Liver Cancer Explained
- Chronic inflammation of the liver can lead to hepatocellular carcinoma (HCC), the main type of liver cancer.
- Risk factors for HCC include a chronic viral infection known as hepatitis, cirrhosis (scarring of the liver), obesity, and type 2 diabetes.
- Symptoms like jaundice (yellowing of the skin and whites of the eyes), abdominal pain, and unexplained weight loss are key indicators, but liver cancer often shows no early signs and is often diagnosed in later stages.
- Doctors recommend that people at high risk for liver cancer be screened every year or more often.
To begin with it’s important to know which of the two types of liver cancer you have. Dr. Miriam Eskander, a surgical oncologist and assistant professor of surgery at the Rutgers Cancer Institute of New Jersey, explains to SurvivorNet.
Read MoreWhat are the risk factors?
The risk for getting liver cancer depends on a variety of factors including genetics, the environment, and lifestyle habits.“It’s usually caused by chronic inflammation in the liver — it could be because of genetics or it could be because of environmental factors [which] can lead over a lifetime to develop HCC,” Dr. Milan Kinkhabwala, professor of surgery and the director of the hepatobiliary section and transplantation at Montefiore Einstein’s Comprehensive Cancer Center, explains to SurvivorNet
Risk factors include:
- Chronic viral hepatitis (having a long-term hepatitis B virus or hepatitis C virus infection)
- Cirrhosis (a disease in which liver cells become damaged and are replaced by scar tissue)
- Significant alcohol use
- Tobacco use
- Being overweight/obese
- Nonalcoholic fatty liver disease (extra fat in the liver that is not caused by alcohol)
- Type 2 diabetes
- Hemochromatosis (a condition where the body takes up and stores more iron than it needs)
In the U.S., liver cancer is also more common among people of certain ethic backgrounds. Asian Americans and Pacific Islanders have the highest rates of liver cancer, followed by Latin Americans, Native Americans, and Black Americans.
The disease is also significantly more common in men than in women.
What are the signs/symptoms?
Symptoms of liver cancer are often nonspecific, meaning that they can overlap with those of various other conditions. This is why it’s so important to see a doctor to determine a diagnosis.
Symptoms of liver cancer can include:
- Jaundice (yellowing of skin and whites of the eyes)
- Intensely itchy skin
- White or clay-like stool (also known as acholia)
- Dark urine (also known as choluria)
- Fatigue
- Abdominal pain (on the right side, just below the ribs)
- Unexplained weight loss
- Fever
- Night sweats
Abdominal discomfort associated with liver cancer is typically concentrated on the right side near the rib cage, where the liver is situated within the body. Abdominal swelling may indicate liver failure or advanced cancer.
Bilirubin is a yellow substance produced when the body breaks down old red blood cells. It’s what gives the digestive fluid called bile its color. Jaundice, evidenced by yellowing of the eyes or darkened urine, is a result of increased bilirubin levels in the bloodstream.
Related: The Difference Between Bile Duct Cancer and Liver Cancer
Should I be screened for liver cancer?
Currently, experts don’t recommended screening tests for liver cancer in individuals without any known risks.
However, individuals at higher risk may be advised to undergo regular testing.
Alpha-fetoprotein (AFP) is a protein produced in the liver that’s often higher in the blood of people with liver cancer. Research indicates that screening for AFP may improve survival rates for liver cancer.
Experts recommend a blood test for this protein every six months if the patient has:
- Hereditary hemochromatosis (a genetic condition where the body absorbs too much iron from food, leading to excess iron buildup in organs)
- Cirrhosis (a scarring of the liver from any cause) especially if it worsens over time
- Chronic hepatitis B, a viral infection (even without cirrhosis)
However, relying solely on high AFP levels isn’t foolproof for diagnosing liver cancer. Many patients with early liver cancer have normal AFP levels, and elevated AFP levels can also occur in other types of cancer and certain non-cancerous conditions.
How is liver cancer diagnosed?
Liver cancer often shows no symptoms in its early stages. Tumors are usually too small to be felt from the outside. Detecting these tiny spots on the liver requires special techniques administered by skilled specialists.
If you’re experiencing symptoms of liver cancer, your doctor will start with an initial physical exam.
