The liver is the largest organ inside of the body. It is located on the right side of the abdomen behind the ribs. The liver has many important functions, including:
- Removing harmful substances from the blood.
- Making bile that helps in the digestion of fats from food.
- Storing glycogen (sugar) that the body can use for energy.
When cancer is identified in the liver, it is important to know whether the cancer started in the liver (hepatocellular carcinoma) or spread to the liver from another organ such as the colon or lung. The treatment information in this section focuses on primary liver cancer. If your cancer began in another organ and has spread to the liver (metastasized), visit the treatment information for that organ.
Benign Liver Tumors
When cells grow abnormally, they can form a mass known as a tumor. Tumors may be benign (not cancer) or malignant (cancer). Benign liver tumors do not spread to other parts of the body, but they may require treatment if they cause symptoms, post a risk of bleeding or rupture, or appear suspicious for cancer.1,2 When treatment is required, benign liver tumors can often be surgically removed. Some of the more common types of benign liver tumors are hemangioma, nodular hyperplasia, and adenoma.
In contrast to benign liver tumors, liver cancer has the capacity to spread to other parts of the body. There are several different types of liver cancer:
- Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults. It begins in the liver cells known as hepatocytes.
- Cholangiocarcinoma is cancer that develops in the cells that line the bile ducts within the liver.
- Hepatoblastoma is a rare type of liver cancer that develops in children.
- Angiosarcoma and Hemangiosarcoma are rare cancers that start in the blood vessels of the liver.
Each year in the United States, there are more than 25,000 individuals diagnosed with primary liver cancer and more than 18,000 deaths from the disease. Liver cancer is the fifth leading cause of cancer death among U.S. men, and the ninth leading cause of cancer death among U.S. women. Worldwide, more than 1 million individuals are diagnosed with liver cancer each year.3,4
Because hepatocellular carcinoma accounts for 80-90% of all primary liver cancers, the liver cancer information that follows focuses primarily on this type of cancer.5
Signs & Symptoms of Liver Cancer
Liver cancer often causes no symptoms during its early stages. Symptoms that you may experience as the cancer grows however can include the following:4
- Pain in the upper abdomen on the right side; the pain may extend to the back and shoulder
- Swollen abdomen (bloating)
- Weight loss
- Loss of appetite and feelings of fullness
- Weakness or feeling very tired
- Nausea and vomiting
- Yellow skin and eyes, and dark urine from jaundice
These signs and symptoms can be caused by other conditions and do not necessarily mean that you have cancer, but it’s a good idea to discuss them with your doctor.
Cause of Liver Cancer
Liver cancer begins when healthy cells acquire a genetic change (mutation) that causes them to turn into abnormal cells. Hereditary conditions, chronic viral infection of the liver and heavy alcohol use all contribute to the development of liver cancer.4,6,7,8,9,10
Risk Factors for Development of Liver Cancer
Risk factors for liver cancer include:
- Hereditary hemochromatosis6
- Chronic infection with hepatitis B virus (HBV)7,8,9
- Chronic infection with hepatitis C virus (HCV)7,8,9
- Heavy alcohol use10
Diagnosis & Test for Liver Cancer
When liver cancer is suspected, imaging tests such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) play an important role in confirming the diagnosis. Blood levels of a protein known alpha-fetoprotein (AFP) will also be assessed. Elevated levels of AFP in combination with a liver mass is a common indication of liver cancer. When a liver mass is present and AFP levels are normal, additional imaging procedures may be used to help confirm or exclude the diagnosis of liver cancer.
In contrast to many other types of cancer, biopsy (removal of a sample of tissue) is often not required to diagnosis liver cancer. For most patients (particularly those with cirrhosis), imaging and lab tests provide reliable information about the diagnosis. Furthermore, biopsy of liver cancer carries a small risk of spreading the cancer. Biopsy may be considered, however, in circumstances when there is doubt about the diagnosis.11
Evaluation of Colon Cancer
The following tests may be used to evaluate the cancer and determine the extent of spread of the cancer.
- Computed Tomography (CT) Scan: A CT scan is a technique for imaging body tissues and organs, during which X-ray transmissions are converted to detailed images, using a computer to synthesize X-ray data. A CT scan is conducted with a large machine positioned outside the body that can rotate to capture detailed images of the organs and tissues inside the body. This method is more sensitive and precise than an X-ray.
- Magnetic Resonance Imaging (MRI): MRI uses a magnetic field rather than X-rays and can often distinguish more accurately between healthy and diseased tissue. MRI gives better pictures of tumors located near bone than CT, does not use radiation as CT does, and provides pictures from various angles that enable doctors to construct a three-dimensional image of the tumor.
- Ultrasound: Ultrasound is a technique that uses sound waves to differentiate tissues based on varying tissue density. Ultrasound can be used transdermally (through the skin), transrectally (using a small probe inserted into the rectum) or intraoperatively (during surgery or during colonoscopy, which is called endoscopic ultrasound). Transrectal or endoscopic ultrasound may be used in conjunction with CT or MRI scans to help with staging.
Not all liver cancer cells are alike. They may differ from one another based on what genes have mutations. Molecular testing can be performed to identify cancer causing genetic mutations or the proteins they produce. By testing an individual’s liver cancer for specific unique biomarkers doctors can offer the most personalized treatment approach utilizing precision cancer medicines. All individuals with liver cancer should discuss the role of genomic testing for the management of their cancer with their doctor.
1 National Cancer Institute. Adult Primary Liver Cancer Treatment (PDQ®). Available at: http://www.cancer.gov/cancertopics/pdq/treatment/adult-primary-liver/Patient
2 Ibrahim S, Chen CL, Wang SH et al. Liver resection for benign liver tumors: indications and outcome. American Journal of Surgery. 2007;193:5-9.
4 National Cancer Institute. What You Need to Know About Liver Cancer. Available at: http://www.cancer.gov/cancertopics/wyntk/liver
5 Lau W-Y, Lai ECH. Hepatocellular carcinoma: current management and recent advances. Hepatobiliary and Pancreatic Diseases International. 2008;7:237-257.
6 Elmberg M, Hultcrantz R, Ekbom A et al. Cancer risk in patients with hereditary hemochromatosis and in their first-degree relatives. Gastroenterology. 2003;125:1733-41.
7 Parkin DM. The global burden of infection-associated cancers in the year 2002. International Journal of Cancer. 2006;118:3030-3044.
8 4Centers for Disease Control and Prevention, Division of Viral Hepatitis. Hepatitis B. Available at: http://www.cdc.gov/hepatitis/HBV.htm
9 Raza SA, Clifford GM, Franceschi S. Worldwide variation in the relative importance of hepatitis B and hepatitis C viruses in hepatocellular carcinoma: a systematic review. British Journal of Cancer. 2007;96:1127-34.
10 Morgan TR, Mandayam S, Jamal MM. Alcohol and hepatocellular carcinoma. Gastroenterology. 2004;127:S87-S96.
11 Silva M, Hegab B, Hyde C, et al. Needle track seeding following biopsy of liver lesions in the diagnosis of hepatocellular cancer: a systematic review and meta-analysis. Gut. 2008;57:1592-1596.