Liver Cancer

Liver cancer is a condition where abnormal cells grow into a tumor in the liver.

Liver cancer can be primary (meaning it starts in the liver) or secondary (meaning it has spread from another organ). The most common type of liver cancer is hepatocellular carcinoma (sometimes shortened to HCC).

Chronic liver infections with hepatitis B or C, cirrhosis, obesity, smoking, and heavy alcohol consumption can increase the risk of liver cancer.

There are many options for diagnosing and treating liver cancer, and its progress or stage determines treatment options.

Learn more about liver cancer, including its definition, symptoms, complications, staging, prognosis, and treatment options.

Liver cancer definition, symptoms and complications

What is liver cancer?

The liver is a large organ in the lower abdomen with several functions. It filters harmful substances from the blood so they can be passed from the body in stools and urine. It also makes bile to help digest fat that comes from food and stores glycogen (sugar), which the body uses for energy.

Cancer beginning in the liver occurs when abnormal cells begin to grow out of control in the liver, often after symptoms of liver malfunction have begun to occur. The tumors beginning in the liver can spread to lymph nodes, tissues and other organs as it progresses.

Because all the blood in the body must pass through the liver, it is unusually accessible to cancer cells that travel in the bloodstream. Most liver cancers are metastases from some other organ, so these cancers are treated differently than primary tumors that originate in the liver.

Learn more about liver cancer from Siteman Cancer Center>>

Are there different types of liver cancer?

The two types of primary liver cancer are:

• Hepatocellular carcinoma: This is the most common type of primary liver cancer. Hepatocellular carcinoma occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection. This cancer is also sometimes related to long-term Type 2 diabetes, smoking, alcohol use, and obesity.
• Cholangiocarcinoma: This is cancer that begins in the bile duct of the liver, the slender tubes that carry the digestive fluid bile through the liver. Doctors divide cholangiocarcinoma into different types based on where the cancer occurs in the bile ducts. These cancers are more often caused by genetic conditions, diseases that harden bile ducts and old age.

Learn more about cholangiocarcinoma>>

What are the symptoms of liver cancer?

Symptoms differ between patients, but those experiencing early stages of liver cancer may experience the following:

• A hard lump on the right side just below the rib cage
• Discomfort in the upper abdomen on the right side
• A swollen abdomen
• Pain near the right shoulder blade or in the back
• Jaundice (yellowing of the skin and whites of the eyes)
• Easy bruising or bleeding
• Unusual tiredness or weakness
• Nausea and vomiting
• Loss of appetite or feelings of fullness after eating a small meal
• Weight loss for no known reason
• Pale, chalky bowel movements and dark urine
• Fever

Learn more about liver cancer symptoms, risk, and diagnosis>>

Liver cancer stages

Like other cancers, liver cancer progresses in stages, during which symptoms may change or become more severe. Liver cancer is staged differently from other cancers. The Barcelona Clinic Liver Cancer (BCLC) Staging System is widely used to predict the patient’s chance of recovery and to plan treatment. It is based specifically on where the cancer as spread, how well the liver works, and general health and wellness of the patient.

The BCLC staging system has five stages:

• Stage 0: Very early cancer with no symptoms and a small number of cancerous cells in one layer of tissue.
• Stage A: Early cancer with mild symptoms and a localized tumor that remains in one area of the liver.
• Stage B: Intermediate stage cancer that may have more advanced symptoms and has spread through parts of the liver.
• Stage C: Advanced stage cancer that has progressed to other regional (nearby) structures.
• Stage D: End-stage cancer that now exists in distant structures, tissues or organs.

For BCLC stages 0, A and B, treatment is administered to cure the cancer. For stages C and D, treatments are not likely to cure the cancer, but symptoms can be relieved.

Are there complications to liver cancer?

Common complications resulting from liver cancer include problems with the correct balancing of molecules in the blood, since this is the main purpose of the liver. Liver cancer may result in a high calcium level in the blood, known as hypercalcemia. This imbalance may cause nausea and vomiting, extreme muscle weakness and confusion, which can progress to coma and even death if left untreated. Anemia, imbalanced blood pressure and high frequency of bleeding can also result from cancerous damage to the liver.

Hepatorenal syndrome is a condition in which liver disease leads to kidney disease due to changes in blood vessels and reduced blood flow to the kidneys. Liver cancer can also impact the brain, as toxins that the liver is unable to remove travel to the brain. This can result in memory loss, disorientation, personality changes and severe confusion that presents like Alzheimer’s disease.

