Liver cancer develops when the cells that make up the liver reproduce at an abnormal rate. As the cells continue to grow, they begin to form a mass, called a tumor. A tumor can either be benign (meaning it’s noncancerous and unlikely to spread to other parts of the body) or malignant (meaning that the tumor is cancerous, and the cancerous cells may spread throughout the body). There are also several different types of liver cancer, which are categorized by the type of cells that grew to create the tumor: liver cells, blood vessel cells or bile duct cells.
In most cases, the exact cause of liver cancer is not known. Certain factors can increase the risk of liver cancer, such as having cirrhosis (a condition common in those who heavily drink alcohol or have chronic viral hepatitis infections), having fatty liver disease, being male or having certain inherited metabolic diseases. You can reduce your risk of liver cancer by maintaining a healthy weight, drinking responsibly, stopping smoking and getting your hepatitis B vaccine.
The symptoms of liver cancer
The signs and symptoms of liver cancer vary greatly from patient to patient and also depend on the type of liver cancer a patient has. Many of these symptoms, too, may be due to an unrelated, less-serious condition. For example, experiencing stomach pain is a common sign of liver cancer, but could also point to gallstones, intestinal inflammation or stomach ulcers. Still, it’s important to discuss any worrisome or uncomfortable symptoms you’re experiencing with your doctor so they can be tested and treated. If your symptoms are the result of liver cancer, early detection is key to the best possible outcome and quality of life.
Aside from stomach pain, some of the other signs of liver cancer may include:
- Unexplained weight loss
- Jaundice (yellowing of the skin and eyes)
- Persistent nausea and vomiting
- Swelling or hard lumps on the right side of the upper abdomen
- Loss of appetite
- Feeling full after a small meal
- Itchy skin
- Enlarged veins on the abdomen that can be seen through the skin
- Abnormal bruising or bleeding
- General fatigue
Diagnosing liver cancer
Liver cancer is commonly diagnosed with a series of tests. These can include:
- Physical exams – A doctor will examine a patient’s upper stomach to check for swelling and hard lumps, which can be the first signs of liver cancer.
- Blood tests – A doctor may order blood tests to check for high levels of alpha-fetoprotein (AFP), calcium and cholesterol; decreased blood glucose numbers and the presence of hepatitis B and C.
- Imaging tests – Ultrasounds, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans and angiograms can be used to detect liver cancer.
- Biopsies – Several types of biopsies may be ordered to diagnose liver cancer, including needle biopsies, laparoscopic biopsies and surgical biopsies.
Staging liver cancer
Liver cancer can be staged in a variety of ways, all of which help clinicians create the most appropriate treatment plans for their patients. Some of the different staging systems include:
- The TNM system – Using the TNM system is the most common way that clinicians stage cancer. Liver cancer can be staged between 1 and 4. Stage 1 indicates that the tumor has not spread into any blood vessels or outside the liver, and Stage 4 indicates advanced liver cancer that has grown into nearby blood vessels and/or organs.
- The Child-Pugh score – Specifically for patients with cirrhosis, the Child-Pugh score takes note of a patient’s liver function. A Class A Child-Pugh score means normal liver function while a Class C score means the patient’s liver is too damaged for surgery and major cancer treatments.
- Liver cancer classification – A more simplified option, this classification system indicates whether or not a liver can undergo resection (surgery). The liver cancer is classified as potentially resectable/transplantable, unresectable or inoperable.
Types of liver cancer
There are five main types of liver cancer, although only four occur in adult patients. Hepatoblastoma is a rare form of liver cancer that typically develops in children younger than 4 years of age and is often successfully treated when caught early before it has spread to other areas of the body.
The other types of liver cancer include:
Accounting for approximately 75% of all cases, hepatocellular carcinoma is the primary type of liver cancer. Individuals with chronic liver disease and those who drink excessive amounts of alcoholic beverages are most at risk for this cancer, which starts in the liver—or, more specifically, in the hepatocytes, the main functional cells of the liver that carry out a wide range of metabolic, endocrine and secretory functions. Hepatocellular carcinoma can begin as a single tumor that grows or as a series of small cancer nodules that form throughout the liver.
More commonly referred to as bile duct cancer, this type of liver cancer accounts for around 10% of cases. The bile ducts are thin tubes that carry a digestive fluid called bile from the liver through the pancreas and into the small intestine. There, the bile breaks down fats into fatty acids to help food move through the digestive tract. Cancer cells can grow in the bile ducts within the liver (less common) and outside the liver (more common).
Angiosarcoma and hemangiosarcoma
Angiosarcoma and hemangiosarcoma are rare, fast-growing types of liver cancer. They develop in the blood cells lining the liver and are often too widespread once found to be surgically removed. Risk factors for these cancers include exposure to vinyl chloride, thorium dioxide, radium or arsenic, but about half of all patients diagnosed with these cancers have no identifiable cause.
Liver cancer treatment
A liver cancer treatment plan is highly individualized depending on the type and stage of the cancer. Most treatment plans include a combination of:
- Surgery – A patient in the early stages of liver cancer may be eligible for a hepatectomy, in which a portion of the liver is removed, or a liver transplant.
- Chemotherapy – A drug regimen that uses powerful chemicals to destroy cancer cells, chemotherapy can be administered intravenously or orally.
- Radiation therapy – Using high-energy rays to kill cancer cells is a common therapy for cancer patients. Radiation therapy for liver cancer can include external beam radiation therapy or internal radiation therapy.
- Interventional radiology – Interventional radiology includes ablation, which destroys cancer cells without removing them, and embolization, which reduces or blocks the blood flow to the tumor.
Because liver cancer is a rare form of cancer, it’s crucial to receive treatment at a high-volume cancer center with oncological specialists who diagnose and treat this type of cancer regularly. Moffitt Cancer Center has a Gastrointestinal Oncology Program staffed with surgical oncologists, medical oncologists, radiation oncologists, radiologists, pathologists, nurses and other specialists who focus exclusively on liver diseases. This team takes a collaborative and individualized approach to diagnosing and treating each patient, fully assessing each patient and performing such services as:
- Reviewing previous test results for a second opinion
- Initial exams and consultations
- X-rays, MRIs or CT scan imaging
- Biopsies, blood tests and other diagnostic testing
- Review of results
- Discussion of treatment options
With this information, our team will meet weekly as a collaborative tumor board to review each patient’s condition individually, come up with the most effective treatment plan and monitor the patient’s progress during his or her liver cancer treatment. Because our experts are involved in some of the latest drug studies and clinical trials, and our physicians utilize the most advanced techniques, our patients and their families can rest assured that they’re receiving the best liver cancer treatment available. In fact, our dedication to individualized patient care and continued research has led to Moffitt Cancer Center being named a Comprehensive Cancer Center by the National Cancer Institute.