Primary malignant tumor of the liver associated with the ingestion of oral contraceptives

A 42 year old woman who had been on oral contraceptives (OCs) for 10 years was admitted to the hospital for pains in the hepatic region. Laparoscopy showed an enlarged liver and biopsy confirmed the diagnosis of primary carcinoma. The patient died. The literature on the subject has reported on 22 similar cases; common signs of alarm are pain and enlarged liver. The length of contraception and the type of contraceptive do not seem to be of primary importance. It is impossible to state that OCs are carcinogenic although it is highly probable. Hepatic lesions are usually benign but sometimes they are malignant and it is possible that genetic predisposition plays a role in such cases. It is also possible that OCs by diminishing biliar excretion may augment the hepatic concentration of toxic metabolites. The essential argument against OCs is the regression of benign tumors after use of contraceptives is stopped. Women on OCs should be checked routinely for early recognition of benign or malignant lesions. A national register of cases would be helpful in determining the prevalence of tumors.