Malignant Hepatic (Liver) Lesions
What is liver cancer?
Liver cancer is a type of malignant tumor that begins in the liver, the largest internal organ in the body. Most liver cancers develop from the cells in the liver called hepatocytes. These cancers are referred to as primary liver cancer. Rarely, they may develop from cells lining the bile duct or the blood vessels. Other cancers spread to the liver from another area, such as the colon, breast, or lung. These are referred to as metastatic cancers.
The liver is vital for several life functions, including the digestion of food, the collection and filtering of blood from the intestines, storing nutrients, metabolizing food into energy, helping the blood produce clotting factors, removing toxic waste from the body, and helping maintain the proper level of sugar in the body. A person cannot live without a liver.
Who gets liver cancer?
Anyone can get liver cancer, but some people are at higher risk. Risk factors for liver cancer include:
- Cirrhosis: Liver cancer is usually preceded by a condition called cirrhosis, a disease in which scar tissue replaces damaged liver cells. Cirrhosis can be the result of hepatitis B or C infection, heavy alcohol use, non-alcoholic fatty liver disease and autoimmune liver disorders.
- Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV): Infection with HBV or HCV is the main cause of liver cancer. It often develops after many years of infection with either of these viruses.
- Aflatoxin: Liver cancer can be caused by aflatoxin, a harmful substance made by certain types of mold. This toxic substance can form on nuts and grains, including peanuts and corn. High levels of aflatoxin are rare in the United States due to safety regulations. They are more common in parts of Asia and Africa.
- Iron storage disease: Liver cancer may occur in people who have a disease that causes the body to store too much iron in organs, including the liver.
- Heavy alcohol use: This is a risk factor because alcohol abuse is linked to cirrhosis.
- Obesity and diabetes: Studies have shown that obesity and diabetes may be risk factors for liver cancer as these may lead to non-alcoholic fatty liver disease and cirrhosis.
What are the different types of liver cancer?
There are three main types of liver cancer. These are:
- Hepatocellular carcinoma (HCC): This is the most prevalent type of liver cancer, accounting for close to 90% of cases. Almost 80% of patients diagnosed with HCC will have underlying cirrhosis.
- Cholangiocarcinoma (bile duct cancer): This cancer grows in the bile duct of the liver. This narrow tube extends from the liver to the small intestine. It accounts for about 9% of liver cancers.
- Angiosarcoma: This rare kind of liver cancer accounts for only about 1% of cases. It is an aggressive, rapidly growing cancer that starts in the blood vessels of the liver.
Symptoms and Causes
What are the symptoms of liver cancer?
Liver cancer often does not cause symptoms until it has reached an advanced stage. Symptoms that may become apparent include:
- A bloated or swollen abdomen
- A lump or a heavy feeling in the upper abdomen
- Loss of appetite and feelings of fullness
- Weight loss
- Feeling weak or very tired
- Yellow skin and eyes, pale stools, and dark urine from jaundice
Many of these symptoms can be caused by a variety of health problems, with the exception of yellow skin or jaundice. This is a strong symptom of a problem with the liver. If you notice any of these symptoms, you should consult your physician as soon as possible.
Diagnosis and Tests
How is liver cancer diagnosed?
Your physician may perform several tests if you have symptoms suggesting liver cancer. He or she will usually start with a full physical exam. This will include feeling your abdomen to check your liver, spleen and other organs for lumps or changes in size. Your physician will also be checking for ascites, an abnormal buildup of fluid in the abdomen. Your skin and eyes will also be examined for signs of jaundice (yellowing).
Following a physical examination, your doctor may do the following:
- Blood tests: Several blood tests can be done to check for liver problems. These include a test of your levels of alpha-fetoprotein (AFP). High levels of this protein could be a sign of liver cancer.
- Ultrasound test: This test uses echoes to create an image of your liver and other organs in the abdomen.
- Computed tomography (CT) scans or a magnetic resonance imaging (MRI) scan: These scans allow your physician to look inside your body. You may be given an injection of contrast material so that your liver and any potential liver masses show up clearly in the pictures.
- Biopsy: A biopsy is sometimes needed to diagnose liver cancer. This is usually done with a needle inserted through the skin into the liver.
Management and Treatment
How is liver cancer treated?
Treatment for liver cancer depends on the stage and type of cancer, the degree of liver function and a person's overall health. Possible treatments include:
- Hepatectomy: This type of surgery is an option when liver cancer has been caught early and has not spread. If a patient has compensated (showing no symptoms) cirrhosis of the liver, hepatectomy may be an option. Otherwise, hepatectomy may be risky in patients with decompensated (showing symptoms) cirrhosis. The surgeon will remove the tumor and a margin of healthy tissue surrounding it. Up to 70% of the liver can be removed in this way. The remaining healthy part will take over the liver's function.
- Liver transplant: A transplant is an option if the tumors are small, the disease has not spread outside the liver, and suitable donor can be found. This is the best option for selected patients with liver cancer and decompensated cirrhosis. A donation can come from a live person, in which case only a portion of liver is taken. A whole liver can also be taken from a deceased person.
- Ablation: A procedure to control liver cancer and extend life by killing cancer cells. Ablation is usually performed with tiny electrodes inserted through the skin into the cancer. These electrodes can be used to kill the cancer cells with heat.
- Embolization: An option for patients who cannot have surgery or as a bridge toward liver transplant. Your physician inserts a tiny catheter containing sponges or other particles into an artery in your leg and moves the catheter into the hepatic artery leading to the liver. This stops the blood flow into the liver and helps kill the tumor.
- Drug therapy: Medications are now available that can be taken by mouth to slow the growth of the tumor.
- Radiation therapy: The use of strong rays of energy to kill cancer cells.
- Chemotherapy: Intravenous (through the vein) chemotherapy drugs are sometimes used to treat liver cancer.
Your doctor will come up with the plan best suited to your type and stage of liver cancer.
Outlook / Prognosis
What is the prognosis (outlook) for someone who has liver cancer?
Liver cancer can only be cured if it is found early, before it has spread, and if a patient is healthy enough for surgery or liver transplant. However, there are several options to prolong life and improve the quality of life even for those with more advanced cancer or those unable to have surgery. Some of these treatments may be experimental and you may be asked if you are willing to participate in clinical trials. Your doctor will collect all of the available information and come up with a treatment plan best suited to your condition.