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.
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 extrahepatic 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 percent.
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
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.
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 following:
- 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.
Treatment for liver cancer varies. It depends on:
- the number, size, and location of the tumors in the liver
- 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.
Ablation involves 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.
Radiation therapy 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
Embolization and 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.
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.
- Maintain 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 screening.
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.