Liver Cancer

What Is It?

Liver cancer is the uncontrolled growth of abnormal cells in the liver. The liver:

• Produces elements that help blood to clot
• Removes or neutralizes poisons, drugs and alcohol
• Manufactures bile, which helps the body to absorb fats and cholesterol
• Helps to maintain normal blood sugar levels
• Regulates several hormones

Cancer in the liver either starts in the liver (primary liver cancer) or spreads to the liver from other places in the body (secondary liver cancer). Primary liver cancer is the most common solid tumor worldwide, with more than one million cases diagnosed each year. However, it is relatively rare in the United States and Europe. The American Cancer Society estimates that more than 17,000 people are diagnosed with primary liver cancer each year. Most of them are over age 40, and more than 15,000 will die of the disease. In the United States, liver cancer is about twice as common in men as in women.

Most liver tumors in the United States have spread (metastasized) to the liver from other organs, most commonly from the colon, rectum, lung, breast, pancreas and stomach. When a cancer spreads to the liver from somewhere else, the cancer cells are the same in both places. For example, if lung cancer spreads to the liver, the cancerous cells in the liver are the same as the cancerous cells in the lung. For that reason, the person is treated for lung cancer, not liver cancer. Doctors would call the cancer in the liver "metastatic lung cancer." The liver is the most common place for cancer to spread.

Only primary liver cancer is treated as liver cancer. There are four main types of primary liver cancer:

• Hepatocellular carcinoma (hepatoma or HCC) -- This cancer accounts for about 84% of primary liver cancers in the United States. It behaves aggressively.
• Cholangiocarcinoma (bile duct cancer) -- This cancer accounts for about 13% of primary liver cancer in the United States. Several conditions increase the risk of developing this cancer, including gallstones, gallbladder inflammation and, sometimes, chronic ulcerative colitis (an inflammation of the large bowel).
• Angiosarcoma (hemangiosarcoma) -- This is a very rare form of liver cancer.
• Hepatoblastoma -- This is a rare type of liver cancer usually found in children younger than age 4.

Risk Factors

Factors that increase your risk of developing primary liver cancer include:

• Hepatitis, which is an inflammation of the liver caused by a viral infection. A different virus causes each of the six types (A, B, C, D, E and G). Hepatitis B and Hepatitis C are responsible for most cases of hepatocellular carcinoma. Hepatitis A does not increase your risk of developing liver cancer.
• Cirrhosis, which is the scarring of liver cells that has several causes. In the United States, the most common causes of cirrhosis are hepatitis C and drinking too much alcohol. Fifty percent to 70% of liver cancers in the United States are associated with cirrhosis.
• Direct contact with vinyl chloride (polyvinyl chloride or PVC) -- This chemical, used in manufacturing some types of plastics, such as PVC pipe, has been linked to hepatocellular carcinoma in some studies.
• Exposure to arsenic, a chemical used as a wood preservative, herbicide, insecticide, and in manufacturing some glass and metallic alloys. Some drinking water is contaminated by arsenic. It also exists in natural mineral deposits.
• Anabolic steroids, which are male hormones used to treat certain conditions, and are sometimes used illegally by athletes to enhance performance. Long-term use may slightly increase the risk of liver cancer.
• Tobacco use, which makes you more likely to develop other cancers that can spread to the liver, including cancers of the lung, colon and pancreas. It is not known whether there is a direct link between tobacco use and liver cancer.

Symptoms

Symptoms usually do not appear until the disease is advanced. Symptoms can include:

• Unexplained weight loss
• Loss of appetite
• Feeling full after a small meal
• Pain or swelling, especially in the upper-right abdomen
• A yellow tint in the skin and eyes (jaundice)
• Liver enlargement or a mass in the area of the liver
• Worsening of chronic hepatitis or cirrhosis
• Low blood sugar (hypoglycemia)
• Breast enlargement in men

Diagnosis

Liver cancer most often is diagnosed in later stages of the disease because symptoms do not appear until then. Once your doctor suspects you might have liver cancer, he or she will use one or more of the following methods to diagnose the disease:

• Physical examination -- To check for weight loss, malnutrition, weakness, enlargement of the liver, and associated diseases such as hepatitis and cirrhosis
• Blood tests -- To detect elevated levels of a protein called alpha-fetoprotein, which may indicate that you have liver cancer
• Computed tomography (CT) scan, a process that uses X-rays and computer technology to produce cross-sectional images of the body -- To detect and locate tumors
• Ultrasound -- To detect liver cancer and distinguish between cancerous (malignant) and noncancerous (benign) tumors
• Hepatic artery angiogram, a test that looks at blood vessels using X-rays and a dye injected into a blood vessel -- To examine the blood vessels that supply blood to liver cancer and to determine whether the tumor can be removed surgically
• Magnetic resonance imaging (MRI), a technique that uses a magnetic field to produce pictures of structures inside the body -- To produce more detailed images than computed tomography or ultrasound; usually not required
• Biopsy -- Removal of a small amount of tissue for examination by a pathologist to determine if it is cancerous
• Laparoscopy -- Insertion of a thin, lighted tube through a small incision in the abdomen to view the liver

Expected Duration

Without treatment, liver cancer will continue to grow.

