Liver Cancer

Overview

What is liver cancer?

Cancer is a disease that happens when abnormal cells grow too quickly and leave less space for normal cells.

Liver cancer can be classified in two ways. Primary liver cancer is one that starts in the tissue of the liver. The most common type of primary liver cancer is called hepatocellular carcinoma. The number of cases of primary liver cancer in the United States has been increasing over the years.

Secondary liver cancer is cancer that started in some other place in the body and moved to the liver. This type is also called metastatic liver cancer.

What does the liver do?

The liver is one of the most important organs in the body. The liver is divided into sections, called lobes, and acts as a filter for blood. It takes harmful substances out of the blood that are later passed out of the body as waste. The liver also:

  • Makes bile, a fluid that helps digest fat.
  • Digests and stores other nutrients from food like sugar, which is used for energy.
  • Makes substances used for many body functions, including ones that make your blood clot.

What are the risk factors for liver cancer?

A risk factor does not mean that you will develop a disease, but it does increase your chances of getting a disease. For liver cancer, risk factors include:

  • Having other liver diseases, including hepatitis B or C (viral diseases that attack the liver) or cirrhosis (a disease that causes scarring). Having a family history of liver diseases that can cause cirrhosis (liver diseases that run in families) is also a risk factor.
  • Having diabetes.
  • Being obese.
  • Being a man. Men are more likely to get liver cancer than women.
  • Drinking too much alcohol over a long period of time.
  • Being exposed to a type of poison made by moldy crops.

Symptoms and Causes

What are the signs and symptoms of liver cancer?

When liver cancer is in the early stages, you may have no symptoms at all. If your liver is swollen, you might notice the following symptoms: You may have:

  • A lump below the rib cage or pain on the right side of the abdomen, or pain near the right shoulder.
  • Jaundice (a disease that causes skin and eyes to yellow).
  • Unexplained weight loss, nausea, or loss of appetite.
  • Fatigue.
  • Dark-colored urine.
  • Bloating.

Remember, though, that liver cancer is only one of the reasons that a liver can be swollen.

What causes liver cancer?

You might get liver cancer from liver diseases like hepatitis. Having cirrhosis also increases your risk. However, some people who get liver cancer don’t have any other liver diseases. In many cases, the actual cause isn’t known.

Diagnosis and Tests

How is liver cancer diagnosed?

Your doctor may think about liver cancer if they find lumps or other symptoms during your physical exam. The doctor might order other tests, like:

  • Blood tests: A serum marker test measures the amounts of certain substances linked to cancer. For liver cancer, cirrhosis, and hepatitis, the substance alpha-fetoprotein (AFP) may show up in higher levels. AFP in high levels is considered a tumor marker. Liver enzyme tests that show high levels of liver enzymes may also point to liver disease.
  • Ultrasound (sonography): This test provides pictures of your soft tissue structures.
  • Computed Tomography (CT Scan): This special type of X-ray takes detailed images of organs.
  • Magnetic Resonance Imaging (MRI): This test produces very clear images of the human body using a large magnet, radio waves, and a computer.
  • Angiogram: During this test, a dye is injected into an artery to show liver tissue and any tumors.
  • Laparoscopy: The doctor uses a thin tube with a light (laparoscope) to observe the liver and other organs inside the stomach area.
  • Biopsy: The removal of tissue for study under a microscope. It may be done using a laparoscope. A biopsy is the most reliable way to determine cancer.

What are the stages of liver cancer?

One thought you might have when you hear that you have cancer is, “Has it spread?” The doctor uses a process called staging to give the cancer diagnosis a number from I to IV. The higher the number, the more cancer has a chance to spread. Cancers are also defined by how they can be treated, mostly by deciding if cancer can be removed by surgery.

Liver cancer stages include the following:

  • Stage I: One tumor is found in the liver only.
  • Stage II: One tumor is found, but it has spread to the blood vessels, OR more than one tumor is present, but they are all smaller than 3 cm.
  • Stage III: In Stage III liver cancer, there is more than one tumor and one of them at least is larger than 5 cm, OR the cancer has moved beyond the liver to large blood vessels, another organ, or to the lymph nodes.
  • Stage IV: The cancer has spread to other places in the body, such as the lungs or bones, as well as lymph nodes.

Liver cancer that has returned may be also be called recurrent. Recurrent liver cancer could come back in the liver or anywhere else in the body.

Management and Treatment

How is liver cancer treated?

If you have liver cancer, your treatment and chance of recovery (also called prognosis) may depend on certain things. These include your general health, how well your liver is working, the stage of the cancer that you have and your levels of alpha-fetoprotein.

Liver cancer may be treated using one or more methods: surgery, loco-regional therapy, different types of drug therapy, and even liver transplantation.

Surgical treatments
  • Partial hepatectomy: Removing part of the liver, ranging from a smaller wedge to an entire lobe.
  • Total hepatectomy and liver transplant: Removing the whole liver and replacing it with one from an organ donor.
Other treatments
  • Ablation therapy: Destroying tumors in the liver without taking them out. There are several ways to do this, like cryoablation, microwave ablation, radiofrequency ablation and ethanol ablation.
  • Chemotherapy: Using drugs to kill cancer cells or stop them from reproducing. Chemotherapy may be systemic (pills or injections that travel through the entire body).
  • Targeted therapy: Using drugs that zero in on the cancer genes or tissue. Targeted therapy is different than chemotherapy.
  • Immunotherapy: Using drugs that direct the body’s immune system to kill cancer cells. It, too, is different than chemotherapy.
  • Loco-regional therapy: Injecting beads that give off radiation into the blood vessel that is feeding the tumor (radioembolization). Another version of this type of therapy is called chemoembolization of the hepatic artery. The chemotherapy drug is combined with the beads to block the artery.

Prevention

How can you prevent liver cancer?

While you can’t completely prevent liver cancer, you can do the following things to lower your chances of getting liver cancer:

  1. Avoid behaviors that lead to cirrhosis. Do not drink alcoholically. Reach or maintain a healthy weight to prevent nonalcoholic fatty liver disease.
  2. Get a hepatitis B vaccine. This vaccine is safe for nearly everyone. Ask your doctor about the hepatitis A vaccine.
  3. Avoid getting hepatitis C by practicing safe sex, not using IV drugs, and refusing to get a tattoo or piercing from any tattoo shop that can’t prove to you that they use clean needles. If you do use IV drugs, do not share needles or use needles that aren’t clean.
  4. Ask your doctor about how often you should have liver cancer screenings if you have any type of liver disease. Also, ask about screenings if you are a heavy drinker, have diabetes or weigh more than is recommended.

Outlook / Prognosis

What is the outlook if you have liver cancer?

Your outlook, also called your prognosis, depends on things like your overall health, the type and stage of your cancer, and how well you respond to treatment.

Liver cancer will be cured for the small number of people who are able to have a successful organ transplant. Liver cancer is also resolved for about one in three people who have surgery to remove tumors or parts of the liver. Liver cancer that is not treated successful is fatal, but researchers are working daily to find more effective treatments.

Resources

Where can you find information or support if you have liver cancer?

Here is a list of a few organizations that may help if you have liver cancer. Also, ask your healthcare provider for any suggestions.

Here are some other resources:

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