significant portal hypertension; EBL, endoscopic band ligation; EHS, extrahepatic spread; HBV, hepatitis B virus; HCV, hepatitis C virus; MELD, Model for End-Stage Liver Disease; OLT, orthotopic liver transplantation; PHT, portal hypertension; VI, vascular invasion.