The Basics of Liver Cancer

Although the most frequent type of liver cancer comes from the spread of cancer to the liver from other parts of the body (metastatic liver cancer), there are cancers that originate in liver cells themselves. The most common form is the hepatocellular carcinoma. It usually arises from an infection with the hepatitis B virus (HBV) or the hepatitis C virus (HCV). Other types of primary liver cancers, such as fibrolamellar carcinoma, cholangiocarcinoma, and hepatoblastoma are rare.

Fibrolamellar carcinoma is a specific type of hepatocellular carcinoma with the cancerous liver cells surrounded by layers of fiber-like tissue, and has no association with cirrhosis or either hepatitis B virus (HBV) or hepatitis C virus (HCV). If detected early enough, the outcome is better than for hepatocellular carcinoma. Cholangiocarcinoma comes from the cells lining the bile ducts from the liver into the intestine. Infants also develop liver cancer, the most common being hepatoblastoma. A rare tumor of the liver’s blood vessels, angiosarcoma, has been linked to the industrial exposure to vinyl chloride. These liver tumors are best diagnosed by biopsy. Some patients survive several years after tumor resection.

Who’s at risk?

The development of liver cancer is closely associated with certain factors:

  • If you visit or live in an area with a high prevalence of hepatitis B virus infections (HBV), or develop a hepatitis B virus infection yourself.
  • Exposure to environmental carcinogens such as aflatoxins from food contaminated by certain fungi, and vinyl chloride (a form of plastic and solvent) exposure.
  • Chronic hepatitis C virus (HCV) infection. The tumor may evolve from tissue changes related to the cirrhosis that develops in many people as a result of hepatitis C virus (HCV) infection.
  • Other types of cirrhosis, for example alcoholic, cryptogenic, and especially hemochromatotic cirrhosis may lead to cancerous changes in liver cells.
  • Presence of a benign hepatic adenoma, which may change to a malignant form of tumor.

What are the symptoms?

The signs and symptoms of liver cancer are vague at first, usually presenting with some pain in the upper-right side of your abdomen, or the feeling of bulkiness or fullness in that area. A “rubbing” sensation felt with you hand over that same area also may be present.

Weight loss, an unexplained downward course of health in someone with a history of stable cirrhosis, and fever (acting like an infection) are other common signs. On occasion, the first sign of a tumor is its rupture or bleeding, causing a sudden emergency.

How is it diagnosed?

In addition to the physical examination and history findings mentioned above, laboratory blood tests can help in the diagnosis of liver cancer. Some of these findings include:

  • A progressive increase in alpha-fetoprotein (AFP) – a measure of tumor presence
  • A sudden/progressive increase in alkaline phosphatase – indicating destruction of cells
  • A rapid deterioration of hepatic function tests
  • Polycythemia – increased blood cell counts
  • Hypoglycemia – persistent low blood sugar
  • Hypercalcemia – increased calcium in the blood
  • Dysfibrinogenemia – changes in the clotting factors made in the liver and found in the blood
  • Hyperlipidemia – increased lipids (fats) in the blood

Specialized x-ray tests, such as a CAT scan and an MRI can visualize a tumor in the liver itself, and a magnetic resonance angiography will outline the blood vessels in and around the tumor. A laparoscopic evaluation (a small fiber optic tube inserted under anesthesia into the abdominal cavity to provide a visual examination) may detect metastatic disease or involvement of both liver sections (lobes), which may reduce the need for more involved surgery.

A biopsy of the liver, using a small needle inserted under local anesthesia through the skin and into the tumor, gives a small sample of tissue for examination by a pathologist. The path of the needle is guided by using ultrasound “pictures” to locate the tumor site.

What are the stages?

Stage 1
Cancer is in only one lobe of the liver and can be completely removed through surgery.

Stage 2
The cancer is in only one lobe of the liver, but cannot be completely removed through surgery.

Stage 3
The cancer has spread throughout both lobes of the liver or to other parts of the body.

Stage 4
Liver cancer that has come back after it has been treated. It may recur in the liver or elsewhere in the body.

How is it treated?

The most effective way of treating a primary liver cancer is to remove it surgically. Unfortunately, most primary liver cancers are too large by the time they are discovered, and not likely to be surgically removable. Because the diagnosis is established late, the outlook is grim and death often occurs within a few months.

Hepatocellular carcinoma is not sensitive to radiation therapy, and chemotherapy is usually unsuccessful. If you have a primary liver cancer and surgery is not an option for you, there are clinical trials being conducted to evaluate such developments as placing chemotherapy drugs directly into the blood supply to the liver, or using certain chemicals to close off the tumor’s blood supply. A liver cancer vaccine may ultimately prove useful as well.

Another option is complete removal of the liver, followed with a liver transplant. This procedure has met with a moderate degree of success, but this may be due to only patients with small, localized tumors being selected for transplant. If a loved one develops advanced liver cancer, attention should be placed on considerations for relief of their pain and suffering.

How can I help prevent liver cancer?

You can lower your risk of developing liver cancer by reducing your exposure to certain risk factors – excessive drinking, hepatitis, and anabolic steroids. Excessive drinking is the most common cause of cirrhosis of the liver, which often leads to liver cancer.

A vaccination is now available to protect against hepatitis B. Children should be vaccinated at the appropriate age. Ask your child’s pediatrician.

The American Cancer Society
The National Cancer Institute
The American Society of Clinical Oncologists