Liver Cancer

liver and bile duct passage

The liver is one of the largest organs in the body. It has four lobes and fills the upper right side of the abdomen inside the rib cage. Three of the many important functions of the liver are:

  • To filter harmful substances from the blood so they can be passed from the body in stools and urine.
  • To make bile to help digest fat that comes from food.
  • To store glycogen (sugar), which the body uses for energy.

The two types of adult primary liver cancer are:

  • Hepatocellular carcinoma
  • Cholangiocarcinoma

The most common type of adult primary liver cancer is hepatocellular carcinoma.

This section discusses the treatment of primary liver cancer (cancer that begins in the liver). Treatment of cancer that begins in other parts of the body and spreads to the liver is not discussed.

Risk Factors
Symptoms
Screening and Diagnosis
Staging
Treatment
Support


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Risk Factors

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. The following are risk factors for adult primary liver cancer:

  • Having hepatitis B or hepatitis C. Having both hepatitis B and hepatitis C increases the risk even more.
  • Having a close relative with both hepatitis and liver cancer.
  • Having cirrhosis, which can be caused by:
    • Hepatitis (especially hepatitis C).
    • Drinking large amounts of alcohol for many years or being an alcoholic.
  • 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).
  • Having hemochromatosis, a condition in which the body takes up and stores more iron than it needs. The extra iron is stored in the liver, heart, and pancreas.

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Symptoms

These and other signs and symptoms may be caused by adult primary liver cancer or by other conditions. Check with your doctor if you have any of the following:

  • A hard lump on the right side just below the rib cage
  • Discomfort in the upper abdomen on the right side
  • A swollen abdomen
  • Pain near the right shoulder blade or in the back
  • Jaundice (yellowing of the skin and whites of the eyes)
  • Easy bruising or bleeding
  • Unusual tiredness
  • Nausea and vomiting
  • Loss of appetite
  • Weight loss for no known reason

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Screening and Diagnosis

Tests that examine the liver and the blood are used to detect (find) and diagnose adult primary liver cancer. The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Serum tumor marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. An increased level of alpha-fetoprotein (AFP) in the blood may be a sign of liver cancer. Other cancers and certain noncancerous conditions, including cirrhosis and hepatitis, may also increase AFP levels. Sometimes the AFP level is normal even when there is liver cancer.
  • Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver cancer.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the liver. This procedure is also called nuclear magnetic resonance imaging (NMRI). To create detailed pictures of blood vessels in and near the liver, dye is injected into a vein. This procedure is called MRA (magnetic resonance angiography).
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the sample of cells or tissues include the following:
    • Fine-needle aspiration biopsy: The removal of cells, tissue or fluid using a thin needle.
    • Core needle biopsy: The removal of cells or tissue using a slightly wider needle.
    • Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Another instrument is inserted through the same or another incision to remove the tissue samples.

A biopsy is not always needed to diagnose adult primary liver cancer.

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Staging

After adult primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body.

The process used to find out if cancer has spread within the liver or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis . Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if primary liver cancer spreads to the lung, the cancer cells in the lung are actually liver cancer cells. The disease is metastatic liver cancer, not lung cancer.

There are several staging systems for liver cancer. The Barcelona Clinic Liver Cancer (BCLC) Staging System is widely used and is described below. This system is used to predict the patient's chance of recovery and to plan treatment, based on the following:

  • Whether the cancer has spread within the liver or to other parts of the body.
  • How well the liver is working.
  • The general health and wellness of the patient.
  • The symptoms caused by the cancer.

The BCLC staging system has five stages:

  • Stage 0: Very early
  • Stage A: Early
  • Stage B: Intermediate
  • Stage C: Advanced
  • Stage D: End-stage

The following groups are used to plan treatment.

BCLC stages 0, A, and B

Treatment to cure the cancer is given for BCLC stages 0, A, and B.

BCLC stages C and D

Treatment to relieve the symptoms caused by liver cancer and improve the patient's quality of life is given for BCLC stages C and D. Treatments are not likely to cure the cancer.

