What Is Liver Cancer?
Liver cancer is cancer that occurs in the liver. The liver is the
largest glandular organ in the body and performs various critical functions to
keep the body free of toxins and harmful substances. It’s located in the right
upper quadrant of the abdomen, right below the ribs. The liver is responsible
for producing bile, which is a substance that helps you digest fats, vitamins,
and other nutrients. This vital organ also stores nutrients such as glucose, so
that you remain nourished at times when you’re not eating. It also breaks down
medications and toxins. When cancer develops in the liver, it destroys liver
cells and interferes with the ability of the liver to function normally.
Liver cancer is generally classified as primary or secondary. Primary liver cancer begins in
the cells of the liver. Secondary liver
cancer develops when cancer cells from another organ spread to the
liver. Unlike other cells in the body, cancer cells can break away from the
primary site, or where the cancer began. The cells travel to other areas of the
body through the bloodstream or the lymphatic system. Cancer cells eventually collect in another body
organ and begin to grow there.
This article focuses on primary liver cancer. If you had cancer
in another organ before you developed liver cancer, please see our article
about liver metastasis
to learn more about secondary liver cancer.
What Are the Different Types of Primary Liver Cancer?
The different types of primary liver cancer originate from the
various cells that make up the liver. Primary liver cancer can start as a
single lump growing in the liver, or it can start in many places within the
liver at the same time. People with severe liver damage are more likely to have
multiple cancer growth sites. The main types of primary liver cancer are:
Hepatocellular carcinoma (HCC), also known as hepatoma, is the
most common type of liver cancer, accounting for 75 percent of all
liver cancers. This condition develops in the hepatocytes, which are the predominant
liver cells. It can spread from the liver to other parts of the body, such as
the pancreas, intestines, and stomach. HCC is much more likely to occur in
people who have severe liver damage due to alcohol abuse.
Cholangiocarcinoma, more commonly known as bile duct cancer,
develops in the small, tube-like bile ducts in the liver. These ducts carry
bile to the gallbladder to help with digestion. Bile duct cancer accounts for
approximately 10 to
20 percent of all liver cancers. When the cancer begins in the section of the
ducts inside the liver, it’s called intrahepatic bile duct cancer. When the
cancer begins in the section of the ducts outside the liver, it’s called
intrahepatic bile duct cancer.
Liver angiosarcoma is a rare form of liver cancer that begins in
the blood vessels of the liver. This type of cancer tends to progress very
quickly, so it’s typically diagnosed at a more advanced stage.
Hepatoblastoma is an extremely rare type of liver cancer. It’s nearly
always found in children, especially those under age 3. With surgery and
chemotherapy, the outlook for people with this type of cancer can be very good.
When hepatoblastoma is detected in the early stages, the survival rate is
higher than 90
What Are the Symptoms of Liver
Many people don’t experience symptoms in the early stages of
primary liver cancer. When symptoms do appear, they may include:
- abdominal discomfort, pain, and tenderness
- yellowing of the skin and the whites of the
eyes, which is called jaundice
- white, chalky stools
- bruising or bleeding easily
Who Is at Risk for Liver Cancer?
Doctors aren’t sure why some people get liver cancer while others
don’t. However, there are certain factors that are known to increase the risk of
developing liver cancer:
- Liver cancer is more common in people over age 50.
- A long-term hepatitis B or C infection can
severely damage your liver. Hepatitis is spread from person-to-person through
direct contact with the bodily fluids of an infected person, such as their
blood or semen. It may also be passed from mother to child during childbirth. You
can lower your risk for hepatitis B and C by using protection during sexual
intercourse. There’s also a vaccine that can protect you against hepatitis B.
- Having two or more alcoholic beverages every day
over many years increases your risk for liver cancer.
- Cirrhosis is a form of liver damage in which
healthy tissue is replaced by scarred tissue. A scarred liver can’t function properly
and may ultimately lead to numerous complications, including liver cancer.
Long-term alcohol abuse and hepatitis C are the most common causes of cirrhosis
in the United States. The majority of Americans with liver cancer have
cirrhosis before they develop liver cancer.
- Exposure to aflatoxin is a risk factor. Aflatoxin
is a toxic substance produced by a type of mold that can grow on peanuts, grains,
and corn. In the United States, food-handling laws limit widespread exposure to
aflatoxin. Outside of the country, however, aflatoxin exposure can be high.
- Diabetes and obesity are also risk factors. People
with diabetes tend to be overweight or obese, which can cause liver problems
and increase risk for liver cancer.
How Is Liver Cancer Diagnosed?
The diagnosis of liver cancer begins with a medical history and a
physical examination. Make sure to tell your doctor if you have a history of
long-term alcohol abuse or a chronic hepatitis B or C infection.
Diagnostic tests and procedures for liver cancer include the
- Liver function tests help your doctor determine
the health of your liver by measuring levels of proteins, liver enzymes, and
bilirubin in your blood.
- The presence of alpha-fetoprotein (AFP) in the blood can be a sign of
liver cancer. This protein is usually only produced in the liver and yolk sac
of babies before they’re born. AFP production normally stops after birth.
- Abdominal CT or MRI scans produce detailed images
of the liver and other organs in the abdomen. They can allow your doctor to pinpoint
where a tumor is developing, determine its size, and assess whether it has
spread to other organs.
Another diagnostic test available is a liver biopsy. A liver
biopsy involves removing a small piece of liver tissue. It’s always done using
anesthesia to prevent you from feeling any pain during the procedure.
In most cases, a needle biopsy is performed. During this
procedure, your doctor will insert a thin needle through your abdomen and into
your liver to obtain a tissue sample. The sample is then examined under a
microscope for signs of cancer.
