Liver Cancer

What is liver cancer?
More than 24,000 cases of liver cancer affect Americans each year, according to the National Cancer Institute. Liver cancer accounts for less than 1 percent of cancers in the United States. The average age of diagnosis is 64, with 90 percent of cases occurring in individuals age 45 and older.

The most common form of liver cancer in adults, hepatocellular carcinoma represents 75 percent of cancers starting in the liver cells. This cancer usually begins in many spots within the liver but sometimes starts as a single tumor and does not spread until later stages of the disease. Intrahepatic bile duct cancer, also known as peripheral cholangiocarcinoma, accounts for 10 to 20 percent of liver cancers. Other, rarer forms of liver cancer include angiosarcoma and epithelioid hemangioendothelioma. Another type–hepatoblastoma–occurs in children under age four.

Who is most likely to have liver cancer?
Most people with hepatocellular carcinoma have livers damaged by cirrhosis, which may be caused by alcohol abuse, chronic infection from the hepatitis B and C virus, or by hemochromatosis, a genetic condition causing too much iron deposition in the liver. Other risk factors include smoking, obesity, diabetes, anabolic steroid use, and a history of an inherited metabolic disease. Men are more likely to have hepatocellular carcinoma than women. Asian-Americans, Pacific Islanders, and native Alaskans have higher-than-average incidences of liver cancer. However, not all cases of liver cancer have identifiable risk factors. In addition, it is unlikely that liver cancer has a single cause and in all probability the tumor develops in a multifactorial and multistep manner.

What characterizes liver cancer?
Liver cancer usually doesn’t cause symptoms at the early stage. When the cancer grows larger, symptoms may include pain; a lump or feeling of heaviness in the right, upper abdomen; bloating; loss of appetite; weight loss; weakness and fatigue; nausea and vomiting; fever; and jaundice.

How does the pathologist make the diagnosis?
The pathologist reviews the results of a physical examination and blood tests. During a physical exam, the doctor checks the abdomen for lumps or abnormal fluid buildup. The eyes and skin are checked for signs of jaundice. The blood test may show abnormal liver enzymes and increased alpha fetal protein (AFP).

Other diagnostic tests for liver cancer may include computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound. These tests allow the pathologist to view images of the liver area and to check for a tumor or other problems. Other imaging tests such as a bone scan or positron emission tomography (PET) may be given if there is concern that the liver cancer has spread.

How is a definitive diagnosis of liver cancer rendered by the pathologist?
If a tumor is found, the physician may obtain a biopsy specimen–a sample of the tumor’s cells–for the pathologist to examine under a microscope. Sometimes, the pathologist has to use certain markers to label a specific type of tumor cells for a definitive diagnosis. To obtain the biopsy sample, the physician may use a small needle (needle biopsy) along with ultrasound or a CT scan to guide the needle directly into the tumor. In some cases, a surgical incision may be made in the operating room to obtain the tumor tissue.

What is meant by the stage of the cancer?
The pathologist and cancer specialists (surgeon and oncologist) determine the extent of the disease, e.g. the cancer’s stage, to plan the best treatment. Stage I liver cancers are small and confined to one area of the liver. Stage IV cancers have spread beyond the original area into other parts of the body. Stage II and III describe conditions in between these two extremes.

How do doctors determine what treatment will be necessary?
Not all liver cancers are treated with the same regiment. Thus, it is extremely important to have the correct diagnosis and the stage of the tumor. The recommended treatment, whether surgery or chemotherapy, will depend on the specific type and stage of the liver cancer, the size and location of cancer cells, how well the liver is working and whether cirrhosis is present, and the patient’s age and general health. The primary care physician or specialist consults the pathologist to form a disease management team. Together, using their combined experience and knowledge, they determine treatment options most appropriate for the patient’s condition. It’s important to learn as much as possible about treatment options and make the decision that’s right for you.

What kinds of treatments are available for liver cancer?
The most effective treatment option for liver cancer is surgery, if possible, which may include a liver transplant. Other options include ablation, embolization, chemotherapy, targeted therapy, and radiation therapy. All these options can be used individually or in combination.

Surgery removes part or all of the liver. Partial removal of the liver is recommended if the liver is working well and the cancer has not spread to other parts of the body. As much as 80 percent of the liver may be removed because it can re-grow and compensate for its function.

If the entire liver must be removed, it is replaced with a healthy donor liver during a liver transplant–an option if the cancer has not spread beyond the liver and if donated liver tissue is available. A whole liver may come from a deceased person, or part of a liver from a live donor, often a relative. After a liver transplant, patients must take immunosuppressive drugs to prevent the body’s immune system from rejecting the new liver tissue.

Ablation destroys cancer by delivering heat through a special probe guided by ultrasound, CT, or MRI. Another type of ablation uses ethanol rather than heat. Ablation reduces tumor burden and extends life, but it is not an attempt for cure; it may be used for people waiting for a liver transplant, or for those who cannot have surgery or a liver transplant.

Another option for people who can’t have surgery or a liver transplant, embolization blocks blood flow from the hepatic artery to the liver tumor, thereby preventing the tumor from receiving the oxygen and nutrients it needs to grow. This method can reduce the tumor burden from its large size and slow down the tumor growth; but it is unlikely to cure the disease by killing all the tumor cells.

Chemotherapy and targeted therapy use drugs to kill or slow the growth of tumors. Radiation therapy uses pinpointed, high-energy beams to kill cancer cells and to relieve pain. In some cases, a physician can deliver chemotherapy or radiation therapy directly to the tumor by injecting the agent into the hepatic artery that supplies the tumor. This procedure requires specialized liver surgeon.

In addition, people with liver cancer may receive other treatments to control pain and other symptoms, relieve side effects, or to ease emotional problems. Liver cancer patients must receive frequent check-ups after treatment because liver cancer may come back. Checkups may include a physical exam, blood tests, ultrasound, CT scans, or other tests. For people who have had a liver transplant, the doctor will regularly test how well the new liver is working.

Clinical trials of new treatments for liver cancer may be found at www.cancer.gov/clinicaltrials. These treatments are highly experimental in nature but may be an option for advanced cancers. For more information about clinical trials, talk to your doctor or call the National Cancer Institute’s Cancer Information Service at 1–800–4–CANCER.

For more information, go to www.cancer.gov (National Cancer Institute) or www.medicinenet.com (a division of Web MD). Type liver cancer into the search box.

What kinds of questions should I ask my doctors?

Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:

    • Please describe the type of cancer I have and what treatment options are available.
    • What is the stage of my cancer?
    • What are the chances for full remission?
    • What treatment options do you recommend? Why do you believe these are the best treatments?
    • What are the pros and cons of these treatment options?
    • What are the side effects?
    • Is your medical team experienced in treating the type of cancer I have?
    • Can you provide me with information about the physicians and others on the medical team?
    • If I want a second opinion, could you provide me with the names of physicians and/or institutions that you would recommend?

DEFINITION OF TERMS

Bile duct: A tube that carries bile from the liver to the gallbladder and then to the small intestine.

Hepatic: Relating to the liver.

Malignant: Cancerous.

Metastatic: Spreading beyond the original tumor location to other parts of the body.

Pathologist: A physician who examines tissues and fluids to diagnose disease or specific types of cancer in order to guide treatment decisions.

 

Images

Liver cancer cells  NORMAL

Liver cancer cells

Normal liver cells
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This information was developed by the College of American Pathologists’ Public Affairs Committee in conjunction with the College’s Cancer Committee and Council on Scientific Affairs. The College is providing this information to help you better understand your health. Ultimately any decisions you make about your health, however, should be between you and your doctor.

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