What Is It?

Liver cancer is the uncontrolled growth of abnormal cells in the liver. The liver is an important organ that has a number of important jobs. The liver:

• Produces elements that help the blood to clot
• Removes or neutralizes poisons, drugs and alcohol
• Manufactures bile that helps the body to absorb fats and cholesterol
• Helps to maintain normal blood sugar levels
• Regulates several hormones

Cancer in the liver either starts in the liver (primary liver cancer) or spreads to the liver from other places in the body (secondary liver cancer). Primary liver cancer is the most common solid tumor worldwide, with more than one million cases diagnosed each year. However, it is relatively rare in the United States and Europe.

In the United States, most liver tumors have spread (metastasized) to the liver from other organs, most commonly the colon, rectum, lung, breast, pancreas and stomach. When a cancer has spread from somewhere else, the cancer cells are the same in both places. For example, if lung cancer spreads to the liver, the cancerous cells in the liver are the same as the cancerous cells in the lung. For that reason, the person is treated for lung cancer, not liver cancer. Doctors would call the cancer in the liver “metastatic lung cancer.” The liver is the most common place for cancer to spread.

Only primary liver cancer is treated as liver cancer. The American Cancer Society estimates that about 18,920 people will be diagnosed with primary liver cancer in 2004, most of them over the age of 40, and 14,270 will die of the disease. In the United States, liver cancer is about twice as common in men as in women.

There are four main types of primary liver cancer:

• Hepatocellular carcinoma (hepatoma or HCC) — This cancer accounts for about 84 percent of primary liver cancers in the United States. It behaves aggressively.
• Cholangiocarcinoma (bile-duct cancer) — This cancer accounts for about 13 percent of primary liver cancer in the United States. Several conditions increase the risk of developing this cancer. They include gallstones, gallbladder inflammation and sometimes chronic ulcerative colitis (a chronic inflammation of the large bowel).
• Angiosarcoma (hemangiosarcoma) — This is a very rare form of liver cancer.
• Hepatoblastoma — This is a rare type of liver cancer usually found in children younger than age 4.

Risk Factors
Factors that increase your risk of developing primary liver cancer include:

• Hepatitis, an inflammation of the liver caused by a viral infection. Each of the six types, A, B, C, D, E, and G, is caused by a different virus. Hepatitis B and Hepatitis C are the most common types of hepatitis and are responsible for most cases of hepatocellular carcinoma. Hepatitis A infection does not increase your risk of developing liver cancer.



• Cirrhosis, which is scarring of liver cells that has several causes. In the United States, the most common causes of cirrhosis are hepatitis and drinking too much alcohol. Fifty percent to 70 percent of liver cancers in the United States are associated with cirrhosis.



• Direct contact with vinyl chloride (polyvinyl chloride or PVC) — This chemical is used in manufacturing some types of plastics, such as PVC pipe, and has been linked to hepatocellular carcinoma in some studies.



• Exposure to arsenic, a chemical used as a wood preservative, an herbicide, an insecticide, and in manufacturing some glass and metallic alloys. Some drinking water is contaminated by arsenic. It also exists in natural mineral deposits.



• Anabolic steroids, which are male hormones used to treat certain conditions and sometimes used illegally by athletes to enhance performance. Long-term use may slightly increase the risk of liver cancer.



• Tobacco use, which makes you more likely to develop other cancers that can spread to the liver, including cancers of the lung, colon and pancreas. It is not known whether there is a direct link between tobacco use and liver cancer.

Symptoms usually do not appear until the disease is advanced. They can include:

• Unexplained weight loss
• Loss of appetite
• Feeling full after a small meal
• Pain or swelling, especially in the upper-right abdomen
• Jaundice (yellow coloration of the skin and eyes)
• Liver enlargement or a mass in the area of the liver
• Worsening of chronic hepatitis or cirrhosis
• Hypoglycemia (low blood sugar)
• Breast enlargement in men

Liver cancer most often is diagnosed in later stages of the disease because symptoms do not appear until then. Once your doctor suspects your might have liver cancer, he or she will use one or more of the following methods to diagnose the disease:

• Physical examination — To check for weight loss, malnutrition, weakness, enlargement of the liver, and associated diseases such as hepatitis and cirrhosis



