Liver Cancer: Introduction
What is cancer?
Cancer is when cells in the body change and grow out of control. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body does not need them any longer.
Cancer is made up of abnormal cells that grow even though your body doesn't need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasis).
What is liver cancer?
Liver cancer is cancer that starts in your liver. This is also called primary liver cancer. Primary liver cancer is not the same as cancer that started somewhere else in the body and then has spread (metastasized) to the liver. Cancer that starts in another organ, such as the colon, breast, or lung, and then spreads to the liver is called secondary liver cancer. Secondary liver cancer is more common in the U.S. than primary liver cancer. Cancer that has spread to the liver from somewhere else is treated like the original cancer. For instance, lung cancer that has spread to the liver is treated like lung cancer.
Understanding the liver
The liver is a large, pyramid-shaped organ that lies behind the ribs on the right side of the body. It’s under the right lung. It is divided into right and left lobes.
The liver helps break down nutrients. These include sugars, starch, fats, and proteins. It also stores some of these. The liver also makes proteins, such as albumin. This helps the body balance fluids. It also makes clotting factors, which help blood thicken or clot when a person is bleeding. Bile made in the liver is important for digesting food and for other bodily functions.
One of the liver’s most important jobs is to filter out and destroy toxins in the body. When the liver isn’t working well, chemicals can build up inside the body and cause damage.
What types of cancer start in the liver?
The main types of primary liver cancer include:
Hepatocellular carcinoma. This is the most common liver cancer. It’s also called hepatoma. About 4 out of every 5 primary liver cancers are of this type. This type of cancer starts in the main liver cells called hepatocytes.
Intrahepatic cholangiocarcinoma. About 10–20% of all liver cancers are cholangiocarcinomas. These cancers start in the bile ducts. These are small tubes where bile leaves the liver and goes into the gallbladder and intestines during digestion. This type of cancer can also start in the bile ducts outside the liver.
Hepatoblastoma. This is a rare liver cancer often found in children.
Angiosarcoma. This is another uncommon form of liver cancer. It starts in blood vessels inside the liver.
Several types of non-cancerous (benign) tumors can also form in the liver. These include hemangiomas, hepatic adenomas, and focal nodular hyperplasia. These tumors don’t spread to other parts of the body. But they can still cause problems if they grow large enough.
Talk with your healthcare provider
If you have questions about liver cancer, talk with your healthcare provider. Your healthcare provider can help you understand more about this cancer.
Liver Cancer: Diagnosis
If your healthcare provider thinks you might have liver cancer, you will need certain exams and tests to be sure. Diagnosing liver cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.
What tests might I need?
You may have one or more of the following tests:
You may have blood tests to look for signs of liver cancer.
Alpha-fetoprotein (AFP) blood test
AFP is a protein in the blood that should go down right after birth. AFP levels are often high in people with liver cancer. But other conditions can also raise AFP levels. So this test alone can't be used to diagnose liver cancer.
Liver function tests (LFTs)
These tests check liver function. They can show liver irritation and inflammation. These tests can't tell for sure if you have liver cancer. But if the tests show that your liver has been damaged, your healthcare provider may do other tests to see if you have cancer.
Imaging tests may also be done to look for liver cancer.
This is often the first test done if your healthcare provider suspects liver cancer. An ultrasound is easy to do and doesn’t use radiation. This test is very helpful in seeing whether a liver tumor is a fluid-filled sac that’s likely not cancer (cyst) or a solid mass that’s more likely to be cancer. An ultrasound uses sound waves to look for abnormalities in the liver. The sound waves bounce off body parts and send back a series of signals. Then a computer turns these signals into images of your body.
Magnetic resonance imaging (MRI)
This test creates detailed images of the liver and nearby organs. An MRI uses magnets and radio waves to take pictures of the inside of the body. MRIs can show more detail than other imaging tests.
Computed tomography (CT scan)
A CT scan uses X-rays taken from many angles. This creates very detailed cross-section pictures of the liver and nearby organs.
