Liver Cancer

The largest organ inside the abdomen, the liver filters harmful substances from the blood in addition to making substances (enzymes and bile) that help digest food. It also converts food into substances needed for life and growth.

Cancer that forms inside the liver is called primary liver cancer. While far less common than cancer that spreads to the liver from somewhere else in the body (metastatic cancer), each year approximately 15,000 men and 6,000 women in the United States are told they have liver cancer. Most of those who are diagnosed with liver cancer are more than 64 years old.

In a healthy liver, normal cells grow and divide to form new cells that replace those that grow old, get damaged or die. Sometimes, though, this process goes wrong and new cells form when the body doesn't need them - or old or damaged cells don't die as they should. These extra cells can form a mass of tissue called a growth, nodule or tumor.

Growths in the liver can be benign or malignant. Benign growths are not cancer. They can be removed, are rarely a threat to life and don't grow back. They also don't invade the tissues around them and don't spread to other parts of the body.

Malignant growths, however, are cancer. They may be a threat to life and cannot always be removed. If they are removed they can grow back. They also can invade and damage nearby tissues and organs such as the stomach or intestine and can spread to other parts of the body.

Most primary liver cancers begin in liver cells (hepatocytes). This type of cancer is known as hepatocellular carcinoma or malignant hepatoma.

Prevention

The main cause of liver cancer around the world is infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV). Liver cancer can develop after many years of infection with either of these viruses, so avoiding becoming infected may prevent liver cancer.

HBV and HCV can be spread by sexual contact or through blood (such as by sharing IV drug needles). An infected mother can also pass the virus on to her baby.

A vaccine is available to prevent uninfected people from catching HBV. Researchers are currently working on a vaccine for HCV, too.

Drinking alcohol only in moderation may also prevent liver cancer as heavy alcohol use (more than two drinks a day for many years) is known to increase risk. The risk increases with the amount of alcohol a person drinks.

Both heavy drinking and infection with HBV or HCV, can cause cirrhosis, a serious disease that develops when liver cells are damaged and replaced with scar tissue. Almost all cases of liver cancer in the United States occur in people who first had cirrhosis. Cirrhosis is also caused by certain drugs, parasites or by a condition that causes too much iron to be stored in the liver.

Obesity and diabetes have both also been shown to be risk factors for liver cancer.

Eating foods tainted with aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts, that have not been stored properly) is also a risk factor for developing liver cancer. However, the United States has safety measures limiting aflatoxin in the food supply.
Symptoms

Symptoms of liver cancer include pain on the right side of the upper abdomen; a lump or a feeling of heaviness in the upper abdomen; swollen abdomen (bloating); loss of appetite and feelings of fullness; weight loss; weakness or feeling very tired; nausea and vomiting; yellow skin and eyes, pale stools and dark urine (from jaundice); and fever.

These symptoms may be caused by other health problems in addition to liver cancer. If you are experiencing any of them, see your primary health physician or gastroenterologist for a complete diagnosis so that problems can be treated as early as possible.

Treatment

In order to choose the best treatment for liver cancer, doctors first need to determine the extent or stage of the disease. Staging is an attempt to find out whether the cancer has spread and, if so, to what parts of the body. Liver cancer that has spread may be found in the lungs, bones and in lymph nodes near the liver.

Treatment options include surgery (including a liver transplant), ablation, embolization,, targeted therapy, radiation therapy and chemotherapy. Patients with liver cancer may receive a combination of these treatments.

Currently, liver cancer can be cured only when found in an early stage (before it has spread) and only if the patient is healthy enough to have surgery. Other treatments may be able to help people who can't have surgery live longer and feel better. Doctors often encourage people with liver cancer to consider taking part in clinical trials (research studies) that are testing new treatments.

Surgery

For people with an early stage of liver cancer, surgical options include liver transplant, or removal of part of the liver.

Liver transplant (total hepatectomy) is an option if the tumors are small, the cancer has not spread outside the liver and suitable donated liver tissue can be found. Donated liver tissue comes from a deceased person or a live donor. If the donor is living, the tissue is part of a liver rather than a whole liver.

Removal of part of the liver is called partial hepatectomy. A person with liver cancer may have part of the liver removed if lab tests show that the liver is working well and if there is no evidence that the cancer has spread to nearby lymph nodes or to other parts of the body.

The surgeon removes the tumor or tumors along with a margin of healthy tissue surrounding the tumor. The extent of the surgery depends on the size, number and location of the tumors and how well the liver is working.

After the tumor is removed, the remaining healthy tissue takes over the work of the liver. Over a period of several weeks, the missing part of the liver can grow back.

Ablation

Methods of ablation destroy the cancer in the liver. They are treatments to control liver cancer and extend life. People waiting for a liver transplant and people for whom surgery is not an option may have ablation.

Methods of ablation include:

Radiofrequency ablation:

A probe containing tiny electrodes is used to kill the cancer cells with heat. Ultrasound, CT or MRI may be used to guide the probe to the tumor. Usually, the doctor can insert the probe directly through the skin and only local anesthesia is needed. But sometimes, the doctor inserts the probe through a small incision in the abdomen using an instrument called a laparoscope or through a wider incision that opens the abdomen.

Radiofrequency ablation is a type of hyperthermia therapy - a treatment in which body tissue is exposed to high temperatures to kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs. Other therapies that use heat to destroy liver turmors include laser or microwave therapy, but these are used less frequently than radiofrequency ablation.

Percutaneous ethanol injection:

The doctor uses ultrasound to guide a thin needle into the liver tumor. Alcohol (ethanol) is injected directly into the tumor and kills cancer cells. The procedure may be performed once or twice a week. Usually local anesthesia is used, but if you have many tumors in the liver, general anesthesia may be needed.
Embolization

For those who can't have surgery, embolization or chemoembolization may be an option. These procedures block the flow of blood to tumors causing them to die. In embolization, blood flow is blocked by tiny sponges or other particles injected into the hepatic artery through a tiny catheter inserted through an artery in the leg. During chemoembolization, an anticancer drug (chemotherapy) is injected into the artery before the tiny particles that block blood flow. Without blood flow, the drug stays in the liver longer.

Other nonsurgical treatments sometimes used for liver cancer include targeted therapy (the administering of a drug by mouth that slows the growth of liver tumors and reduces their blood supply); radiation therapy (the use of high-energy rays to kill cancer cells) and chemotherapy (the use of drugs, usually given through a vein, to kill liver cells).

The information provided on these educational pages is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. And, if experiencing a medical emergency call 9-1-1.

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