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.
If you have symptoms of liver cancer, the first step is a physical exam. The doctor will:
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:
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:
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:
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:
Often the best approach uses 2 or more of these treatment methods.
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:
Numbers or letters that appear after T, N, and M provide more details about each of these factors:
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.)|
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.
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.
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:
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.
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:
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.
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.
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:
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.
There are many ways to get a second opinion:
You may have one treatment or many treatments together:
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.
Here’s an overview of some new prevention and treatment methods being studied:
Gene therapy (research only). This may improve a person’s chance of surviving liver cancer.
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.