Liver Cancer

By Stephen Holt, MD, PhD, FACP

• What is Liver Cancer?
• Causes
• Symptoms
• How is it Diagnosed?
• Treatment
• What is the Outlook?
• Suggested Articles

What is Liver Cancer?

Cancer begins when abnormal cells grow out of control and invade other tissues in the body and continue to multiply. Many different cancers can affect the liver. Cancer of the liver can originate in the liver itself (primary liver cancer) or originate in other parts of the body, then spread to the liver through the bloodstream (metastatic cancer).

Types of primary liver cancer:

• Hepatocellular carcinoma (HCC) (also called hepatoma because it comes from hepatocytes, the main type of liver cells). HCC is the most common form of primary liver cancer in children and adults and one of the most frequently occurring cancers in the world.  Some hepatocellular cancers begin as a single tumor that grows larger and spreads to other parts of the body late in the disease. Other hepatocellular cancers begin as many, small cancer nodules throughout the liver, rather than a single tumor and is seen predominantly in people with chronic liver damage (cirrhosis).
• Intrahepatic cholangiocarcinoma. Also known as bile duct cancer, this cancer can appear in both the liver and the bile ducts outside the liver. Bile ducts are tubes that carry bile to the gallbladder. Seen mostly in older people (average age of 73), about 2,000 to 3,000 people in the United States develop bile duct cancer.
• Hepatoblastoma. This rare type of cancer essentially develops only in children usually before the age of four years. If diagnosed early, the survival rate is high for children with hepatoblastoma. However, for hepatoblastomas that are large or have spread beyond the liver, prognosis is poor.

About Metastatic Cancer

Metastatic cancer (secondary liver cancer) is not actually known as liver cancer. Most cancer that occurs in the liver begins in another part of the body. Some of the most common cancers that metastasize to the liver are those originating in the colon, pancreas, lung and the breast. These cancers are named after the organ in which the cancer originated. So cancer that starts in the colon and spreads to the liver is known as metastatic colon cancer, not liver cancer. Lymphomas and leukemias, cancers that originate in the lymph nodes and bone marrow, respectively, can also invade the liver. In the United States and Europe, secondary (metastatic) liver tumors are more common than primary liver cancer. The opposite is true for many areas of Asia and Africa.

According to the American Cancer Society’s most recent estimates, there are about 42,220 new cases of primary liver cancer and bile duct cancer in the United States and about 30,200 deaths from these cancers.

Causes

Factors that increase the risk for developing primary liver cancer are as follows:

• Cirrhosis (scarring of the liver)
• Chronic Infection with hepatitis B or hepatitis C (also one of the major causes of cirrhosis in the United States)
• Diabetes
• Excessive alcohol consumption (also one of the major causes of cirrhosis in the United States)
• Obesity
• Gender (liver cancer occurs twice as often in men than in women)
• Age (liver cancer affects mostly older adults in North America, Australia and Europe. However, in developing countries such as Africa and Asia, liver cancer is mostly diagnosed in younger individuals between 20 and 50 years of age)
• Non-alcoholic fatty liver disease (an accumulation of fat in the liver).
• Inherited liver diseases (Wilson’s Disease, autoimmune hepatitis and hemochromatosis increase the risk of liver cancer)
• Anabolic steroids (male hormones used by some athletes to enhance performance and strength)
• Aflatoxins (rare in the United States and Europe, aflatoxins are poisons that are produced by a mold that contaminates peanuts, grains, beans, soybeans, groundnuts, corn and rice when they are not stored properly)
• Arsenic (well water that is contaminated with arsenic)

Having a risk factor, or even several risk factors, does not mean that a person will get cancer. And many people who get the disease don’t have any known risk factors.

Symptoms

Symptoms don’t usually occur in the early stages of liver cancer which in many cases is why it is not until the disease is advanced that a diagnosis is made. Because some of the symptoms can be the result of other cancers or conditions, it is important to seek the care of a physician right away.

• Jaundice (yellowing of the skin and eyes), pale stools and dark urine
• Unintentional weight loss
• Nausea and/or vomiting
• Loss of appetite
• Itchy skin
• Feeling of fullness after a small meal
• Pain on the right side of the abdomen, the back or the shoulder
• Fever
• Insomnia (inability to sleep)
• Fatigue or feeling faint
• Swollen liver or a mass that can be felt through the skin on the right side
• Swollen veins on the stomach
• Swollen spleen (felt as a mass under the left rib)
• Sudden deterioration in condition for those with chronic hepatitis or cirrhosis

How is it Diagnosed?

