Liver Tumors

What Are Liver Tumors?

The liver continuously filters blood that circulates through the body, converting nutrients and drugs absorbed from the digestive tract into ready­to­use chemicals. The liver performs many other important functions, such as removing toxins and other chemical waste products from the blood and readying them for excretion. Because all the blood in the body must pass through it, the liver is unusually accessible to cancer cells traveling in the bloodstream.

The liver can be affected by primary liver cancer, which arises in the liver, or by cancer which forms in other parts of the body and then spreads to the liver. Most liver cancer is secondary or metastatic, meaning it started elsewhere in the body. Primary liver cancer, which starts in the liver, accounts for about 2% of cancers in the U.S., but up to half of all cancers in some undeveloped countries. This is mainly due to the prevalence of hepatitis, caused by contagious viruses, that predisposes a person to liver cancer. In the U.S., primary liver cancer strikes twice as many men as women, at an average age of 67.

Because the liver is made up of several different types of cells, several types of tumors can form there. Some of these are benign (noncancerous), and some are cancerous and can spread to other parts of the body (metastasize). These tumors have different causes and are treated differently. The outlook for health or recovery depends on what type of tumor you have.

 

Liver Tumors: Types & Stages

There are two types of primary liver tumors or cancers. The first and more common of the two is hepatocellular carcinoma (HCC). HCC is most commonly caused by cirrhosis of the liver. Alcoholism and hepatitis C are the two most common causes of cirrhosis in the U.S. Obesity, anabolic steroid abuse, exposure to certain chemicals, and Hepatitis B have also been linked to hepatocellular carcinoma.

Because it often doesn’t cause symptoms in its early stages hepatocellular carcinoma often goes undetected until in its advanced stages. When HCC symptoms are present, they include weight loss, nausea, pain on the upper right side of the abdomen, a feeling of fullness after eating a small amount, and jaundice (yellowing of the eyes and skin). HCC treatment options depend on the stage of the liver cancer and may include: liver resection, in which the tumor is surgically removed; radiofrequency ablation, in which microwaves are used to kill the tumor; radiation; and chemotherapy. A team of physicians works with our patients to decide which HCC treatment option will be best for him or her.

Cholangiocarcinoma, or bile duct cancer, is a fast­moving and often lethal form of cancer. It is a relatively rare, but aggressive tumor that grows from the bile ducts of the liver. There are only approximately 5,000 new cases of cholangiocarcinoma each a year and it is a difficult cancer to cure. The preferred cholangiocarcinoma treatment is surgical resection of the liver or liver transplantation. Cholangiocarcinoma treatment options are determined based on how advanced the cancer is. For bile duct cancer patients that are not surgical candidates, cholangiocarcinoma can be managed, though not cured, with adjuvant therapies like chemotherapy and radiation.

A staging system is a standard way for the cancer care team to sum up information about how far a cancer has spread. Doctors use staging systems to get an idea about a patient’s prognosis (outlook) and to help determine the most appropriate treatment.

The TNM system for staging contains 3 key pieces of information:

  • T describes the number and size of the primary tumor(s), measured in centimeters (cm), and whether the cancer has grown into nearby blood vessels or organs.
  • describes the extent of spread to nearby (regional) lymph nodes,which are bean­sized collections of immune system cells to which cancers often spread first.
  • M indicates whether the cancer has metastasized(spread) to distant parts of the body

Numbers or letters that appear after T, N, and M provide more details about each of these factors:

  • The numbers 0 through 4 indicate increasing severity.
  • The letter X means “cannot be assessed” because the information is not available.

T groups

  • TX:Primary tumor cannot be assessed
  • T0:No evidence of primary tumor
  • T1:A single tumor (any size) that hasn’t grown into blood vessels
  • T2:Either a single tumor (any size) that has grown into blood vessels, OR more than one tumor but no tumor is larger than 5 cm (about 2 inches) across
  • T3a:More than one tumor, with at least one tumor larger than 5 cm across T
  • 3b:At least one tumor (any size) that has grown into a major branch of a large vein of the liver (the portal or hepatic vein)
  • T4:The tumor (any size) has grown into a nearby organ (other than the gallbladder), OR the tumor is growing into the thin layer of tissue covering the liver (called the visceral peritoneum)

N groups

  • NX:Regional (nearby) lymph nodes cannot be assessed.
  • N0:The cancer has not spread to the regional lymph nodes.
  • N1:The cancer has spread to the regional lymph nodes.

M groups

  • M0:The cancer has not spread to distant lymph nodes or other organs.
  • M1:The cancer has spread to distant lymph nodes or other organs. Liver cancer most often spreads to the lining of the belly (peritoneum), the lungs, and to bones.

Stages of liver cancer

Once the T, N, and M groups have been determined, they are then combined to give an overall stage, using Roman numerals I to IV (1 to 4).

