Overview
What Is Liver Cancer?
The liver is an organ located in the upper-right part of your abdomen. It is a vital part of your body and performs many functions, including:
- Filtering all of the blood from the stomach, intestines and spleen
- Producing bile, which helps the body absorb fat
- Removing toxins from the blood, including medication
- Regulating blood sugar and stores extra blood sugar
- Helping with digestion
- Storing vitamins and minerals
- Regulating other organs, like your kidneys
- Controlling production and removal of cholesterol
- Producing proteins and blood-clotting factors
Primary liver cancer occurs when cancer cells grow in the liver. Other cancers may spread to the liver, but primary liver cancer means the cancer formed in the liver.
Secondary liver cancer is cancer that developed in a different part of the body and spread to the liver.
The most common form of liver cancer is hepatocellular carcinoma, which accounts for four out of five liver cancers. Other types of primary liver cancer include:
- Cholangiocarcinoma: Forms in the bile ducts of the liver. It accounts for 10% to 20% of all liver cancers.
- Mixed hepatocellular carcinoma and cholangiocarcinoma: A rare and aggressive form of liver cancer.
- Hepatoblastoma: A rare liver cancer usually found in children.
- Angiosarcoma: Forms in the lining of the blood and lymph vessels of the liver.
- Hemangioendothelioma: Grows in the cells that make up blood vessels.
Symptoms
Symptoms of Liver Cancer
Typically, liver cancer symptoms do not occur until advanced stages of the disease. Symptoms of liver cancer may include:
- Unexplained weight loss
- Loss of appetite
- Feeling of fullness, even if you only eat a small amount
- Nausea or vomiting, blood-tinged vomit
- Yellowing of the skin (jaundice) or the whites of the eyes (scleral icterus)
- Lump or mass on upper-right side of your abdomen
- Abdominal swelling
- Constant pain in the upper-right side of your abdomen
- Frequent bruising
- Severe bleeding from minor injuries or activities like brushing your teeth
- Fever
- Hypercalcemia (too much calcium in the blood)
Causes and Diagnoses
Liver Cancer Risk Factors
The cause of liver cancer is unknown, but certain factors may increase your risk of developing liver cancer. Risk factors include:
- Hepatitis B or C
- Heavy alcohol use
- Diabetes (when combined with other risk factors)
- Obesity
- Certain chemical exposures
- Other diseases, including:
- Hereditary hemochromatosis
- Tyrosinemia
- Alpha-1 antitrypsin
- Porphyria cutanea tarda
- Wilson disease
- Glycogen storage diseases
Diagnosing Liver Cancer
Your care team will use a variety of leading-edge methods to diagnose liver cancer.
Diagnostic tests and imaging to detect liver cancer may include:
- Blood panel: Samples of your blood will be tested in a lab to assess how your liver is working.
- Ultrasound: This uses high-frequency sound waves to create an image of the internal organs, including the liver, pancreas, spleen and kidneys, and to assess blood flow through various vessels. The ultrasound may be done with an external or internal device.
- Computed tomography scan (CT scan): This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce images of the body. CT scans are more detailed than general X-rays.
- Magnetic resonance imaging (MRI): Using large magnets, radiofrequencies and a computer, an MRI produces detailed images of organs and structures in the body.
- Liver biopsy: A sample of liver tissue is surgically removed to be examined under a microscope for cancerous cells.
Stages of Liver Cancer
“Staging” is the term oncologists use to define where liver cancer is located and how much it has spread. After the stage of liver cancer is determined, your physician can recommend a particular course of treatment.
Most cancer teams use the system developed by the American Joint Committee on Cancer, known as the TNM staging system.
T = Tumor
Where is the primary tumor and how large is it?
N = Nodes
Has the tumor spread to nearby lymph nodes (part of your immune system)?
M = Metastasis
Has cancer spread to other parts of the body?
For each letter, there are five numbered stages, from zero to four, depending on how much the cancer has spread. The lower the number, the more the cancer cells look like normal cells and the easier they are to treat and cure. A higher number means it has spread more.
The place where cancer forms is called the primary site. Cancer can spread from the primary site to other parts of the body. Even if liver cancer is found in other parts of your body, it’s still considered liver cancer. For example, if liver cancer has spread to the colon, it’s called metastatic liver cancer, not colon cancer.