Prevention

Most primary liver cancer can be prevented. Here are some things you can do:

• Hepatitis -- To minimize the risk of being infected with a hepatitis virus:
  • Get vaccinated (available for hepatitis B, but not C).
  • Practice safer sex (use latex or polyurethane condom with nonoxynol-9), and do not have unprotected sex.
  • Wear latex gloves at work when touching or cleaning up blood or personal items, such as tampons and tissues.
  • Don't share personal items such as razors, toothbrushes or earrings with anyone.
  • Make sure needles used for body piercing or tattoos are properly sterilized using a machine called an autoclave.
• Alcohol -- To avoid getting cirrhosis of the liver, limit the amount of alcohol you drink to no more than two drinks per day.
• Diet -- What you eat may be associated with several types of cancer, including colon, rectal, breast and lung cancers, which are known to spread to the liver. It is recommended that you maintain a healthy body weight and eat a diet that is high in dietary fiber (whole grains, cereal, vegetables and fruits) and lower in saturated fats.

Treatment

The type of treatment depends on a number of factors, including the stage of the cancer, your age and your general health. Surgery, radiation therapy and chemotherapy are potential treatment options. Often, a combination of all three is used.

Usually, a single-tumor cancer that has not spread to lymph nodes or other organs can be removed through surgery. However, only a small percentage of liver cancers are found in this early stage.

For a few cases, a liver transplant may be considered. There also are several experimental treatment methods. In many cases, a cure is not possible, so treatment focuses on relieving the symptoms of the cancer or keeping the cancer from growing, spreading or returning.

People with liver cancer may not be able to have surgery or the type of surgery is limited because their liver isn't working right or they have other health problems. Surgery usually doesn't work for people with cirrhosis, hepatitis or multiple liver tumors in different locations. For these people, other techniques may stop the growth of the cancer temporarily and relieve symptoms:

• Cryosurgery destroys liver cancer by freezing it with extremely cold metal probes. Done under general anesthesia, cryosurgery can be repeated. Complications generally are minimal, and recovery usually is rapid.
• Ethanol ablation, also called percutaneous ethanol injection, injects concentrated alcohol directly into the liver cancer. This dehydrates and kills cancerous cells. The procedure can be done under local anesthesia. Side effects can include pain around the injection sites that last a few minutes and a fever after the injection.

Note that these techniques have not been proven to help someone survive longer.

For most cases of liver cancer, it is not possible to remove the entire tumor, or the cancer has spread throughout much of the liver or to distant sites. There are no standard treatments for liver cancer in these stages. You may be able to participate in a clinical trial -- an experimental treatment being tested. These trials involve risk because the treatment might not work and you can have unanticipated side effects.

When To Call A Professional

Call your doctor if you have any of the symptoms of liver cancer. Call if you have any symptoms of diseases related to liver cancer, including:

• Fatigue
• Mild fever
• A yellowing of skin and eyes (jaundice)
• Muscle or joint aches
• Nausea
• Dark colored urine
• Vomiting
• Loss of appetite
• Abdominal pain or swelling

Prognosis

The outlook for people with liver cancer depends on whether the tumor is confined to the liver and whether it can be entirely removed with surgery. Even with surgery, the 5-year survival rate for people with hepatocellular carcinoma and cholangiocarcinoma is less than 20%. The outlook following a successful liver transplant may be better.

In children with hepatoblastoma, the 5-year survival rate is about 70% when the cancer is confined to the liver and can be removed completely. Most people with angiosarcoma of the liver have disease that has already spread at the time of diagnosis and the outlook usually is poor.

Additional Info

American Cancer Society (ACS)

1599 Clifton Road, NE

Atlanta, GA 30329-4251

Toll-Free: 1-800-227-2345

http://www.cancer.org/

American Liver Foundation

75 Maiden Lane

Suite 603

New York, NY 10038

Phone: 212-668-1000

Toll-Free: 1-800-465-4837

Fax: 212-483-8179

Email: info@liverfoundation.org

http://www.liverfoundation.org/

Cancer Research Institute

681 Fifth Ave.

New York, NY 10022

Toll-Free: 1-800-992-2623

Email: info@cancerresearch.org

http://www.cancerresearch.org/

Centers for Disease Control and Prevention (CDC)

1600 Clifton Road

Atlanta, GA 30333

Phone: 404-639-3534

Toll-Free: 1-800-311-3435

http://www.cdc.gov/

National Cancer Institute (NCI)

U.S. National Institutes of Health

Public Inquiries Office

Building 31, Room 10A03

31 Center Drive, MSC 8322

Bethesda, MD 20892-2580

Phone: 301-435-3848

Toll-Free: 1-800-422-6237

TTY: 1-800-332-8615

Email: cancergovstaff@mail.nih.gov

http://www.nci.nih.gov/

National Comprehensive Cancer Network (NCCN)

500 Old York Road

Suite 250

Jenkintown, PA 19046

Phone: 215-690-0300

Toll-Free: 1-888-909-6226

Fax: 215-690-0280

http://www.nccn.org/