 Stage Stage grouping Stage description
I T1, N0, M0 There is a single tumor (any size) that has not grown into any blood vessels. The cancer has not spread to nearby lymph nodes or distant sites.
II T2, N0, M0 Either there is a single tumor (any size) that has grown into blood vessels, OR there are several tumors, and all are 5 cm (2 inches) or less across. The cancer has not spread to nearby lymph nodes or distant sites.
IIIA T3a, N0, M0 There is more than one tumor, and at least one is larger than 5 cm (2 inches) across. The cancer has not spread to nearby lymph nodes or distant sites.
IIIB T3b, N0, M0 At least one tumor is growing into a branch of a major vein of the liver (portal vein or hepatic vein). The cancer has not spread to nearby lymph nodes or distant sites
IIIC T4, N0, M0 A tumor is growing into a nearby organ (other than the gallbladder), OR a tumor has grown into the outer covering of the liver. The cancer has not spread to nearby lymph nodes or distant sites.
IVA Any T, N1, M0 Tumors in the liver can be any size or number and they may have grown into blood vessels or nearby organs. The cancer has spread to nearby lymph nodes. The cancer has not spread to distant sites
IVB Any T, Any N, M1 The cancer has spread to other parts of the body. (Tumors can be any size or number, and nearby lymph nodes may or may not be involved.)

Liver Tumors: Detection & Treatment Options

If you have symptoms of liver cancer, the first step is a physical exam. The doctor will:

  • Feel your abdomen to examine the liver, spleen and nearby organs
  • Check your abdomen for ascites, an abnormal accumulation of fluid
  • Examine your skin and eyes for signs of jaundice If the doctor suspects liver cancer, you may have one or more of the following tests to diagnose it and find out if it has spread.

Blood tests: One common blood test detects alpha­fetoprotein (AFP), which can be a sign of liver cancer. Other blood tests may measure how well the liver is working.

Imaging tests, which may include:

  • CT or CAT (computed axial tomography) scans: This is usually the most reliable test for evaluating the extent of liver cancer. Our technology includes the precise triple­phase CT scan.
  • Ultrasound
  • Angiogram: The doctor injects dye into an artery. This allows the blood vessels in the liver to be seen on an X­ray.

Biopsy:A sample of tissue from the tumor or the healthy part of the liver is removed and looked at under a microscope. Healthy tissue may be tested to see how well the liver is working. A biopsy may be obtained by:

  • Fine needle aspiration (FNA): A thin needle is inserted into the liver to remove a small amount of tissue.
  • Core biopsy: This is similar to FNA, but a thicker needle is used to remove small cylinder­shaped samples (cores).
  • Laparoscopy: A small incision (cut) is made in the abdomen, and a thin, lighted tube (laparoscope) is inserted to view the tumor.
  • Surgical biopsy: Tissue is removed during an operation.

General treatment information

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment options and recommendations depend on several factors:

  • How much of the liver the cancer is affecting
  • Whether the cancer has spread
  • The patient’s preferences and overall health
  • The damage to the remaining cancer­free area of the liver

When a tumor is found at an early stage and the patient’s liver is working well, treatment is aimed at trying to eliminate the cancer. The care plan may also include treatment for symptoms and side effects, an important part of cancer care. When liver cancer is found at a later stage, or the patient’s liver is not working well, the patient and doctor should talk about the goals of each treatment recommendation. At this point, the goals of treatment may focus on slowing growth of the cancer and relieving symptoms to improve quality of life.

The various disease­directed treatment options can be grouped according to whether they may cure the cancer or will improve survival but will most likely not eliminate the cancer. Descriptions of the most common treatment options, both disease­directed and those aimed at managing side effects and symptoms, are listed below. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

The main treatments for stomach cancer are:

  • Surgery
  • Disease­directed treatments
  • Targeted therapy
  • Radiation therapy
  • Chemotherapy
  • Immunotherapy

Often the best approach uses 2 or more of these treatment methods.

Liver Tumors: FAQs

Answer :

The liver is the largest solid organ in the body. It is located behind the ribs on the right side of the body, under the right lung. It is important for many metabolic functions.

Answer :

No. The liver stores nutrients that help feed the body when a person has not eaten for a few hours. It also changes other nutrients into more basic elements before sending them to other parts of the body to be used. The liver helps break down sugars, starch, fats, and proteins.

The liver also makes albumin, a protein that helps the body balance fluids. The liver makes clotting factors. They help blood thicken or clot when a person is bleeding. Bile made in the liver is important for digesting food and for other bodily functions.

One of the liver’s most important functions is to collect and destroy poisons in the body. The liver breaks down and removes medicines. When the liver is not working well, chemicals can build up inside the body and cause damage.

Answer :

Liver cancer is cancer that starts in the cells of the liver. It is not the same as cancers that start somewhere else in the body and then spread to the liver. Healthcare providers call those cancers liver metastases (or secondary liver cancers).

Liver cancer is rare in the United States and Europe. It is the most common form of cancer in some African and East Asian countries, though. There are several kinds of liver cancers:

  • Hepatocellular carcinoma (by far the most common type)
  • Intrahepatic cholangiocarcinoma
  • Hepatoblastoma
  • Angiosarcoma
Answer :

In 2016, the American Cancer Society estimates there will be 39,230 new cases of primary liver cancer, and 2,000 to 3,000 people will develop bile duct cancer. Men are more likely to get liver cancer than women. Liver cancer is more common in some African and East Asian countries than in North America and Europe. In some areas of Africa and Asia, it is the most common type of cancer.