Complications to the function of the bile duct can also pose problems. Liver tumors or bile duct tumors can block ducts (tubes) in the organ, causing bile duct obstruction. When a duct is obstructed, it results in the severe and constant pain in the right upper abdomen, nausea, vomiting, jaundice and itching as bile is unable to travel through the normal routes.

Liver cancer causes, risk factors and prevention

What causes or contributes to the development of liver cancer?

While there are no singular causes for any type of cancer, liver cancer is often the result of another condition that has long-term impacts on the health of the liver. This may be an acquired condition, such as hepatitis B or C, cirrhosis, or other liver damage related to alcohol consumption. Liver cancer is also very frequently a metastatic cancer, meaning that the cancer has traveled to the liver from another location or tissue through the blood.

Are there risk factors for developing liver cancer?

Anything that increases the risk of getting a disease is called a risk factor. Having a risk factor does not mean that someone will get a particular cancer; not having risk factors doesn’t mean that someone will not get a particular cancer.

Risk factors for developing liver cancer include:

• Having hepatitis B and/or hepatitis C
• Having cirrhosis, which can be caused by hepatitis or heavy alcohol use
• Having a metabolic syndrome that may cause high blood sugar, high blood pressure, high levels of triglycerides or other metabolic issues in the blood
• Having a liver injury that is long-lasting, especially if it leads to cirrhosis
• Having hemochromatosis, a condition which misprocesses iron
• Eating foods tainted with aflatoxin, a poison from a fungus that can grow on grains and nuts
• Cancer in another location of the body, developing in the liver as a metastatic cancer

Can liver cancer be prevented? How?

Liver cancer diagnosis and treatment

How is liver cancer diagnosed?

The following screenings, tests and procedures may be used to detect or diagnose liver cancer and determine the stage of its progress:

• Physical exam and history: This basic exam looks at the patient’s medical history, symptoms, abnormalities and family history.
• Tumor marker test: A blood sample is taken to measure the amounts of certain molecules made by tumor cells in the body. Certain molecules at high levels are linked to specific types of cancer, but this test is not definitive. In ten percent of patients with cancer, these molecules will not be elevated, and some without cancer can have elevated levels.
• Liver function test: A blood sample is checked for unusual amounts of certain enzymes that might indicate that cancer has spread from the pancreas to the liver.
• Abdominal CT-Scan: Detailed scans taken of the abdomen and organs can identify some problems, such as the presence of tumors or abnormalities in the pancreatic tissue.
• PET (positron emission tomography) scan: This procedure finds malignant tumor cells in the body by using a small amount of radioactive glucose (sugar) injected into a vein. The PET scanner makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter, because they are more active and use more glucose than normal cells do.
• MRI (magnetic resonance imaging): An MRI uses makes a series of detailed pictures of the liver. To create detailed pictures of blood vessels in and near the liver, dye is injected into a vein. Images may be taken at three different times to get the best picture of abnormal areas in the liver.
• Ultrasound exam: This procedure uses high-energy sound waves (ultrasound) bounced off internal tissues or organs to form a picture of body tissues.
• Laparoscopy: This surgical procedure looks at the organs inside the abdomen to check for signs of disease through small incisions made in the abdomen. A thin, lighted tube is inserted into an incision. Another instrument is inserted through the same or another incision to remove the tissue samples (biopsy).
• Biopsy: Taking a sample of cells so they can be viewed under a microscope to check for signs of cancer.

What options are available for liver cancer treatment? Are any more common or successful?

There are multiple factors of liver cancer that require medical attention, and several methods of treatment may be necessary to address all patient symptoms. Treatment also depends on cancer stage. Treatment methods include:

Surgery and other procedures

Surgery is performed for both primary tumors which started in the liver and for secondary tumors (also called “metastatic”) that travelled to the liver from a different organ such as the colon, lung or breast.

Surgical procedures include:

• Partial hepatectomy (liver resection): This surgery is performed for both primary and secondary tumors, removing the part of the liver where cancer is found, as much as 75 percent of the liver. The remaining liver tissue takes over the functions of the resected liver and will regrow in most cases to the size of the original liver. Chemotherapy is frequently used as an adjunct when secondary tumors are removed to lessen the chance of cancer coming back.
• Staged partial hepatectomy: When there are large or multiple tumors, surgery may be performed in two stages. This is a safer method. Tumors are cleared from one side of the liver in the first procedure. An interventional radiologist may block blood flow to the other side of the liver to encourage growth in the side which has been cleared of tumors. After giving time for the cleared side to grow, the tumors in the other side of the liver are removed.
• Liver transplantation: In this procedure, which is mainly used for primary tumors, the whole liver is removed and replaced with a healthy donor liver. The cancer must be confined to the liver for this surgery to work. While on the waiting list for a new liver, other treatments may be done. Eligible patients with the common kind of liver cancer can be accepted on the liver transplantation list if they have a single tumor that is kept below 5 centimeters (about 2 inches) in diameter or three tumors less than 3 centimeters in diameter. Larger or more tumors may become eligible after treatment.