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Treatment

At Huntsman Cancer Institute, liver cancer is treated by a team of specialists, including gastroenterologists (doctors who specialize in treating problems of the digestive organs), surgeons, medical oncologists (doctors who treat cancer with medicine), radiation oncologists (doctors who treat cancer with radiation), nurses, dietitians, and social workers.

Different types of treatments are available for patients with adult primary liver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Six standard treatments are used:

New treatments are being studied in clinical trials.

Surgery

A partial hepatectomy (surgery to remove the part of the liver where cancer is found) may be done. A wedge of tissue, an entire lobe, or a larger portion of the liver, along with some of the healthy tissue around it is removed. The remaining liver tissue takes over the functions of the liver and may regrow.

Liver transplant

In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.

Ablation therapy

Ablation therapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer:

  • Radiofrequency ablation: The use of special needles that are inserted directly through the skin or through an incision in the abdomen to reach the tumor. High-energy radio waves heat the needles and tumor which kills cancer cells.
  • Microwave therapy: A type of treatment in which the tumor is exposed to high temperatures created by microwaves. This can damage and kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs.
  • Percutaneous ethanol injection: A cancer treatment in which a small needle is used to inject ethanol (pure alcohol) directly into a tumor to kill cancer cells. Several treatments may be needed. Usually local anesthesia is used, but if the patient has many tumors in the liver, general anesthesia may be used.
  • Cryoablation: A treatment that uses an instrument to freeze and destroy cancer cells. This type of treatment is also called cryotherapy and cryosurgery. The doctor may use ultrasound to guide the instrument.
  • Electroporation therapy: A treatment that sends electrical pulses through an electrode placed in a tumor to kill cancer cells.

Embolization therapy

Embolization therapy is the use of substances to block or decrease the flow of blood through the hepatic artery to the tumor. When the tumor does not get the oxygen and nutrients it needs, it will not continue to grow. Embolization therapy is used for patients who cannot have surgery to remove the tumor or ablation therapy and whose tumor has not spread outside the liver.

The liver receives blood from the hepatic portal vein and the hepatic artery. Blood that comes into the liver from the hepatic portal vein usually goes to the healthy liver tissue. Blood that comes from the hepatic artery usually goes to the tumor. When the hepatic artery is blocked during embolization therapy, the healthy liver tissue continues to receive blood from the hepatic portal vein.

There are two main types of embolization therapy:

  • Transarterial embolization (TAE): A small incision (cut) is made in the inner thigh and a catheter (thin, flexible tube) is inserted and threaded up into the hepatic artery. Once the catheter is in place, a substance that blocks the hepatic artery and stops blood flow to the tumor is injected.
  • Transarterial chemoembolization (TACE): This procedure is like TAE except an anticancer drug is also given. The procedure can be done by attaching the anticancer drug to small beads that are injected into the hepatic artery or by injecting the anticancer drug through the catheter into the hepatic artery and then injecting the substance to block the hepatic artery. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. This type of treatment is also called chemoembolization.

Targeted therapy

Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Adult liver cancer may be treated with a targeted therapy drug that stops cells from dividing and prevents the growth of new blood vessels that tumors need to grow.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation therapy is given in different ways:

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer.
    • 3-D conformal radiation therapy uses a computer to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while preventing damage to normal tissue as much as possible. This type of radiation therapy is being studied in clinical trials.
    • Stereotactic body radiation therapy uses special equipment to position a patient and deliver radiation directly to the tumors. The total dose of radiation is divided into smaller doses given over several days. This type of radiation therapy helps prevent damage to normal tissue. This type of radiation therapy is being studied in clinical trials.
    • Proton-beam radiation therapy is a type of high-energy radiation therapy that uses streams of protons (small, positively-charged particles of matter) to kill tumor cells. This type of radiation therapy is being studied in clinical trials.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, visit HCI's clinical trials website.

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Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

There are several places you can go for support:

  • Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
  • The G. Mitchell Morris Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist.
  • Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to HCI patients and their families.
  • The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.

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Adapted from the National Cancer Institute's Physician Data Query (PDQ®) Cancer Information Summaries
This information last updated on HCI website January 2014

*If you are interested in a trial that is currently marked *Not Open, please contact the Patient Education team at 1-888-424-2100 or patient.education@hci.utah.edu for other trial options. Enrollment is updated daily.

