Types of Liver Cancer
Primary liver cancer, which starts in the liver.Secondary liver cancer, which starts in another area of the body and spreads to the liver. Secondary liver cancer is also known as metastatic disease.
Types of primary liver cancer include:
Hepatocellular carcinoma This is the most common type of primary liver cancer, and it starts in liver cells called hepatocytes. It’s the form doctors most often are referring to when they talk about liver cancer.Intrahepatic cholangiocarcinoma (bile duct cancer) starts in cells that line the bile ducts, tubes in the liver that carry bile to the intestines. It accounts for between 10 percent and 20 percent of primary liver cancers.Hepatoblastoma is a rare liver cancer that usually affects children younger than 4 years old.Angiosarcoma and hemangiosarcoma are rare cancers that start in cells that line the blood vessels of the liver.
Unexplained weight lossLoss of appetiteYellowing of the skin or whites of the eyes (jaundice)Pain in the upper abdomenSwelling or bloating of the abdomenNausea or vomitingWeaknessFatigueChalky, white stoolsDark-colored urineEasy bruising or bleeding
Risk Factors for Liver Cancer
Researchers have identified several risk factors that increase a person’s chances of developing liver cancer. “Often, a patient presents with more than one risk factor and risk increases exponentially with the number of risk factors,” says Dr. Strazzabosco.
Cirrhosis of the liver, chronic hepatitis B, or hepatitis CSmokingOverweight or obesityCertain inherited diseases, such as Wilson’s disease (a rare disorder that causes copper poisoning) or hemochromatosis (a buildup of excess iron in the liver)Excessive alcohol consumptionDiabetesFoods that contain aflatoxin (a fungus that can grow on grains and nuts that haven’t been properly stored)Nonalcoholic fatty liver disease (an accumulation of fat in the liver)Age older than 60
“An important concept is that by addressing these risk factors, it would be possible to drastically reduce the incidence of [liver cancer],” says Strazzabosco. “There are also well-defined protocols for oncologic [cancer-preventing] surveillance in patients with identified risk factors. Unfortunately, these recommendations are not always followed.” “The patients we cure were typically found first to have cirrhosis, and then were monitored on a regular basis with blood tests and ultrasounds. Small tumors can be discovered this way and cured,” says Lawrence.
Blood tests can uncover liver function irregularities or markers in the blood that suggest the development of liver cancer.Imaging tests such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) are used to give doctors a more detailed look at the liver.Biopsy involves removing a piece of tissue to test it in the lab for cancer.Angiogram is done by injecting a dye into an artery and can reveal any tumors in the liver.Laparoscopy is a type of surgery that uses smaller incisions and special instruments to look inside the liver.
Staging Liver Cancer
Which Experts Diagnose and Treat Liver Cancer?
Medical oncologist, who has special training in treating cancer with chemotherapy and other medicinesHepatologist, who focuses on treating diseases of the liver and related problems in the gall bladder, bile ducts, and pancreasRadiation oncologist, who uses high-energy radiation to destroy cancer cellsInterventional radiologist, who treats cancer with procedures like embolization (which blocks blood flow to a tumor) and ablation (which shrinks tumors)Transplant surgeon, who exclusively performs organ transplantsGeneral surgeon, who is skilled in many different types of operationsGastroenterologist, who is an expert in diseases of the digestive systemPathologist, who studies blood, body fluids, and tissue samples to help diagnose and monitor the diseasePalliative care specialist, who helps with pain management and provides other types of support
“There are many different treatments, and the best way to pick the right one is to go to a center with a multidisciplinary tumor board,” advises Lawrence. “Two heads, or in this case about 10 heads, are better than one.” “Some patients die with hepatocellular carcinoma, not from it,” Strazzabosco notes. “Patients with liver cancers require a really holistic approach, and they need to remain under close medical control, as in most cases the hepatocellular carcinoma recurs and needs to be treated again.” “The biggest challenge derives from the dual nature of hepatocellular carcinomas: a neoplastic disease [one that causes tumor growth] in a failing organ,” says Strazzabosco. “All treatments must be weighed against the ability of the patient to tolerate them.”
Surgery for Liver Cancer
Tumor removal A surgeon may remove the tumor and some of the healthy liver tissue that surrounds it.Liver transplant The diseased liver is removed and replaced with a healthy donor liver. This procedure is available only for a select number of patients, based on many considerations, including the stage of the disease, whether the cancer has spread beyond the liver, and whether the patient has other serious health problems.
Other Procedures
Radiofrequency ablation uses an electric current to heat up and destroy cancer cells. Similar procedures use microwaves or lasers.Cryoablation involves placing liquid nitrogen directly in the liver tumor to freeze and destroy cancer cells.Alcohol injection uses a needle to inject pure alcohol directly into tumors, causing cancer cells to die off.Chemoembolization involves injecting chemotherapy drugs directly into the liver.Radiation beads can be placed in the liver where they deliver radiation directly to the tumor.Radiation therapy focuses high-energy beams on tumors to kill the cancer cells. Different types of radiation therapy include external beam radiation (beams are directed at a specific point on the liver) and stereotactic radiation (many beams are focused simultaneously at one point on the liver).
Medications for Liver Cancer
Targeted drugs block specific abnormalities in cancer cells. Targeted treatments for liver cancer include kinase inhibitors (which block proteins that help tumors grow) and monoclonal antibodies (which are immune system proteins created in a lab to recognize and interact with specific types of cancer cells).Immunotherapy uses the body’s own immune system to attack and destroy cancer cells. Medicines that target immune checkpoints — proteins on immune cells that turn on or off to start a response — are being used for liver cancer.Chemotherapy uses drugs to kill cancer cells. In liver cancer it is primarily used when other treatments have not been helpful.
Newer Treatments and Clinical Trials
People with liver cancer also sometimes opt to join a clinical trial in the hope of receiving cutting-edge treatments that are not yet available outside the study. “There is still a long way to go, but we are starting to see some hope also for patients with advanced disease,” Strazzabosco says. “The next few years will bring more and more advances in this field.”
Don’t drink heavily. Women shouldn’t have more than one drink a day, and men should have no more than two drinks a day.Get a hepatitis B vaccine. The CDC recommends the hepatitis B vaccine for all babies at birth and for adults who may be at risk of developing the infection.Avoid behaviors that can lead to hepatitis C. Practice safe sex, don’t share needles, and choose clean, safe shops to get tattoos and piercings to lower the risk of hepatitis C.Maintain a healthy weight. Exercise and follow a healthy diet to promote weight loss.Don’t smoke. Quit smoking, or don’t start, to lower your risk of developing liver cancer.Get screened. People at risk for liver cancer, including heavy drinkers or those with liver disease, should ask their doctors about getting screened.
“The main complications of liver cancer are on the side related to the cancer itself, such as invasions of the main veins coming into the liver and metastasis to the bone, lung, or brain,” says Strazzabosco. Patients might also experience other problems, he adds, such as:
Ascites (fluid buildup in the abdomen)Bleeding from enlarged veins in the esophagusPortosystemic encephalopathy (a neuropsychiatric syndrome that can impair brain function)Liver failure
CirrhosisNonalcoholic fatty liver disease Hepatitis BHepatitis CDiabetesAlcoholismWilson’s diseaseHemochromatosis
American Cancer SocietyNational Cancer InstituteAmerican Liver FoundationCancer.netCenters for Disease Control and Prevention (CDC)Mayo ClinicCancerCareDailyStrength.orgVA Healthcare: Liver Cancer Patient Guide