Learn more about hepatectomy (liver resection)>>

Learn more about transplant for liver cancer>>

After surgery, some patients are given chemotherapy and/or to kill any remaining cancer cells and lessen the chances the cancer will come back.

These procedures include:

• Interventional radiology: These interventional procedures target the tumor and leave most of the liver intact, so the procedure can be repeated if necessary. Many patients need repeated treatments because they are prone to developing new primary or recurrent metastatic liver tumors.
• Chemoembolization: In this procedure, chemotherapeutic drug(s) are delivered into the liver to the tumor through a catheter. A very highly concentrated dose of the drug is delivered to the tumor. The blood vessels are also partially blocked to starve the tumor of its blood supply to slow or stop tumor growth, and sometimes shrink it.
• Radioembolization: This procedure is like chemoembolization, but it is administered with radiation instead of chemotherapy drugs.
• Portal vein embolization: This procedure is used to prepare patients for a liver resection. If the tumor is in one side, the blood supply to that side can be blocked or embolized, allowing the other side to grow and provide enough liver to sustain life. The process can help patients who are not surgical candidates become surgical candidates in about four weeks.

Ablation surgery

This type of treatment uses different techniques to destroy abnormal liver tissue without surgery. It’s useful for certain tumors where location or general health of the patient make surgical resection too risky.

Ablation procedures include:

• Radiofrequency ablation: Through special needles inserted directly into the tumor, high-energy radio waves heat the needles and tumor, killing cancer cells.
• Microwave therapy: In this type of treatment, the tumor is exposed to high temperatures created by microwaves to damage and kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs.
• Cryoablation: The opposite of microwave therapy, a special instrument freezes and destroys cancer cells under ultrasound guidance.
• Electroporation therapy: Currently being studied in clinical trials, this treatment sends electrical pulses through an electrode placed in a tumor to kill cancer cells.

Regional therapy

Local therapy, like surgical resection of a tumor, ablation, stereotactic radiation, or proton beam works well when there are one to three tumors identified. When the cancer is more diffuse, a regional approach addresses multiple tumors, making it more effective than systemic treatment.

Regional therapies include:

• Staged surgery that resects tumors, allowing the liver to grow until other tumors can be reached more effectively
• Liver transplant to replace a liver affected with multiple tumors that are confined to the liver
• Catheter delivery of chemotherapy or radiation into the liver
• Radioembolization to block arteries that feed the tumors

Radiation

Radiation oncology has active trials for minimizing the duration and amount of radiation a patient receives to reduce long-term side effects.

• MRI-guided adaptive radiation therapy: By using an MRI to guide the radiation therapy, radiation oncologists can adjust, or adapt, the radiation to the patient every day.
• Stereotactic body radiation therapy: This method uses special equipment to position a patient and deliver radiation directly to the tumors. The total dose of radiation is divided into smaller doses given over several days. This type of radiation therapy helps prevent damage to normal tissue.
• Proton-beam radiation therapy: This is a type of high-energy radiation therapy that uses streams of protons (small, positively-charged particles of matter) to kill tumor cells. In some cases, it may spare normal liver tissue better than stereotactic radiation. This type of radiation therapy is being studied in clinical trials.

Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient.

What is the prognosis for liver cancer? Is there a cure?

The prognosis and treatment options depend on the following:

• The stage of the cancer (whether it affects part of the liver, involves the whole liver, or has spread to other places in the body).
• Whether the tumor can be completely removed by surgery.
• The patient’s general health.

Liver cancer is best controlled before it has spread and can be removed by surgery.

According to the American Cancer Society, five-year survival rates for localized liver cancer is 35%, while this survival rate for patients with regional and distant liver cancer are 12% and 3%, respectively.

In general, survival rates are higher for people who can have surgery to remove their cancer, regardless of the stage.

For example, studies have shown that patients with small, resectable (removable) tumors who do not have cirrhosis or other serious health problems are likely to do well if their cancers are removed.

For people with early-stage liver cancers who have a liver transplant, the 5-year survival rate is in the range of 60% to 70%.