Forte Research Systems in partnership with Huntsman Cancer Institute

Paul J. Campsen, M.D.

Locations
Huntsman Cancer Hospital (801) 585-2708
University Hospital (801) 585-2708
University Hospital (801) 581-2634

Specialties: Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Kidney Transplant, Liver Cancer, Liver Disease, Liver Transplant, Pancreas Transplant, Renal Transplantation, Surgery, General

Robert E. Glasgow, M.D.

Locations
Huntsman Cancer Hospital (801) 585-6035
University Hospital (801) 585-6035

Specialties: Acute Care Surgery, Barrett's Esophagus, Colorectal Surgery, Endocrine Surgery (Adrenal, Thyroid, Parathyroid), Esophageal Diseases, Esophageal Surgery, GI Motility, Gastric/Esophageal Surgery, Gastroesophageal Reflux Disease (GERD), Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Hernia Surgery (open and laparoscopic), Minimally Invasive Gastrointestinal Surgery, Minimally Invasive Lung & Esophageal Surgery, Soft Tissue Sarcoma Surgery, Surgery, General, Therapeutic Endoscopy, Upper Gastrointestinal Tract Surgery

Ying J. Hitchcock, M.D.

Locations
Huntsman Cancer Hospital (801) 581-2396

Specialties: Gastrointestinal Cancers, Head and Neck Cancers, Radiation Oncology, Soft Tissue Sarcomas

Robin D. Kim, M.D.

Locations
Huntsman Cancer Hospital (801) 585-6140
Primary Children's Hospital (801) 585-6140
University Hospital (801) 585-6320

Specialties: Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Kidney Transplant, Liver Cancer, Liver Disease, Liver Transplant, Pancreas Transplant, Surgery, General, Transplant Surgery

Sean J. Mulvihill, M.D.

Locations
Huntsman Cancer Institute (801) 581-7167

Specialties: Biliary Cancer, Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Laparoscopy, Liver Cancer, Pancreatic Cancer, Surgery, General

N. Jewel Samadder, M.Sc., M.D.

Locations
Huntsman Cancer Hospital (801) 213-9797
South Jordan Health Center (801) 213-9797

Specialties: Clinical Genetics, Colon Cancer, Gastroenterology, Gastrointestinal Cancers, Pancreatic Cancer

Courtney L. Scaife, M.D.

Locations
Huntsman Cancer Institute (801) 585-6911

Specialties: Colorectal Surgery, Esophageal Surgery, Gastric/Esophageal Surgery, Gastrointestinal Stromal Tumors, Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Minimally Invasive Gastrointestinal Surgery, Oncology Surgery, Pancreatic Cancer, Sarcoma, Soft Tissue Sarcoma Surgery, Surgery, General, Upper Gastrointestinal Tract Surgery

Dennis C. Shrieve, M.D., Ph.D.

Locations
Huntsman Cancer Hospital (801) 581-2396

Specialties: Brain Tumors, Gastrointestinal Cancers, Genitourinary Cancers, Lung Cancer, Pediatric Radiation Therapy, Prostate Cancer, Radiation Oncology, Soft Tissue Sarcomas

Jonathan D. Tward, M.D., Ph.D.

Locations
Huntsman Cancer Hospital (801) 581-2396
South Jordan Health Center (801) 213-4320

Specialties: Bladder Cancer, Brachytherapy, Gastrointestinal Cancers, Genitourinary Cancers, Intensity-Modulated Radiation Therapy (IMRT), Lymphomas, Penile Cancer, Prostate Cancer, Radiation Oncology, Robotic Prostatectomy, Seed Implants, Stereotactic Body Radiation Therapy (SBRT), Urologic Oncology

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Care coordinator: Christy Steele
Phone: 801-587-4422
E-mail: christy.steele@hci.utah.edu

Did You Know?

  • In the United States, cancer that has spread to the liver is far more common than cancer that starts in the liver (primary liver cancer).
  • Having hepatitis or cirrhosis can affect a person's risk of developing adult primary liver cancer.

 

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