Liver Cancer & Hepatocellular Carcinoma
Liver cancer is the abnormal growth of cells in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in cells called hepatocytes. Less common types include cholangiocarcinoma and angiosarcoma.
- Liver cancer is the result of abnormal changes (mutations) in the DNA of liver cells. This can be caused by liver damage (such as cirrhosis) or infection (such as hepatitis). It can also occur randomly.
- Liver cancer produces a variety of symptoms. In its early stages, these can be mild and difficult to distinguish from other conditions. Later, liver cancer can lead to liver failure.
- There are a variety of ways to treat liver cancer. These include chemotherapy, surgical removal, and liver transplantation.
The underlying cause of liver cancer is when the DNA within liver cells undergoes an abnormal change or mutation that makes the cells multiply. Mutations can be the result of various factors, or may occur when no other conditions are present. However, certain factors can raise the risk of mutations that lead to liver cancer. These include the following:
- Alcohol Abuse: Long-term excessive alcohol consumption is one of the leading causes of liver damage and cirrhosis and can significantly increase the risk of liver cancer.
- Anabolic Steroids: These are hormones used to increase strength and muscle mass. Long-term anabolic steroid use can slightly increase the risk of hepatocellular cancer.
- Arsenic: Drinking water contaminated with arsenic increases the risk of some types of liver cancer.
- Chronic Viral Hepatitis: A long-term infection with hepatitis B or C can lead to cirrhosis and liver cancer.
- Cirrhosis: Cirrhosis is when a liver stops functioning normally because its healthy tissue has been replaced by scar tissue. It significantly increases the risk of liver cancer.
- Inherited Metabolic Diseases: Conditions that can increase the risk of liver cancer include hemochromatosis, alpha-1 antitrypsin deficiency, and Wilson's disease.
- Obesity: Obesity can lead to metabolic syndrome and non-alcoholic fatty liver disease, both of which increase the chances of developing liver cancer.
- Parasites: The parasite that causes schistosomiasis can cause liver damage and lead to liver cancer. Individuals traveling to Asia, Africa, or South America may be affected.
- Tobacco: Smoking has been linked to many forms of cancer, including liver cancer.
- Type II Diabetes: Patients with type II diabetes tend to be overweight or obese, which in turn can cause liver problems.
Because liver cancer often does not have any signs or symptoms until it has progressed to a later stage, early detection can be difficult. Many of its symptoms can also be similar to other conditions.
The following are some of the most common early symptoms of liver cancer:
- Abnormal bruising or bleeding
- Enlarged liver
- Enlarged spleen
- Enlarged veins on the belly
- Jaundice (yellowing of eyes and skin)
- Loss of appetite
- Nausea or vomiting
- Pain in the abdomen or near the right shoulder blade
- Swelling or fluid build-up in the abdomen
- Unexplained weight loss
In rare cases, a liver tumor may cause the liver to produce hormones that cause symptoms in other areas of the body. These may include:
- High blood calcium levels
- High cholesterol levels
- High red blood cell count
- Low blood sugar levels
- Male breast enlargement
- Shrinking of testicles
The following are some of the most common ways to diagnose liver cancer:
- Blood Tests: This includes a test that looks for elevated levels of alfa-fetoprotein, which may be a sign of hepatocellular carcinoma. It may also include liver function tests, blood clotting tests, and test for viral hepatitis.
- Imaging Tests: These form an image of the liver so that doctors can better detect signs of liver damage and/or cancer, such as a tumor. These tests may include a computerized tomography (CT) scan, an ultrasound, and magnetic resonance imaging (MRI).
- Liver Biopsy: This is a surgical procedure that removes a tiny portion of liver tissue so that doctors can examine it under a microscope to determine what is wrong.
Treatment for liver cancer depends on the stage of the cancer, as well as on factors such as the age and overall health of the patient.
The following are the most common treatments for liver cancer:
This type of treatment directly targets the cancer cells or the area surrounding them. It includes the following approaches:
- Chemoembolization: Chemotherapy medicine is injected into the liver and combined with a substance that temporarily traps it near the tumor.
- Radiation Therapy: An external machine directs a focused beam of radiation onto the specific area of the tumor. This is often used when other treatments aren’t successful.
- Radioembolization: Tiny beads containing a radioactive substance (yttrium-90) are sent to the tumor through the hepatic artery. This allows the radiation to specifically target the tumor and destroy it.
- Thermal Ablation: An electric current is sent through one or more needle-like probes, heating the tumor and destroying it. Microwaves and lasers may also be used.
Targeted Drug Therapy
This type of treatment uses drugs designed to target key features identified within cancer cells. By disabling these features, the drugs destroy the cancer. Targeted drug therapy can be used alongside other treatments, such as chemotherapy, or on its own.
Chemotherapy uses medicine (often a combination of different types of medicines) to damage and destroy cancer cells. In systemic chemotherapy, these drugs travel through the bloodstream and attack cancer cells throughout the body instead of in just one specific area. This makes it a good option for cancer that has spread (metastasized) beyond the original tumor.
Chemotherapy drugs used to treat liver cancer include:
Unfortunately, systemic chemotherapy is usually not a very effective treatment for liver cancer. Instead, it may be used to slow the progression of the disease if surgery is not an option.
This treatment uses the body’s own immune system to fight cancer. Because cancer often develops from normal cells, the immune system may not recognize it as something it should remove. Immunotherapy solves this by helping the immune system find the cancer, then slow or stop it from spreading.
Surgery to remove a portion of the liver containing a tumor is called a partial hepatectomy or resection. This type of operation is only available if there is one tumor, it is small and has not developed blood vessels, and the liver will still be able to function after the cancerous portion is removed. For patients with advanced cirrhosis, this may mean surgery is not an option.
This type of treatment involves removing the cancerous liver and replacing it with a healthy donor liver. Liver transplantations are often done in patients with advanced cirrhosis, large tumors, or tumors that have grown blood vessels and cannot be removed. Only rarely is it an option for patients with early-stage liver cancer.
Learn more about liver transplantations.
Successfully treating liver cancer will depend on a variety of factors, such as the stage of the cancer, any underlying conditions, and the overall health of the patient.
Data from the American Cancer Society divides the five-year survival rates for liver cancer into three general categories depending on if the cancer is only in the liver (localized), has spread to nearby organs or lymph nodes (regional), or has spread throughout the body (distant):
- Localized: 31 percent
- Regional: 11 percent
- Distant: 2 percent
In general, surgery increases survival rates substantially. People with early-stage liver cancer who receive a new donor liver have a five-year survival rate of 60 to 70 percent. Patients without cirrhosis or other underlying issues also do well.
A medical and possibly surgical oncologist (doctors who specialize in treating cancer) will work with the patient to remove the cancer and prevent it from recurring. A hepatologist (doctor who specializes in treating the liver) may also work with the patient to treat any other conditions that increase the risk of liver cancer, such as cirrhosis or viral hepatitis. Other specialists may also help the patient reduce alcohol and tobacco use and develop a healthier lifestyle.
Our center specializes in diagnosing and treating all forms of liver cancer. We are one of the few centers in the country capable of performing surgeries and transplantations on tumors other hospitals deem ineligible for surgery. In addition, we also offer experimental procedures such as molecular and targeted therapy.
Call us at (877) LIVER MD/ (877) 548-3763 or use our online form to schedule an appointment.