A 64 year old man presents to the clinic with right upper quadrant discomfort. He has never attended the hospital previously and is usually well. He has just retired from full time employment as a machinist in a PVC factory. CT scanning shows a large irregular tumour in the right lobe of his liver. Which of the following lesions is the most likely?
Hyatid liver disease
Angiosarcoma of the liver is a rare tumour. However, it is linked to working with vinyl chloride, as in this case. Although modern factories minimise the exposure to this agent, this has not always been the case.
Occupational cancers accounted for 5.3% cancer deaths in 2005.
In men the main cancers include:
- Bladder cancer
- Non melanoma skin cancer
- Lung cancer
- Sino nasal cancer
Occupations with high levels of occupational tumours include:
- Construction industry
- Working with coal tar and pitch
- Working with asbestos (accounts for 98% of all mesotheliomas)
- Working in rubber industry
Shift work has been linked to breast cancer in women (Health and safety executive report RR595).
The latency between exposure and disease is typically 15 years for solid tumours and 20 for leukaemia.
Many occupational cancers are otherwise rare. For example sino nasal cancer is an uncommon tumour, 50% will be SCC. They are linked to conditions such as wood dust exposure and unlike lung cancer is not strongly linked to cigarette smoking. Another typical occupational tumour is angiosarcoma of the liver which is linked to working with vinyl chloride. Again in the non occupational context this is an extremely rare sporadic tumour.