Liver Cancer with Portal Vein Tumor Thrombus Explained

Liver cancer with portal vein tumor thrombus occurs when hepatocellular carcinoma invades the portal venous system and forms a tumor mass within the portal vein. This condition is a common manifestation in the progression of liver cancer and should be diagnosed in conjunction with primary liver cancer. When a patient already has a confirmed diagnosis of hepatocellular carcinoma and imaging tests—such as CT scans—reveal signs of portal vein tumor thrombus, including a solid mass within the portal vein, partial enhancement during the arterial phase, and filling defects during the portal phase, the diagnosis of liver cancer with portal vein tumor thrombus can be confidently made.

Differentiating portal vein tumor thrombus from benign blood clots is crucial in clinical practice, although it can sometimes be challenging. Here are the key differences:

1. Portal vein blood clot (thrombosis): This typically occurs in patients with advanced cirrhosis, especially those who have recently undergone splenectomy or other procedures involving the portal system. On contrast-enhanced CT scans, these blood clots do not usually show enhancement during the arterial phase. In many cases, they can resolve or improve with anticoagulant therapy.

2. Portal vein tumor thrombus: Classified according to the Cheng's classification system into four types, this condition indicates cancer cell infiltration. Type I involves tumor thrombus in the segmental or lobar branches of the portal vein. Type II extends to the left or right branch of the portal vein. Type III involves the main trunk of the portal vein, and Type IV extends into the superior mesenteric vein.

Liver cancer with portal vein tumor thrombus is a significant negative prognostic factor and requires a multidisciplinary treatment approach. The management plan should take into account whether the primary tumor is resectable, the type of tumor thrombus, liver function status, and the patient's overall physical condition. Treatment options may include surgical resection, interventional radiology procedures, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.