The exam will include:
- Abdomen check to examine the liver, spleen, and nearby organs
- Check for fluid buildup in your abdomen (ascites)
- Skin and eye exam for signs of jaundice
If your doctor suspects liver cancer, you may need follow up tests to confirm the diagnosis, which can include:
- Ultrasound: This machine uses sound waves to create a computer image and can detect tumors. This is often the first test used to look at the liver.
- Blood tests: These tests are used to detect substances like alpha-fetoprotein (AFP).
- CAT scan: These scans use X-ray technology that makes detailed images of your body and can give specific information about the size, shape, and location of any tumors in the liver or elsewhere in the abdomen, as well as nearby blood vessels.
- MRI scan: These scans provide detailed images of liver cancers, sometimes using contrast material and X-rays of the bile ducts.
- Genomic/Molecular Profiling: These tests can identify specific biomarkers to help determine the best treatment options and clinical trials for liver cancer.
- Biopsy: This involves removing a small sample of tissue from the tumor to examine it under a microscope.
Different biopsy techniques include:
- Fine needle aspiration (FNA): A thin needle is used to take a small tissue sample from the liver.
- Core biopsy: Similar to FNA, but a thicker needle is used to remove larger samples.
- Percutaneous biopsy: Using ultrasound or a CT scan, the doctors can find the tumor and use a fine needle to take a tiny sample of tissue.
- Laparoscopy: A small incision is made in the abdomen, and a thin tube with a camera is used to view and obtain a tissue sample.
- Surgical biopsy: Tissue is taken during a surgical procedure.
Related: Is Minimally Invasive Surgery For Liver Cancer Right For Me?
How is liver cancer staged?
Liver cancer is often staged using the TNM system, which stands for tumor size (T), lymph node involvement (N), and metastasis (M).
- Tumor Size (T): How large has the cancer grown? Is there more than one tumor in the liver? Has the cancer reached nearby structures like the veins in the liver? In general, the higher the number, the larger and/or more invasive the cancer.
- Lymph nodes (N): has the cancer spread to nearby lymph nodes?
- Metastasis (M): has the cancer spread to distant organs such as the bones or lungs?
Doctors also need to know how well your liver is functioning. This is especially important if you have liver damage, like cirrhosis.
To determine this they use the BCLC staging system and the Child-Pugh score.
- BCLC Staging System: Classifies liver cancer based on tumor size, liver function, physical condition, and cancer-related symptoms. It helps doctors determine the best treatment plan and predict patient prognosis.
- Child-Pugh Score: Assesses the severity of chronic liver disease, using clinical measures to evaluate liver function and health.
Unfortunately, if your liver is severely damaged, you might not be healthy enough to undergo cancer treatment.
What are the treatment options?
Doctors often take a multidisciplinary approach to treat liver and bile duct cancers. Your team may include a medical oncologist, surgical oncologist, radiation oncologist, hepatologist or gastroenterologist, and more.
Your care team will work together to come up with a comprehensive yet tailored strategy you.
“We kind of individualized treatment based on a few factors. Stage is definitely an important consideration in deciding the best treatment. So an earlier stage cancer may be appropriate for something like surgical resection. However, there’s other factors also such as the patient’s condition, their medical comorbidities and what their goals are in care,” explains Dr Kinkhabwala.
“Someone who may not want to undergo aggressive surgery or transplant can certainly be offered non-surgical techniques that may be less likely to affect their function and allow them to continue to work and perform their daily activities without much interruption. Other patients who may want a much more aggressive approach to trying to cure their cancer could be candidates for a big operation such as hepatectomy for example.”
Common treatments include:
- Surgery (liver resection)
- Liver transplantation
- Chemotherapy
- Radiation therapy
- Targeted drugs that hit specific cancer mechanisms or genetic markers while preserving healthy cells
- Immunotherapy to boost the body’s immune system
- Ablation therapies that use radiofrequency ablation or microwave ablation to freeze, heat or cut off the blood supply to small tumors that remain or recur
Related: SurvivorNet Clinical Trail Finder
Questions to Ask Your Doctor
- What type of liver cancer do I have?
- What stage is my cancer?
- What are my treatment options?
- How will we manage treatment side effects?
- How much of my treatment will be covered by insurance and how much will I pay out of pocket?
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