Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology Oncology at the New York Presbyterian Weill Cornell Medical Center.
There are several types of cells in the liver, including the main liver cells called hepatocytes, that can form cancerous tumors.
Liver cancer is uncommon in the United States, but it is common worldwide due to risk factors such as chronic hepatitis B and C infections and exposure to aflatoxin (toxins produced by certain fungus in agricultural crops). People with cirrhosis are at an increased risk of liver cancer.
Imaging tests and blood tests are used to diagnose liver cancer. Treatment depends on the size of the tumor or tumors and health of the liver, but may include surgery, a liver transplant, ablation therapy (a needle or probe is used to kill cancer cells), embolization therapy (cutting off blood supply to a tumor), oral targeted agents, chemotherapy, anti-angiogenic agents, and immunotherapy.
The exact causes aren’t fully understood, but risk factors include viral hepatitis B and hepatitis C infections, heavy alcohol use, smoking, family history of liver cancer or genetic diseases linked to liver cancer, chemical exposures, and medical conditions such as non-alcoholic fatty liver disease and diabetes.
If caught early and the liver is healthy, surgery can sometimes be curative. If caught early and the liver is damaged, a liver transplant is also sometimes an option that can be curative. Although, transplant candidates often have to wait for prolonged periods to receive a transplant. The size of the tumor and whether or not it has affected nearby blood vessels is also important in prognosis.
Liver cancer can cause right-sided abdominal or shoulder blade pain. It can also lead to complications such as a bile duct obstruction that can cause severe abdominal pain. Treatments, including surgery, may also lead to some temporary pain.
Stage 4 liver cancer is much harder to successfully treat than other stages because it means that the cancer has spread to nearby lymph nodes and/or to distant organs and sites, such as the lungs, bones, and adrenal glands. Survival rates vary and are only overall estimates, but the relative 5-year survival rate is about 2% (distant spread) to 11% (regional spread).
In the early stages of disease, there are often no symptoms. The signs and symptoms of liver cancer are often related to liver damage and include jaundice (yellow skin/eyes), right-sided abdominal pain, right shoulder blade pain, right-sided abdominal mass or lump, itching, unexplained weight loss, shortness of breath, and bloating.
A viral hepatitis infection and resulting inflammation that lasts for more than six months. Hepatitis B and C can be acute or chronic. Hepatitis A and E are acute and clear without becoming chronic. Chronic hepatitis infections can lead to complications such as cirrhosis, liver cancer, and liver failure.
A rare type of cancerous tumor in the liver that most often develops in children. It usually occurs in children younger than three years old. The majority of cases are treated successfully with surgery and chemotherapy.
A cancerous tumor or tumors that occur in hepatocytes, the main cells of the liver. Hepatocytes are involved in many roles of the liver, including metabolism, detoxification, and protein synthesis. Hepatocellular carcinoma is the most common form of liver cancer. It can begin as a single tumor or multiple small tumors throughout the liver.
A cancerous tumor in the cells that line the small bile ducts (tubes that transport bile from the liver). Intrahepatic cholangiocarcinomas are in the bile ducts within the liver. Cancers can also occur in the bile ducts outside the liver.
A needle is inserted into the abdomen and is used to take a small sample of liver tissue. The sample is then examined closely under a microscope to check for abnormal cells. Laparoscopic or transjugular surgical biopsies are also sometimes done. In many cases, a biopsy is not necessary to diagnose liver cancer, but if imaging tests are inconclusive it may be needed.
The spread of cancer cells from the organ or region where they first formed to other areas of the body. Liver cancer that metastasizes may spread to nearby lymph nodes and/or to distant organs, such as the lungs and bones. Liver metastases are cancers that began in other areas of the body and then spread to the liver.
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