Understanding Liver Cancer Terminology
- Liver cancer comes in various forms. Hepatocellular carcinoma (HCC) originates in the liver itself. Cholangiocarcinoma affects the liver’s bile ducts.
- Your doctor may use terms like NAFLD (fat buildup in the liver without alcohol use) and NASH (more severe liver inflammation and damage) to explain how fatty liver plays a part in your diagnosis.
- Another term you may hear, cirrhosis, means the liver is heavily scarred, usually from long-term damage such as drinking too much alcohol.
- Your doctor may also refer to signs like yellow skin (jaundice), itchiness, and tiredness that often show up late but point to liver problems.
- Liver cancer is often described by whether it is early or late stage. This depends on the type, location and spread of the cancer.
“It can be very confusing because some of the terms are changing too,” Dr. Mariam F. Eskander, a surgical oncologist and assistant professor of surgery at the Rutgers Cancer Institute of New Jersey, tells SurvivorNet.
What type of liver cancer do I have?
Read More- Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, usually discovered in patients with underlying chronic liver disease and cirrhosis, which is a heavy scarring (fibrosis) of the liver caused by various liver diseases and conditions. It originates in the hepatocytes, the liver’s main cell type, and is often linked to inflammation caused by a chronic infection known as hepatitis B or C infections, fatty liver, and repeated exposure to harsh chemicals.
- Cholangiocarcinoma, also known as bile duct cancer or biliary cancer, is a rare form of cancer that occurs in the bile ducts located within the liver. Bile is produced in the liver, stored in an organ called the gallbladder, and flows into the small intestine to aid in digestion.
- Intrahepatic bile duct cancer: Occurs within the liver’s bile ducts. It’s the least common subtype but has been increasing in incidence.
- Perihilar bile duct cancer: Also called hilar cholangiocarcinoma or Klatskin tumor, arises at the confluence of the left and right hepatic bile ducts outside the liver but not extending into the bile ducts within the liver or down to where the bile duct enters the intestine. This subtype is the most common.
- Distal bile duct cancer: Found in the bile ducts closer to the small intestine, outside the liver. This type affects the part of the bile duct that runs through the pancreas to the small intestine.
Related: Introduction to Bile Duct Cancer & Overview of Treatment Options
Why is fatty liver a factor in my diagnosis?
If you are diagnosed with a form of liver cancer, your doctor may tell you that having a fatty liver is one of the causes.
Liver cancer can develop from fat buildup in the liver due to inflammation, scarring, and eventually this will lead to cellular changes hat fuel uncontrolled growth of cancer cells.
There are a number of ways your doctor may describe a fatty liver:
- NAFLD (Non-alcoholic fatty liver disease) is a broad term for a range of liver conditions affecting individuals who drink little to no alcohol and have a high level of excess fat stored in the liver cells. NAFLD can range from simple fatty liver, which may be referred to as steatosis. But it can also progress into a more serious condition.
- NASH (Non-alcoholic steatohepatitis) is a more advanced form of NAFLD. There is a build up of fat in the liver plus inflammation and liver cell damage.
If you have trouble understanding the difference between those two terms, think of it this way: while all individuals with NASH have NAFLD, but not all individuals with NAFLD progress to NASH.
As if that isn’t confusing enough, the terms NAFLD and NASH have recently fallen out of favor with some health professionals.
“They made people feel bad and weren’t very useful terms. And so now we’ve renamed them,” Dr. Eskander explains.
Your doctor may use the terms MASLD and MASH instead or even interchangeably:
- MAFLD is short for metabolic dysfunction-associated fatty liver disease. It’s a more accurate way to describe the disease’s association with poor metabolic health – how the body uses and stores fat – including conditions like obesity, type 2 diabetes, and high cholesterol. MAFLD focuses on the metabolic risk factors involved in fatty liver rather than just the idea that alcohol is not a factor.
- MASH, or metabolic dysfunction-associated steatotic liver disease, is the most advanced form of MAFLD. It has been suggested as a replacement for NASH by leading expert liver cancer organizations as a better way to describe how metabolic diseases contribute to fat in the liver.
