The liver is the largest organ in the body and performs many important functions to keep a person healthy. Liver cancer is more common in males than females, with males more than twice as likely to develop liver cancer over a lifetime.
Liver cancer can arise in two ways:
Primary liver cancer (most commonly hepatocellular carcinoma) originates in the liver. Metastatic liver cancer results from the spread (metastasis) of cancer from other areas of the body.
Many cases of liver cancer are metastatic liver cancer, due to the fact that the liver has two blood supplies, thus facilitating the spread of cancer from other organs. In these cases, the other organ is considered the primary site of the cancer.
Hepatocellular Carcinoma: The most common form in adults begins in the hepatocytes, the main type of liver cell. Approximately 75 percent of primary liver cancers are of this type. This type of cancer can have different growth patterns. Some begin as a single tumor that grows large and later spreads to other parts of the liver. However, this type of cancer may also begin in many spots throughout the liver and not as a single tumor. This is most often seen in people with liver cirrhosis and is the most common pattern seen in the United States.
Cholangiocarcinomas: These tumors account for approximately 10-20 percent of cases of liver cancer. These cancers start in the small tubes that carry bile to the gallbladder (called bile ducts). Consequently, cholangiocarcinomas are often referred to as bile duct cancer.
Angiosarcomas and Hemangiosarcomas: These tumors are rare forms of cancer that begin in the blood vessels of the liver and grow quickly. Often by the time they are found they are too widespread to be removed.
In its early stages, liver cancer is difficult to detect, which is why it’s sometimes known as the “silent disease.” As the tumor grows, symptoms may include the following:
- Sudden or unexpected weight loss
- Pain in the right side of the upper abdomen
- Loss of appetite
- Excessive fatigue or weakness
- Nausea or vomiting
- Jaundice – yellow skin and eyes, dark urine.
These symptoms do not necessarily confirm the definite presence of liver cancer. However, anyone experiencing any of the symptoms should contact their doctor immediately.
A patient with the above symptoms that suggest liver cancer may be asked to undergo one or more of the following procedures:
Physical exam: During a physical exam, the doctor will feel the abdomen to examine the liver, spleen and nearby organs for abnormalities in their shape or size. The doctor will also check for ascites in the abdomen, which is an abnormal accumulation of fluid. Lastly, the doctor will also examine the skin and eyes for signs of jaundice.
Blood tests: One common blood test detects alpha-fetoprotein (AFP). High AFP levels can be a sign of liver cancer. Other blood may be performed to measure how effectively the liver is performing.
CT Scan: A CT scan uses X-rays to take many pictures of the body, which are then assembled in order to display images of slices of the part of your body being examined. CT scans are very helpful diagnostic tools for locating evidence of liver cancers.
Ultrasound: A test that uses sound waves to render images of internal organs. During an ultrasound the patient lies on a table while a wand is moved over the part of the body being examined
Angiogram: The doctor injects dye into an artery. This allows the blood vessels in the liver to be visible on an X-ray. For an angiogram, the patient may be in the hospital and may have anesthesia.
Biopsy: A sample of tissue is removed from the liver for examination under a microscope. A biopsy may be performed in several ways:
- Fine Needle Aspiration (FNA): A thin needle is inserted into the liver to remove a small amount of tissue
- Core Biopsy: Similar to FNA, but a thicker needle is used to remove small cylinder-shaped samples (cores)
- Laparoscopy: A small incision is made in the abdomen and a thin, lighted tube (laparoscope) is inserted to view the tumor site
- Surgical biopsy: Tissue is removed during an operation
Staging is an attempt to determine the size of the tumor, whether the disease has spread and, if so, to what parts of the body. Careful staging shows whether the tumor can be removed with surgery
Stage I: There is one tumor and it has not spread to nearby blood vessels.
Stage II: One of the following is found:
- One tumor that has spread to nearby blood vessels
- More than one tumor, none of which is larger than five centimeters.
Stage III: Divided into stages IIIA, IIIB and IIIC.
Stage IIIA: More than one tumor larger than five centimeters; or One tumor that has spread to a major branch of blood vessels near the liver
Stage IIIB: There are one or more tumors of any size that have either:
- Spread to nearby organs other than the gallbladder; or
- Broken through the lining of the peritoneal cavity
Stage IIIC: The cancer has spread to nearby lymph nodes.
Stage IV: The cancer has spread beyond the liver to other places in the body, such as the bones or lungs. Tumors may be of any size and may also have spread to nearby blood vessels and/or lymph nodes.
For adult primary liver cancer, stages are also grouped according to how the cancer may be treated:
- Localized resectable: The cancer is found in the liver only, has not spread and can be completely removed by surgery.
- Localized and locally advanced unresectable: The cancer is found in the liver only and has not spread, but cannot be completely removed by surgery.
- Advanced: Cancer has spread throughout the liver or has spread to other parts of the body, such as the lungs and bone.
Liver cancer can be cured only when found in an early stage and before the disease has spread. Treatment procedures may vary depending on the size of the tumor, and whether or not the patient also has cirrhosis of the liver. If cirrhosis is not a factor, the tumor may be surgically removed or destroyed using non-surgical techniques.
Treatment options for liver cancer may include:
Currently, the best chance for potentially curing liver cancer is through surgery. Surgery can be done in attempt to remove the tumor or to do a liver transplant. If the surgeon is able to remove most of the tumor, this betters the chance of a positive outlook for survival. Transplantation involves the removal of the diseased liver, which is then replaced with a healthy organ from a donor. If the patient suffers from cirrhosis or it the tumor is very large, liver transplantation will likely be recommended as the primary treatment option. Transplantation may also be an option for small liver tumors, although not done very often. Transplantation may also carry an added risk for serious infection and other health issues in some liver cancer patients.
Tumor Ablation is a local treatment. Heat (radiofrequency ablation) or extreme cold (cryosurgery) is used to freeze or burn the tumor in place. Ablation may be used when surgical removal of the tumor is not possible. Ablation may help prolong survival for some liver cancer patients.
Embolization involves the injection of tiny plastic pellets or another material into the arteries that carry blood to the tumor. The pellets block blood flow, which makes it harder for the tumor to grow.
High-energy rays are used to shrink or kill liver cancer cells. Radiation can only be used in low doses, as normal liver tissue will be destroyed along with cancer cells. Radiation therapy cannot cure liver cancer, and is typically used to shrink the tumor or relieve pain.
Chemotherapy uses one drug or a combination of drugs to kill cancer cells. Chemotherapy is not generally used to treat liver cancer because of a low response rate, but research is looking into novel ways to administer chemotherapy.
New treatments are always being tested in clinical trials and some patients with cancer may want to consider participating in one of these research studies. These studies are meant to help improve current cancer treatments or obtain information on new treatments. Talk to your doctor about the clinical trials that may be right for you.