• Blood tests — To diagnose elevated levels of a protein called alpha-fetoprotein, which can indicate that you have liver cancer or a related disease, including cirrhosis, viral hepatitis, hemochromatosis, Wilson’s disease, and alpha-1-antitrypsin deficiency



• Computed tomography (CT) scan, a process that uses X-rays and computer technology to produce cross-sectional images of the body — To detect and locate tumors



• Ultrasound — To detect liver cancer and distinguish between cancerous (malignant) and noncancerous (benign) tumors



• Hepatic artery angiogram, a test that looks at blood vessels using X-rays and a dye that is injected into a blood vessel — To examine blood vessels that supply blood to liver cancer and determine whether the tumor can be removed surgically



•   magnetic resonance imaging (MRI), a technique that uses a magnetic field to produce pictures of structures inside the body — To produce more detailed images than computed tomography or ultrasound; usually not required



• biopsy — Removal of a small amount of tissue for examination by a pathologist to determine if it is cancerous



• Laparoscopy — Insertion of a thin, lighted tube through a small incision in the abdomen to view the liver

Without treatment, liver cancer will continue to grow.

Most primary liver cancer can be prevented. Here are some things you can do:

• Hepatitis —To minimize the risk of being infected with a hepatitis virus:
  • Get vaccinated (available for Hepatitis B, but not C).
  • Practice safer sex (use a latex or polyurethane condom with nonoxynol-9), and do not have unprotected sex.
  • Wear latex gloves at work when touching or cleaning up blood or personal items, such as tampons and tissues.
  • Avoid sharing personal items such as razors, toothbrushes or earrings with anyone.
  • Make sure needles used for body piercing or tattoos are properly sterilized using a machine called an autoclave.



• Alcohol — To avoid getting cirrhosis of the liver, limit the amount of alcohol you drink to no more than two drinks per day.



• Diet — Diet may be associated with several types of cancer, including colon, rectal, breast and lung cancers, which are known to spread to the liver. It is recommended that you maintain a desirable body weight, and eat a diet that is high in dietary fiber (whole-grains, cereal, vegetables and fruits) and lower in fats, especially saturated fats (red meat and pork).

The type of treatment you will have depends on a number of factors. These include the stage of your cancer, your age and your general health. People diagnosed with liver cancer often have liver dysfunction and other health problems that limit their options for therapy. The best approach often involves a combination of surgery, radiation therapy and chemotherapy. There also are several experimental methods. In many cases, a cure is not possible, and treatment focuses on relieving the symptoms of the cancer or keeping the cancer from growing, spreading or returning.

Cancer that is a single tumor and has not spread to lymph nodes or other organs generally can be removed through surgery. However, only a small percentage of liver cancers are found in this early stage.

Surgery usually doesn’t work for people with cirrhosis, hepatitis or multiple liver tumors in different locations. For these people, other techniques may stop the growth of the cancer temporarily and relieve symptoms, though these techniques have not been proven to help someone with this type of cancer survive longer:

• Cryosurgery destroys liver cancer by freezing it with extremely cold metal probes. The procedure is done under general anesthesia. Cryosurgery can be repeated, complications generally are minimal, and recovery usually is rapid.



• Ethanol ablation, also called percutaneous ethanol injection, injects concentrated alcohol directly into the liver cancer. This dehydrates and kills cancerous cells. The procedure can be done under local anesthesia. Side effects include local pain lasting a few minutes and a fever following the injection.

For most cases of liver cancer, it is not possible to remove the entire tumor, or the cancer has spread throughout much of the liver or to distant sites. There are no standard treatments for liver cancer in these stages. Your doctor can tell you how you may be able to participate in a clinical trial — an experimental treatment being tested in patients. These trials involve risk because the treatment might not work and unanticipated side effects can occur.

Call your doctor if you have any of the symptoms of liver cancer. Also call if you have any symptoms of diseases related to liver cancer. Symptoms of these diseases include:

• Fatigue
• Mild fever
• Jaundice (a yellowing of skin and eyes)
• Muscle or joint aches
• Nausea
• Dark-colored urine
• Vomiting
• Loss of appetite
• Abdominal pain or swelling

Fewer than 10 percent of people with Hepatocellular carcinoma and cholangiocarcinoma survive five years or more. The five-year survival rate for hepatoblastoma is 70 percent. Most people with angiosarcoma survive less than six months.

Last Edited: 15 Aug. 2005