A liver biopsy might also be performed using a laparoscope, which
is a thin, flexible tube with an attached camera. The camera allows your doctor
to see what the liver looks like and to perform a more precise biopsy. The
laparoscope is inserted through a small incision in the abdomen. If tissue
samples from other organs are needed, your doctor will make a larger incision.
This is called a laparotomy.
If liver cancer is found, your doctor will determine the stage of
the cancer. Staging describes the severity or extent of the cancer. It can help
your doctor determine your treatment options and your outlook. Stage 4 is the
most advanced stage of liver cancer.
How Is Liver Cancer Treated?
Treatment for liver cancer varies. It depends on:
- the number, size, and location of the tumors in
- how well the liver is functioning
- whether cirrhosis is present
- whether the tumor has spread to other organs
Your specific treatment plan will be based on these factors. Liver
cancer treatments may include the following:
A hepatectomy is performed
to remove either a portion of the liver or all of the liver. This surgery is
usually done when the cancer is confined to the liver. Over time, the remaining
healthy tissue will regrow and replace the missing part.
A liver transplant
involves replacing the entire diseased liver with a healthy liver from a
suitable donor. A transplant can only be done if the cancer hasn’t spread to
other organs. Medicines to prevent rejection are given after the transplant.
the use of heat or ethanol injections to destroy the cancer cells. It’s performed
using local anesthesia. This numbs the area to prevent you from feeling any
pain. Ablation can help people
who aren’t candidates for surgery or a transplant.
Chemotherapy is an
aggressive form of drug therapy that destroys cancer cells. The medications are
injected intravenously, or through a vein. In most cases, chemotherapy can be
given as an outpatient treatment. Chemotherapy can be effective in treating
liver cancer, but many people experience side effects during treatment,
including vomiting, decreased appetite, and chills. Chemotherapy can also
increase your risk of infection.
involves the use of high-energy radiation beams to kill cancer cells. It
can be delivered by external beam radiation or by internal radiation. In
external beam radiation, the radiation is aimed at the abdomen and chest.
Internal radiation involves the use of a catheter to inject tiny radioactive
spheres into the hepatic artery. The radiation then destroys the hepatic artery,
a blood vessel that supplies blood to the liver. This decreases the amount of
blood flowing to the tumor. When the hepatic artery is closed off, the portal
vein continues to nourish the liver.
Targeted therapy involves the use of medications that are
designed to hit cancer cells where they’re vulnerable. They decrease tumor
growth and help shut down blood supply to the tumor. Sorafenib
(Nexavar) has been approved as targeted therapy for people with liver cancer.
Targeted therapy can be helpful for people who aren’t candidates for a hepatectomy or liver transplant.
However, targeted therapy can have significant side effects.
Embolization and Chemoembolization
chemoembolization are surgical procedures. They’re done to block off the
hepatic artery. Your doctor will use small sponges or other particles to do
this. This reduces the amount of blood flowing to the tumor. In chemoembolization,
your doctor injects chemotherapy drugs into the hepatic artery before the
particles are injected. The blockage created keeps the chemotherapy medications
in the liver for a longer period.
How Can Liver Cancer Be Prevented?
Liver cancer can’t always be prevented. However, you reduce your
risk for liver cancer by taking steps to prevent the development of conditions
that can lead to liver cancer.
Get the Hepatitis B Vaccine
There’s a vaccine for hepatitis B that all children should
receive. Adults who are at high risk for infection, such as those who abuse
intravenous drugs, should also be vaccinated. The vaccination is usually given
in a series of three injections over a period of six months.
Take Measures to Prevent Hepatitis C
There’s no vaccine for hepatitis C, but you can reduce your risk
of getting the infection by doing the following:
- Use protection. Always practice safe sex by
using a condom with all of your sexual partners. You should never engage in
unprotected sex unless you're certain your partner isn't infected with
hepatitis or any other sexually transmitted infection.
- Don’t use illegal drugs. Avoid using illegal
drugs, particularly those that can be injected, such as heroin or cocaine. If
you’re unable to stop using drugs, make sure to use a sterile needle each time
you inject them. Never share needles with other people.
- Be cautious about tattoos and piercings. Go to a
trustworthy shop whenever you get a piercing or tattoo. Ask employees about
their safety practices and make sure they use sterile needles.
Reduce Your Risk of Cirrhosis
You can lower your risk of cirrhosis by doing the following:
- If you drink
alcohol, drink in moderation. Limiting the amount of alcohol you
drink can help prevent liver damage. Women shouldn’t drink more than one drink
per day, and men shouldn’t drink more than two drinks per day.
a healthy weight. Exercising for 30 minutes at least three times
per week can help you maintain your weight. Eating a balanced diet is also
important for weight management. Make sure you incorporate lean protein, whole
grains, and vegetables or fruit into most of your meals. If you need to lose
weight, increase the amount of exercise you do each day and reduce the number
of calories you consume. You may also want to consider meeting with a
nutritionist. They can help you create a meal plan and exercise routine that
allow you to achieve your weight loss goals more quickly.
If you already have one of these conditions and you’re concerned
about your risk for liver cancer, talk to your doctor about a liver cancer
Coping with Liver Cancer
A liver cancer diagnosis can be overwhelming. It’s important to
have a strong support network that can help you deal with any stress or anxiety
you may be feeling. You may want to speak with a counselor who can help you
work through your emotions. You might also want to consider joining a cancer
support group where you can discuss your concerns with others who can relate to
what you’re going through. Ask your doctor about support groups in your area.
You can also find information on support groups on the National
Cancer Institute and the American
Cancer Society websites.