For treatment, physicians often use a simpler system of categorizing liver cancer:
- Resectable cancer: These cancers can be surgically removed (resected).
- Borderline resectable cancer: These cancers can be surgically removed but are very close to major blood vessels, or other important parts of your body.
- Locally advanced cancer: These cancers are still only in the area around the liver, but they cannot be removed completely with surgery, often because they are growing into nearby blood vessels. This category is also called unresectable because the cancer cannot be removed with surgery.
- Metastatic cancer: These cancers have spread to other parts of the body, so they cannot be removed completely with surgery (meaning they are also unresectable). Surgery may still be done, but it's used to relieve symptoms that the tumors in other areas of the body are causing.
Be sure to talk to your physician about your stage of cancer and how that will impact your treatment.
Treatments
Liver Cancer Treatments
We provides specialty care for liver cancer with a multidisciplinary team in world-class, patient-centered facilities.
Your Liver Cancer Care Team
Our cancer team includes oncologists (physicians who are specially trained in cancer care), surgeons and a comprehensive support team devoted to treating your cancer. Your cancer care team may include:
- Specialized physicians
- Surgical oncologists
- Physician assistants
Your treatment plan will be tailored to your unique needs and may include a combination of:
- Surgery: A surgical oncologist (a surgeon specially trained in cancer care) may be able to remove all of or a portion of your liver tumor surgically.
- Chemotherapy: Chemotherapy is medication that is administered through your veins or by mouth to eliminate cancer cells.
- Hepatic artery infusion pump chemotherapy: This type of chemotherapy involves a device implanted in your body that connects to the hepatic artery, which supplies blood to your liver.
- Radiation therapy: Radiation therapy uses targeted radioactive waves to eliminate cancer cells and shrink tumors.
- Radioembolization: A specialized interventional radiologist may use intra-arterial yttrium-90 radioembolization (commonly called Y-90) to deliver a dose of radiation to a liver tumor.
- Chemoembolization: A specialized interventional radiologist can perform a chemoembolization. This is procedure administers anti-cancer medications into a tumor through the tumor’s blood supply, allowing for a higher concentration of the medication to have longer contact with the tumor.
- Ablation therapies: Ablation is a type of treatment that eliminates tumors without removing them. These techniques may be used when surgery is not a good option because of poor health or reduced liver function. Ablation can often be done without surgery by inserting a needle or probe into the tumor through the skin.
Palliative Medicine
Side effects from cancer treatment can impact your quality of life and how your body responds to treatment. Palliative medicine specialists work with your cancer care team to help relieve your pain and manage your symptoms. Palliative medicine may help:
- Treat pain and other physical symptoms of cancer, such as fatigue, nausea, trouble sleeping, poor appetite, breathing difficulties and weight loss
- Treat your emotional symptoms, such as depression and anxiety
- Improve your body’s ability to tolerate cancer treatments
- Help you better understand tests, procedures and options
- Guide you and those who care for you to helpful resources
Chemoembolization
If you have primary liver cancer, or liver cancer that has metastasized from elsewhere in your body, chemoembolization may be part of your treatment. we work closely with your referring physician to ensure you receive the best treatment to meet your needs. And, our clinical nurse coordinators assist you in planning, scheduling and following up after your treatment.
What is chemoembolization?
Chemoembolization is used for tumors that cannot be removed surgically because of their location or the number of tumors present. It is a palliative, not a curative, treatment, but can be extremely effective in treating primary liver cancers and some types of metastatic tumors especially when combined with other therapies. The treatment works to reduce or cut off the blood supply to your tumor. Your liver is unique because it has two blood supplies. The portal vein provides 75 percent of the liver’s blood supply and the hepatic artery supplies the remaining 25 percent. Tumors that grow in the liver typically receive their blood supply from the hepatic artery, which make chemoembolization possible. The procedure is usually done on an outpatient, same-day basis.