The shift to MASLD and MASH reflects a deeper understanding of the disease’s nature and its association with poor metabolic health.
Related: Understanding Liver Cancer — Signs, Symptoms & How it is Treated
What is cirrhosis?
Another word your doctor may mention is cirrhosis.
Cirrhosis is a late-stage liver disease marked by severe scarring of the liver and poor liver function.
This condition results from long-term, continuous damage to the liver and subsequent repair attempts by the organ.
As the liver tries to repair itself, scar tissue forms, replacing healthy liver tissue. Over time, the accumulation of scar tissue can significantly affect the liver’s ability to process nutrients, hormones, drugs, and natural toxins. It also reduces the liver’s ability to produce proteins and other substances.
Cirrhosis plays a critical role in the development of liver cancer, particularly HCC.
The damaged liver cells and the chronic inflammatory environment within a cirrhotic liver increase the risk of cancerous mutations in liver cells.
“Anything that causes irreversible injury to the liver or a kind of fibrosis is known as cirrhosis,” Dr. Eskander explains. “The primary factors that cause cirrhosis are viral hepatitis, including hepatitis B and C, MASLD, and more specifically, MASH.”
Eskander notes that alcohol is often a major cause of cirrhosis; it damages liver cells directly and leads to inflammation and scarring, setting the stage for the development of liver cancer.
What is Jaundice?
Liver cancer often does not cause any symptoms until the disease is pretty far along.
“Unfortunately liver and bile duct cancers often don’t have symptoms. Patients usually seek medical assistance once symptoms appear. That usually means that the cancer has grown bigger and more advanced,” Dr. Eskander says.
When symptoms do start, patients often report itchy skin, fatigue, abdominal pain, fever and night sweats. All of these issues could be caused by any number health conditions.
However, yellowing of the skin and the white of your eyes, a condition known as jaundice, does signal a specific problem with the liver.
Jaundice happens when there’s too much bilirubin, a yellow pigment produced in the liver to aid in digestion. Your liver is supposed to filter bilirubin from your blood but when the liver is damaged or cancerous, it can’t do its job properly.
Liver cancer can block the liver’s ability to manage bilirubin, either because the tumor interferes with liver function or because the cancer disrupts the bile ducts.
This buildup is what causes the yellowing seen in jaundice. So, jaundice can be a warning sign of liver cancer, indicating that the liver is not working as it should.
Another symptom you might have is white or claylike stool. Your doctor may refer to this as acholic, or a a lack of bile secretion.
Your doctor may also use the word choluria to refer to dark urine, another common symptom of liver cancer.
What other terms might my doctor use when discussing liver cancer?
Other words and terms your doctor may use when discussing liver cancer:
- Primary and secondary: Primary liver cancer originates in the liver. Secondary, or metastatic liver cancer, means that it has spread into the liver from somewhere else in the body.
- Alpha-fetoprotein (AFP): A blood marker often elevated in liver cancer, especially HCC. While not exclusively indicative of liver cancer, high levels of AFP can prompt further diagnostic testing.
- Liver Function Tests (LFTs): A series of blood tests used to assess the liver’s function and health. Abnormal results can indicate liver damage or disease, including conditions that may lead to liver cancer.
- Staging: This the process used to describe the extent of cancer’s spread within the body. For liver cancer, staging involves determining the size of the tumor, how deeply it has invaded the liver, whether it has spread to nearby lymph nodes, and if it has metastasized to other parts of the body.
Doctors use specific criteria to stage liver cancer, called the TNM system:
- (T) Assesses the size and number of tumors
- (N) Determines whether cancer has spread to nearby lymph nodes
- (M) Shows whether there are distant metastases; that is if it has spread further into the body
“Staging not only details the extent of cancer’s spread but also differentiates between early-stage cancer, which is confined to the liver and may be eligible for curative treatments like surgery, and advanced cancer, which has spread beyond the liver or involves major blood vessels, making treatment more challenging and often focusing on prolonging life and relieving symptoms,” Dr. Eskander says.
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