Liver Cancer

Liver cancer at a glance

  • Liver cancer develops when cells grow out of control in the liver, the largest internal organ in the body located above the stomach and behind the lower ribs.
  • More than 33,000 people in the United States are diagnosed with the disease each year. It affects men more often than women.
  • The most common form is hepatocellular carcinoma, which affects the most common cells in the organ.
  • In the early stages of liver cancer there are few symptoms, but as the disease progresses individuals may suffer from pain in the upper right side of the abdomen, jaundice and more.
  • Cirrhosis of the liver increases the chances of this cancer as does hepatitis B and C infections.
  • Maintaining a healthy lifestyle through diet, exercising, refraining from smoking and limiting alcohol intake can reduce the chances of the disease.
  • Treatments for liver cancer can include surgery, chemo, medication and radiation.

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What is liver cancer?

The liver is a large organ positioned behind the lower ribs on the right side of the body. When cancer begins in this organ, it is called liver cancer. The most common type of this cancer occurs in the hepatocytes, the most abundant types of cells in the liver, and is known as hepatocellular carcinoma (HCC). According to the Centers for Disease Control and Prevention, about 33,000 people in the United States get liver cancer each year, with rates rising over the last several decades.

HCC occurs three times more often in men than women. This type of cancer is much more common in Southeast Asian and sub-Saharan African countries. According to the American Cancer Society (ACS), more than 700,000 deaths each year are attributed to liver cancer, making it the leading cause of cancer deaths worldwide. The ACS estimates that 31,780 people in the U.S. will die of the disease in 2019.

The liver

This vital organ breaks down and stores nutrients necessary for the body to function. The liver metabolizes some of these nutrients before the body can use them. It helps remove poisons and toxins from the body. Bile, the solution that assists with eliminating waste and digesting fats, is produced in the liver. Additionally, the liver makes many of the clotting factors necessary to stop blood flow when the body is injured.

 

Types of liver cancer

Cancer that has spread from another part of the body to the liver is not called liver cancer. It’s metastatic cancer to the liver.

There are several types of cancer that can form in this organ.

Hepatocellular carcinoma (HCC)

This is the most common type of cancer of the liver. Hepatocellular carcinoma develops in the hepatocytes, which represent the bulk of the tissue mass.

A rare subset of this type of liver cancer is fibrolamellar, which occurs in less than 1% of hepatocellular carcinomas. Fibrolamellar is most commonly seen in women under the age of 35 and tends to have a better outlook than other forms of this disease.

Bile duct cancer (intrahepatic cholangiocarcinoma)

This begins in the bile ducts, which transport bile to the gallbladder. Intrahepatic cholangiocarcinomas make up 10%-20% of liver cancers.

When bile duct cancer begins in the liver it is known as intrahepatic. If it begins outside of the liver it is called extrahepatic bile duct cancer.

Hepatoblastoma

Hepatoblastoma is a rare type of pediatric cancer that typically develops in children under 4. Two out of three children diagnosed with hepatoblastoma are successfully treated.

Angiosarcoma and hemangiosarcoma

These are very rare forms of the disease that begin in the blood vessels within the lining of the organ.

Liver cancer symptoms

Symptoms occur when the normal function of the liver is impaired, or the size alone causes discomfort. In the early stages of this disease, there are often no symptoms or signs.

Symptoms include:

  • Unusual tiredness.
  • Jaundice, or yellowing of the skin and eyes.
  • Discomfort on the right side of the upper abdomen.
  • Pain near the right shoulder blade.
  • Easy bleeding or bruising.
  • Vomiting and nausea.
  • Swollen abdomen.
  • Loss of appetite.
  • Hard lump just below the rib cage on the right side of the body.
  • Weight loss for no reason.

Typically, liver cancer is diagnosed through blood and imaging tests. Sometimes a liver biopsy may be necessary to confirm the diagnosis.

Liver cancer causes

Chronic liver irritation or inflammation is the typical background of HCC. These include chronic hepatitis, cirrhosis or exposure to a known liver toxin such as aflatoxins (more details below). However, with some cases of this disease the cause is not known.

