Liver cancer is the fifth most common type of cancer among men, and ninth most common type of cancer among women. Around 28,000 Americans are diagnosed with liver cancer every year.
Risk factors for developing liver cancer include:
- Having hepatitis B and/or hepatitis C
- Having a close relative with both hepatitis B and liver cancer
- Having cirrhosis
- 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)
- Obesity
If you experience any of the following symptoms, you should contact your physician:
- Hard lump on the right side just below the rib cage
- Discomfort in the upper abdomen on the right side
- Pain around the right shoulder blade
- Unexplained weight loss
- Jaundice (yellowing of the skin and whites of the eyes)
- Unusual tiredness
- Nausea
- Loss of appetite
Diagnosis
If you have symptoms that suggest liver cancer, your doctor will try to find out what's causing the problems.
You may have one or more of the following tests:
- Physical exam: Your doctor feels your abdomen to check the liver, spleen, and other nearby organs for any lumps or changes in their shape or size. Your doctor also checks for ascites, an abnormal buildup of fluid in the abdomen. Also, your skin and eyes may be checked for signs of jaundice.
- Blood tests: Many blood tests may be used to check for liver problems. One blood test detects alpha-fetoprotein (AFP). High AFP levels could be a sign of liver cancer. Other blood tests can show how well the liver is working.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your liver and other organs and blood vessels in your abdomen. You may receive an injection of contrast material so that your liver shows up clearly in the pictures. On the CT scan, your doctor may see tumors in the liver or elsewhere in the abdomen.
- MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside your body. Sometimes contrast material makes abnormal areas show up more clearly on the picture.
- Ultrasound test: The ultrasound device uses sound waves that can't be heard by humans. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture (sonogram) of your liver and other organs in the abdomen. Tumors may produce echoes that are different from the echoes made by healthy tissues.
Staging
If liver cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is an attempt to find out whether the cancer has spread, and if so, to what parts of the body.
Stage I
There is one tumor and it has not spread to nearby blood vessels.
Stage II
During this stage either:
- One tumor that has spread to nearby blood vessels; or
- More than one tumor, none of which is larger than 5 centimeters.
Stage III
Divided into stages IIIA, IIIB, and IIIC:
- Stage IIIA - one of the following is found: more than one tumor larger than 5 centimeters; or one tumor that has spread to a major branch of blood vessels near the liver.
- Stage IIIB - there are one or more tumors of any size that have either: spread to nearby organs other than the gallbladder; or broken through the lining of the peritoneal cavity.
- Stage IIIC - the cancer has spread to nearby lymph nodes.
Stage IV
Cancer has spread beyond the liver to other places in the body, such as the bones or lungs. The tumors may be of any size and may also have spread to nearby blood vessels and/or lymph nodes.
When liver cancer spreads, the cancer cells may be found in the lungs. Cancer cells also may be found in the bones and in lymph nodes near the liver.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if liver cancer spreads to the bones, the cancer cells in the bones are actually liver cancer cells. The disease is metastatic liver cancer, not bone cancer. It's treated as liver cancer, not bone cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.
To learn whether the liver cancer has spread, your doctor may order one or more of the following tests:
- CT scan of the chest: A CT scan often can show whether liver cancer has spread to the lungs.
- Bone scan: The doctor injects a small amount of a radioactive substance into your blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.
- PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether liver cancer may have spread.
Treatment Options
The treatment options for liver cancer include: surgery, ablation (this procedure uses high-frequency electric current to heat and destroy the cancer cells), embolization (this procedure involves the injection of substances to try to block or reduce the blood flow to cancer cells in the liver), targeted therapy, radiation therapy and chemotherapy.
Surgery
Surgery is an option for people with an early stage of liver cancer. The surgeon may remove the whole liver (transplant) or only the part that has cancer (hepatectomy). If the whole liver is removed, it's replaced with healthy liver tissue from a donor.
Removal of part of the liver:
As much as 80 percent of the liver may be removed. The surgeon leaves behind normal liver tissue. The remaining healthy tissue takes over the work of the liver. Also, the liver can regrow the missing part. The new cells grow over several weeks.
Liver transplant:
- A liver transplant is an option if the tumors are small, the disease has not spread outside the liver, and suitable donated liver tissue can be found. Donated liver tissue comes from a deceased person or a live donor. If the donor is living, the tissue is part of a liver, rather than a whole liver.
- When healthy liver tissue from a donor is available, the transplant surgeon removes your entire liver (total hepatectomy) and replaces it with the donated tissue.
Ablation
Methods of ablation destroy the cancer in the liver. They may be used for people waiting for a liver transplant. Or they may be used for people who can't have surgery or a liver transplant. Surgery to remove the tumor may not be possible because of cirrhosis or other conditions that cause poor liver function, the location of the tumor within the liver, or other health problems.
Methods of ablation include the following:
- Radiofrequency ablation: The doctor uses a special probe that contains tiny electrodes to kill the cancer cells with heat.
- Percutaneous ethanol injection: The doctor uses ultrasound to guide a thin needle into the liver tumor. Alcohol (ethanol) is injected directly into the tumor and kills cancer cells. The procedure may be performed once or twice a week. Usually local anesthesia is used, but if you have many tumors in the liver, general anesthesia may be needed.
Embolization
For those who can't have surgery or a liver transplant, embolization or chemoembolization may be an option. The doctor inserts a tiny catheter into an artery in your leg and moves the catheter into the hepatic artery.
For embolization, the doctor injects tiny sponges or other particles into the catheter. The particles block the flow of blood through the artery. Depending on the type of particles used, the blockage may be temporary or permanent.
Without blood flow from the hepatic artery, the tumor dies. Although the hepatic artery is blocked, healthy liver tissue continues to receive blood from the hepatic portal vein.
For chemoembolization, the doctor injects an anticancer drug (chemotherapy) into the artery before injecting the tiny particles that block blood flow. Without blood flow, the drug stays in the liver longer.
Targeted Therapy
People with liver cancer who can't have surgery or a liver transplant may receive a drug called targeted therapy. Sorafenib (Nexavar) tablets were the first targeted therapy approved for liver cancer.
Targeted therapy slows the growth of liver tumors. It also reduces their blood supply. The drug is taken by mouth.
Radiation Therapy
Radiation therapy uses high-energy rays to kill cancer cells. It may be an option for a few people who can't have surgery. Sometimes it's used with other approaches. Radiation therapy also may be used to help relieve pain from liver cancer that has spread to the bones.
Doctors use two types of radiation therapy to treat liver cancer:
- External radiation therapy: The radiation comes from a large machine. The machine aims beams of radiation at the chest and abdomen.
- Internal radiation therapy: The radiation comes from tiny radioactive spheres. A doctor uses a catheter to inject the tiny spheres into your hepatic artery. The spheres destroy the blood supply to the liver tumor.
Chemotherapy
Chemotherapy, the use of drugs to kill cancer cells, is sometimes used to treat liver cancer. Drugs are usually given by vein (intravenous). The drugs enter the bloodstream and travel throughout your body.