Answer :

A person can have liver cancer for months or years before having symptoms of the disease. People do not usually show symptoms of liver cancer until the cancer grows large enough to push against other parts of the liver or against other organs in the stomach.

People with liver cancer may have any or all of these symptoms:

  • Weight loss
  • A sudden lack of appetite that lasts for a long time or a feeling of being very full
  • after eating a small meal.
  • Lump or mass in the upper­right side of the stomach
  • Pain in the stomach
  • Swollen stomach (bloating)
  • Jaundice (yellowing of the eyes and skin)
  • Fever

All these symptoms can be caused by many other medical problems. If you have any of these symptoms, you should see your healthcare provider as soon as possible.

Answer :

If you think you might have liver cancer, you should have a medical exam. Many tests may be needed to confirm liver cancer. The steps to diagnosing liver cancer might include a medical history, physical exam, blood tests, imaging tests, and a liver biopsy (removing small pieces of tumor for lab tests). Imaging tests for liver cancer can include ultrasound, MRI (magnetic resonance imaging) and CT (computed tomography) scan. In some cases, the diagnosis of liver cancer can be made by MRI alone (without a liver biopsy). If the diagnosis is in doubt, however, a biopsy is performed.

Answer :

Many people with cancer get an opinion from a second healthcare provider who is a liver specialist. There are many reasons to get a second opinion. Here are some of those reasons:

  • Not feeling comfortable with the treatment decision
  • Being diagnosed with a rare type of cancer
  • Having several treatment choices
  • Not being able to see a cancer expert

Many people have a hard time deciding on a liver cancer treatment. It may help to have a second healthcare provider review the diagnosis and treatment choices before starting treatment. It is important to remember that in most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion. Most other insurance companies will pay for a second opinion if asked.

Answer :

There are many ways to get a second opinion:

  • Ask a primary healthcare provider.He or she may be able to suggest a specialist who is a liver expert. This may be a hepatologist, surgeon, liver transplant surgeon, medical oncologist, interventional radiologist, or radiation oncologist. Sometimes these healthcare providers work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.
  • Call the National Cancer Institute’s Cancer Information Service.The number is 800­4­CANCER (800­422­6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
  • Seek other choices.Check with a local medical society, a nearby hospital or medical school, or a support group to get names of healthcare providers who can give you a second opinion. Or ask other people who’ve had cancer for their recommendations. You may also call a cancer center directly to ask for an appointment.
Answer :

You may have one treatment or many treatments together:

  • Surgery.Surgery offers the best chance to cure liver cancer, but unfortunately only a small percentage of people can have surgery. If the cancer is small and in only one part of the liver (and the rest of the liver is healthy enough), the part of the liver containing the cancer can be removed in an operation called a hepatectomy. Another choice for some people might be to remove the entire liver and replace it with a liver transplant.
  • Tumor ablation and embolization.These techniques can be used to treat some tumors in the liver. Ablation is the use of extreme heat (such as in radiofrequency ablation, or RFA), cold (cryoablation), or other methods to destroy tumors rather than removing them. For embolization, a substance is injected into a blood vessel to try to cut off a tumor’s blood supply. Sometimes this is combined with radiation (radioembolization) or chemotherapy (chemoembolization).
  • Radiation therapy.Radiation therapy uses high­energy X­rays to kill cancer cells. It is used mainly when surgery or or treatments aren’t likely to be good choices.
  • Targeted therapy. This type of therapy uses medicines that target proteins or cell functions that help cancer cells grow. It is used mainly for advanced liver cancers that can’t be treated with other methods.
  • Chemotherapy. The goal of chemotherapy is to stop cancer from growing or spreading. It does this by using medicines to either kill the cells or stop them from dividing. Chemotherapy can be used to treat advanced liver cancer. It is not usually as helpful as targeted therapy.

Healthcare providers are always finding new ways to treat liver cancer. These new methods are tested in clinical trials. Before beginning treatment, you should ask your healthcare provider if there are any clinical trials you should consider.

Answer :

Here’s an overview of some new prevention and treatment methods being studied:

  • Ways to prevent hepatitis infections that cause liver cancer
  • Medicines that treat chronic hepatitis.
  • New forms of targeted therapy, including medicines that can be taken in higher doses
  • Local chemotherapy with beads or oil injected into or near the tumor. The goal is to have fewer side effects than systemic chemotherapy. This goes into the bloodstream and throughout the entire body.
  • Radiation using radioactive beads or external beam radiation therapy. Improved identification of which people with this cancer might benefit from liver transplants. Advances continue to be made in transplantation.

Gene therapy (research only). This may improve a person’s chance of surviving liver cancer.

Answer :

Clinical trials are studies of new cancer treatments. Healthcare providers do clinical trials to learn how well new treatments will work. They also do trials to test for side effects. A promising treatment is compared to the current treatment to see if it works better or has fewer side effects. People who participate in these studies may benefit from new treatments before the FDA approves them. Research studies also help further our understanding of cancer and help future cancer patients.