If an imaging test shows something in your liver that looks like it might be cancer, your healthcare provider may take small samples of liver tissue. This is called a biopsy. A doctor who specializes in looking at cells, called a pathologist, looks at the samples under a microscope to tell whether cancer is there. There are a few ways to do a biopsy.
For this test, a thin, hollow needle is put through your skin. It goes into the liver tumor to get a sample of it. This is normally done during a CT or ultrasound of the liver. This lets your healthcare provider see the needle going into the tumor.
During laparoscopy, small cuts are made in your abdomen. Then your healthcare provider puts long surgical tools (including one with a tiny video camera on the end) into them. Then he or she looks at the surface of your liver and nearby organs. If your healthcare provider sees small pieces of tumors, he or she will remove them.
Your healthcare provider may take a biopsy during surgery to treat the tumor.
Getting your test results
When your healthcare provider has the results of your biopsy, he or she will contact you with the results. Your provider will talk with you about other tests you may need if liver cancer is found. Make sure you understand the results and what follow-up you need.
Liver Cancer: Treatment Choices
Many types of treatment can be used for liver cancer. Which may work best for you? It depends on a number of factors. These include the type, size, location, and stage of your cancer. Other important factors include your age and, overall health, how well the rest of your liver is working, and what side effects you’ll find acceptable.
Learning about your treatment options
You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.
Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, what the risks and side effects are, and the goal of treatment. Your healthcare provider may recommend a certain treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It’s important to take the time you need to make the best decision.
Talk with your healthcare provider about how much time you can take to explore your options. You may want to get a second opinion before deciding on your treatment plan. You may also want to involve your family and friends in this process.
Understanding the goals of treatment for liver cancer
For some liver cancers, the goal of treatment is to cure the cancer. If a cure isn’t possible, treatment may be used to shrink the cancer or keep it under control. Treatment can also improve your quality of life by helping to control symptoms caused by the cancer. The goals of liver cancer treatment can include 1 or more of these:
Remove the cancer in the liver (or the entire liver)
Stop the growth or spread of liver cancer cells
Prevent or delay the cancer's return
Ease symptoms from the cancer, such as pain or blockages
Types of treatment for liver cancer
Here is an overview of the most common treatments used for liver cancer.
Surgery offers the best chance to cure liver cancer. But only a small percentage of people can have surgery. If the cancer is small and in only one part of the liver (and the rest of the liver is healthy enough), the part of the liver with the cancer can be removed. This surgery is called a partial hepatectomy.
Another option might be to remove the entire liver and replace it with a liver transplant. Again, the cancer must only be in the liver. It can't be in nearby tissues or other parts of the body, and a donated liver must be found.
Tumor ablation and embolization
These techniques can be used to treat some tumors in the liver. Ablation involves using heat (such as in radiofrequency ablation or RFA), cold (cryoablation), or other methods to destroy tumors rather than removing them.
Embolization is used to cut off a tumor's blood supply. A substance is injected into the blood vessel going to the tumor. Sometimes this is combined with radiation (radioembolization) or chemotherapy (chemoembolization). In this case, the radioactive particles or chemo are put through the blood vessel into the tumor and then the blood vessel is blocked off. This traps the radiation or chemo in the tumor and cuts off the blood supply.
Radiation uses high-energy X-rays to kill cancer cells. It’s used mainly when surgery can't be done or other treatments aren't good options.
This type of treatment uses medicines that target certain proteins, genes, or cell functions that help cancer cells grow. It’s used mainly for liver cancers that can't be removed with surgery.
The goal of chemotherapy is to stop cancer from growing or spreading. It does this by using medicines to kill the cells or stop them from dividing. Chemotherapy doesn't work very well to treat liver cancer, but it may be used to treat advanced liver cancer.
Your healthcare provider may suggest treatments that help ease your symptoms, but don’t treat the cancer. These can sometimes be used along with other treatments. Or your healthcare provider may suggest supportive care if he or she believes that available treatments are more likely to do you more harm than good.
Clinical trials for new treatments
Researchers are always looking for new ways to treat liver cancer. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.
Talking with your healthcare provider
At first, thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Consider the benefits and side effects of each option. Talk about your concerns with your healthcare provider before making a decision.