Liver cancer risk factors

Some factors can increase the risk of liver cancer. Those include the following.

  • Chronic hepatitis infection. Long-term hepatitis B virus (HBV) or hepatitis C virus (HCV) are the most common risk factors for developing this type of cancer. HBV and HCV can lead to cirrhosis of the liver.
  • Cirrhosis. When the cells in the liver become damaged, they are replaced by scar tissue. Cirrhosis is often caused by excessive alcohol consumption or chronic hepatitis infections.
  • Lifestyle factors. Obesity, tobacco use and heavy alcohol consumption are all linked to an increased risk of liver cancer.
  • Diabetes. Those with diabetes and other risk factors such as obesity or heavy alcohol use are at greater risk.
  • Inherited diseases. Diseases of the liver such as hemochromatosis and Wilson’s disease can increase the chances of this disease.
  • Exposure to aflatoxins. Aflatoxins are cancer-causing substances produced by molds on crops, like peanuts, wheat, rice and corn, that have been improperly stored.
  • Nonalcoholic fatty liver disease. This risk factor typically occurs in obese individuals.

Liver cancer prevention

There is no guaranteed way to prevent cancer, but there are ways to reduce the risk of developing it.

Healthy weight

Maintaining a healthy weight through diet and exercise can help stave off obesity, which increases the chances of the disease. This can also help individuals manage diabetes and reduce the risk of cirrhosis.

Limit tobacco and alcohol

Not drinking, or drinking in moderation, can help prevent cirrhosis, and in turn, liver cancer. According to the U.S. Department of Health and Human Services, drinking in moderation for women means up to one drink per day and up to two drinks per day for men.

Not smoking or quitting smoking can help lower the risk of liver cancer, and many other cancers.

Hepatitis B vaccination

By receiving the hepatitis B vaccine, an individual can reduce the risk of hepatitis B virus (HBV), thereby reducing the chances of developing this disease. The CDC recommends that everyone, children and adults, who may be at risk receive the HBV vaccine.

Avoid or treat HCV

There is no hepatitis C virus vaccination, but there are steps one can take to prevent this infection.

  • Know your sexual partner’s health status and practice safe sex.
  • Do not use intravenous drugs. If that is not an option, use a sterile needle.
  • Ensure any tattoo or piercing is done in a clean, professional shop.

These steps can also be beneficial to prevent HBV.

Liver cancer treatments

If found early, treatments to limit the disease may be possible.

Ablation

This type of treatment destroys tumors on the liver without removing them. Ablation works best for patients with a few smaller tumors and for whom surgery is not a viable option due to reduced liver function.

Types of ablation treatments include:

  • Cryoablation.
  • Ethanol ablation.
  • Microwave ablation.
  • Radiofrequency ablation.

Chemotherapy

Chemo delivers chemicals throughout the whole body that locate and attack the cancerous cells in the liver. It is a common form of cancer treatment and can be administered by mouth or intravenous. Chemotherapy can be used in conjunction with radiation.

Embolization

Embolization blocks or reduces the blood flow to a tumor while not affecting healthy liver cells. This treatment blocks the hepatic artery, which is the main blood supply for cancer in the liver. Embolization is best for larger tumors and patients with adequate liver function.

Immunotherapy

Immunotherapy aims to boost and support the individual’s immune system to destroy the cancer cells through medication. This treatment can be topical, oral, intravenous or via catheter.

Radiation therapy

Radiation therapy can be external or internal, based on the stage of the cancer. It utilizes high doses of radiation to shrink tumors and kill cancerous cells.

Surgery

Removing the cancerous cells through surgery or undergoing a liver transplant are the best options to cure this disease. Removing part of the liver, a partial hepatectomy, is an option for an individual with a single tumor and good liver function.

Targeted therapy

A form of chemotherapy, targeted therapy marks cells with certain traits, such as a protein or abnormal chromosome, and destroys cells with that trait.

Other treatments, according to the National Institutes of Health, include laser therapy and electrocoagulation. Additionally, there may be ongoing clinical trials to treat cancer of the liver.