How chemoembolization works
The interventional radiologists insert a catheter into your liver’s blood supply to attack the cancer in two ways. First, chemotherapy drugs are injected directly into the blood supply of the tumor. This gives the drugs more time and contact with the tumor to work and destroy the cancerous cells. Because the chemotherapy is delivered directly to the tumor, stronger doses can be given than would be possible during standard chemotherapy, which is injected through a vein in your arm. Second, a blocking agent, called an embolizer, is used to stop the blood supply to the tumors. This starves the tumor of oxygen and nutrients, causing them to shrink. Combining chemotherapy with an embolizer has a more powerful effect than if either was given alone. Chemoembolization requires a one to two day hospital stay.
Benefits and risks
Chemoembolization offers key benefits, including:
- Injecting chemotherapeutic drugs into the cancer site lessens side effects, as only a small amount of the medicine enters your bloodstream.
- This procedure can help prevent the growth of the tumor or tumors in your liver, while potentially shrinking them, preserving liver function and allowing you to have a relatively normal quality of life.
- This treatment can be repeated every four to eight weeks or used in combination with other types of therapy to control your liver cancer.
Risks following chemoembolization, include:
- Fever (short-term in 10 percent of patients)
- Nausea and vomiting (nausea can last up to two weeks, vomiting for a few days)
- Fatigue
- Upper right abdominal discomfort (can last from a few days up to a week)
- Infection or bleeding
- Small chance of the embolization material or particles becoming lodged in the wrong place and depriving normal tissue in your body of its blood supply
- Allergic reaction to the contrast dye used for the X-ray
- Kidney damage for those with diabetes or pre-existing kidney disease
Radioembolization (Selective Internal Radiation Therapy) - SIRT
If you have primary liver cancer, or liver cancer that has metastasized from elsewhere in your body, radioembolization may be part of your treatment. we work closely with your referring physician to ensure you receive the best treatment to meet your needs. In addition, our clinical nurse coordinators assist you in planning, scheduling and following up after your treatment.What is radioembolization?
Radioembolization is a minimally invasive treatment that uses tiny radioactive beads, called microspheres, to deliver radiation directly to cancerous tumors in your liver. The beads are extremely small, measuring about one-third the diameter of a human hair, and are placed directly inside the tumor. Over a period of 10 to 12 days, the beads emit high radiation, causing the tumor to shrink. Radioembolization may also be called intra-arterial brachytherapy, selective internal radiation therapy or Y-90. Radioembolization is a palliative treatment used to treat liver cancer that cannot be removed with surgery. Radioembolization has the potential to shrink tumors or downstage them, so you are eligible for other treatments, surgery or a liver transplant. Radioembolization has been shown to help you live longer and improve your quality of life.Initial evaluation
Your physician will discuss all your treatment options with you before scheduling you for a treatment. You will meet with us. we will review your health history, current list of medications, labs, CT scans, MRI or PET scans. You may not be a candidate for radioembolization for several reasons:- Abnormal liver function
- Abnormal or no arteries near your liver tumors
- A very large portion of your liver is covered by tumors
- Your bilirubin, albumin or other lab values are out of normal range
Benefits and risks
Benefits of radioembolization include:- Minimal injury to the surrounding healthy liver tissue.
- Decreased side effects from the radiation.
- Once you have received the radioactive microspheres, the external radiation exposure to other individuals is very low and highly unlikely to cause harm. To be cautious, minimize contact (within a yard) with children under the age of 10 and pregnant women for three days following therapy.
- Radioembolization is the only treatment approved in the United States to treat primary liver cancer in patients with portal vein thrombosis.
- The recovery period after radioembolization is generally short.
- Fatigue (usually lasts 10 to 12 days)
- Mild abdominal discomfort and bloating
- Due to sedation medications, nausea and vomiting may occur one to two days following your procedure
- Fever (10 percent of patients)
- Infection or bleeding
- Allergic reaction to the contrast dye used for the X-ray
- Kidney damage for those with diabetes or pre-existing kidney disease
Even after a safety planning session, there is a very small risk (less than one percent) that radiation could be delivered to your lungs and/or digestive tract. Lung damage might occur causing swelling, scarring or shortness of breath. Irritation of the gastrointestinal tract could result in chronic pain, nausea, vomiting, ulcers, bleeding or pancreatitis. Side effects vary for every patient. Medicines are given to help prevent or relieve most of these side effects. Also, steps can be taken to prevent allergic reactions to contrast dye and lessen the chance of kidney damage for those at risk. If you have any questions on these risks, discuss them with your physician.