Individuals chronically infected with the hepatitis B and hepatitis C virus should be screened periodically for hepatocellular carcinoma, as well as those individuals with cirrhosis, since about 80 percent of people with hepatocellular carcinomas have cirrhosis.

A thorough examination by a physician along with the following tests will diagnose liver cancer.

• AFP test. Measures the blood level of a substance produced by some tumors called alpha-fetoprotein. Not all malignant tumors make AFP, however, and certain conditions, including pregnancy, viral hepatitis and some types of cancer can increase AFP levels.
• Liver Panel (Hepatic Function Panel). A blood sample is drawn from a vein in the arm to determine overall liver function.
• Ultrasound. Used in conjunction with the AFP test for those at high risk of developing liver cancer, this non-invasive, painless procedure uses sound waves to produce images of the liver to show the shape, texture and location of tumors and helps in distinguishing whether a mass is cancerous or benign.
• CT scan (computerized tomography). A painless, non-invasive test that uses a series of X-rays to produce high resolution images of the liver.
• MRI (magnetic resonance imaging). A non-invasive, painless test that uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed images of the liver and bile ducts. MRI does not use x-rays.
• Liver biopsy. A small piece of tissue is removed from the liver using a long thin needle and then studied under a microscope.

Treatment

Liver cancer can be difficult to treat because it is often not diagnosed until it is in an advanced stage. Also compounding treatment options are pre-existing liver conditions, its general resistance to standard chemotherapy treatment and the fact that it tends to recur after surgery in many patients.

Treatment depends on a number of factors.

• the size, location and stage of the tumor
• whether the cancer has metastasized (spread to other areas in the body)
• how well the liver is functioning
• the age of the patient
• overall health of the patient
• personal preferences

If cancer has not spread from the liver to other areas of the body, and the liver is otherwise healthy, surgery to remove the diseased portion of the liver (liver resection) offers the best chance for a cure. Remarkably, the liver’s capacity to regenerate will allow it to function even when a large amount of liver tissue has been removed. Another surgical option for people who cannot undergo resection is liver transplantation. During a liver transplant, the diseased liver is removed and replaced with a healthy, donated organ after which the patient must take drugs for life so the body doesn’t reject the new organ.

For individuals who may not be candidates for surgery or transplantation, other treatments are available.

• Radiation therapy. Radiation (high-energy x-rays) is used to destroy cancer cells
• Ethanol injection. The liver tumor is directly injected with ethanol (alcohol) to destroy liver cells
• Sorafenib (Nexavar). An FDA approved oral medication for use in advanced cases of hepatocellular carcinoma (the most common type of liver cancer)
• Cryosurgery. A metal probe is used to freeze and destroy cancer cells
• Radiofrequency ablation. A probe is used to destroy the cancer cells with heat
• Chemotherapy or chemoembolization. Powerful drugs used to destroy cancer cells, sometimes injected directly into the liver tumor
• Clinical trials. Studies in which the research subjects (cancer patients) are assigned to a treatment and their outcomes are measured. Before joining a clinical trial, a participant must qualify for the study. Participating in a clinical study allows the eligible participant to play an active role in their own health care; gain access to new research treatments before they are widely available; obtain expert medical care at leading health care facilities during the trial; help others by contributing to medical research.

What is the Outlook?

The prognosis after treatment for liver cancer depends upon the size of the tumor and if the liver has already been damaged by cirrhosis, the extent of the liver damage. After cancer treatment, follow-up care in the form of regular checkups which may include imaging tests and blood tests are necessary to watch for treatment side-effects and to watch for cancer that has returned or spread.

This information is intended for educational purposes only and should not be used in any other manner. This information is not intended to substitute for informed medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider.

Suggested Articles

• Seven Ways to Reduce Liver Cancer Risk
• Can Milk Thistle Prevent Liver Cancer?
• Mandarin Oranges to Prevent Liver Cancer

About the Author

Stephen Holt, MD, PhD, FACP

Stephen Holt, M.D. is a Distinguished Professor of Medicine NYCPM (Emerite) and a medical practitioner in New York State. He has published many peer-review papers in medicine and he is a best-selling author with more than twenty books in national and international distribution. He has received many awards for teaching and research. Dr. Holt is a frequent lecturer at scientific meetings and healthcare facilities throughout the world. He is a best selling author and the founder of the Holt Institute of Medicine.