What Is Liver Cancer?

• Primary Liver Cancer This type starts in the liver.
• Secondary Liver Cancer This cancer starts in another area of the body and spreads to the liver. Secondary liver cancer is also known as metastatic disease.

• 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 are usually referring to when they talk about liver cancer.
• Intrahepatic Cholangiocarcinoma (Bile Duct Cancer) This type starts in cells that line the bile ducts, which are tubes in the liver that carry bile to the intestines. It accounts for 10 to 20 percent of primary liver cancers.
• Hepatoblastoma This is a rare liver cancer that usually affects children younger than 4 years old.
• Angiosarcoma and Hemangiosarcoma These are rare cancers that start in cells that line the blood vessels of the liver.

• Unexplained weight loss
• Loss of appetite
• Yellowing of the skin or whites of the eyes (jaundice)
• Pain in the upper abdomen
• Swelling or bloating of the abdomen
• Nausea or vomiting
• Weakness
• Fatigue
• Chalky, white stools
• Dark-colored urine
• Easy bruising or bleeding

Risk Factors for Liver Cancer

• Cirrhosis of the liver, chronic hepatitis B, or hepatitis C
• Smoking
• Being overweight or having obesity
• Certain inherited diseases, such as Wilson’s disease (a rare disorder that causes copper poisoning) and hemochromatosis (a buildup of excess iron in the liver)
• Excessive alcohol consumption
• Diabetes
• Foods that contain aflatoxin (a fungus that can grow on grains and nuts that haven’t been properly stored)
• Metabolic dysfunction-associated steatotic liver disease, formerly known as nonalcoholic fatty liver disease (an accumulation of fat in the liver)

• Blood Tests These are used to detect liver function irregularities or markers in the blood that suggest the development of liver cancer.
• Imaging Tests Ultrasound, computed tomography, or magnetic resonance imaging tests are used to give doctors a detailed look at the liver.
• Biopsy This involves removing a piece of tissue to test for cancer in a lab .

Staging Liver Cancer

Once liver cancer is diagnosed, doctors will next determine the stage, or extent, of the cancer. Staging helps determine a patient’s prognosis and which treatments will work best.

Which Experts Diagnose and Treat Liver Cancer?

• Medical Oncologist This type of cancer doctor has special training in treating cancer with chemotherapy and other medicines
• Hepatologist This is a doctor who focuses on treating diseases of the liver and related problems in the gallbladder, bile ducts, and pancreas.
• Radiation Oncologist This is a cancer doctor who uses high-energy radiation to destroy cancer cells.
• Interventional Radiologist This is a doctor who treats cancer with procedures like embolization (which blocks blood flow to a tumor) and ablation (which shrinks tumors).
• Transplant Surgeon This is a surgeon who exclusively performs organ transplants.
• General Surgeon This type of surgeon is skilled in many different types of operations.
• Gastroenterologist This type of doctor is an expert in diseases of the digestive system.
• Pathologist This type of doctor studies blood, body fluids, and tissue samples to help diagnose and monitor the disease.
• Palliative Care Specialist This is a doctor who helps with pain management and provides other types of support.

The specific treatments doctors recommend for liver cancer depend on many factors, including how advanced the cancer is and how healthy the patient is overall.

Surgery 

• Tumor Removal A surgeon may remove the tumor and some of the healthy liver tissue that surrounds it. This could be an option if the tumor is small and the rest of your liver is healthy enough for surgery.
• 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.

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Other Procedures

• Radiofrequency Ablation An electric current is used to heat up and destroy cancer cells. Similar procedures use microwaves or lasers.
• Cryoablation This involves placing liquid nitrogen directly in the liver tumor to freeze and destroy cancer cells.
• Alcohol Injection A needle is used to inject pure alcohol directly into tumors, causing cancer cells to die off.
• Chemoembolization This involves injecting chemotherapy drugs directly into the liver.
• Radiation Beads These can be placed in the liver, where they deliver radiation directly to the tumor.
• Radiation Therapy High-energy beams are focused 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).

Medication Options

• Targeted Drugs These medicines use abnormalities in cancer cells to focus treatment on those cells specifically. 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).

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• Immunotherapy This treatment 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.

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• Chemotherapy These drugs kill all fast-growing cells, including cancer cells. In liver cancer, chemotherapy is primarily used when other treatments have not been helpful.

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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 of the study.

While there’s no way to completely eliminate the risk of liver cancer, certain lifestyle measures can help lower a person’s likelihood of developing the disease.

• Don’t drink heavily. Women shouldn’t have more than one alcoholic drink a day, and men should have no more than two per day.

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   The World Health Organization’s stance is that no amount of alcohol consumption is safe.

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• Get a hepatitis B vaccine. The Centers for Disease Control and Prevention recommends the hepatitis B vaccine for everyone under age 60, as well as for older adults who may be at risk of developing the infection.

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• 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 high risk of liver cancer, including heavy drinkers and those with liver disease, should ask their doctors about getting screened.

Complications of liver cancer can result from treatments, a diseased liver, or the cancer itself.

• Ascites (fluid buildup in the abdomen)
• Internal bleeding
• Hepatic encephalopathy (a neuropsychiatric syndrome that can impair brain function)
• Liver failure

Liver cancer is a leading cause of cancer death worldwide, and it is more common in other parts of the world, such as sub-Saharan Africa and Southeast Asia, than in the United States.

The Takeaway

• Liver cancer is most common in people who have another type of liver disease that causes cirrhosis, or scarring.
• Liver cancer can be cured if it’s found when the tumor is small enough to be completely removed with surgery, or if you’re able to have a liver transplant.
• Ask your doctor about screening if you have risk factors such as chronic hepatitis, fatty liver disease, or alcohol use disorder.