The liver is made up mainly of cells called hepatocytes that can form cancerous and non-cancerous tumors. Liver cancer starts when cells in the liver begin to grow out of control.
Primary liver cancer begins in the hepatocyte cells of the liver. The most common type of primary liver cancer is called hepatocellular carcinoma. Secondary liver cancer spreads to the liver from somewhere else in the body.
Liver cancer is one of the most common cancers in the world and the fastest-growing cause of cancer death.
The liver is the largest internal organ that lives in the upper right portion of the abdomen beneath the lung. The liver’s primary function is to regulate most chemical levels in the blood and excrete a product called bile. This helps carry away waste products from the liver.
Liver cancer starts when cells in the liver begin to grow out of control. These cells, called hepatocytes, can form cancerous and non-cancerous tumors.
Primary liver cancer forms in the liver and begins in the hepatocyte cells of the liver. The most common type of primary liver cancer is called hepatocellular carcinoma.
Secondary liver cancer, cancer that spreads, or metastasizes, to the liver from somewhere else in the body, is more common than primary liver cancer. Cancer that originates in another part of the body such as lung, esophagus, or colon then migrates to the liver is called liver metastasis or hepatic metastasis and is named for the organ in which it began.
Signs and symptoms
Most people diagnosed with liver cancer develop symptoms in the later stages of the disease. Signs and symptoms of liver cancer include:
- Feeling full after a small meal. This is caused by an enlarged liver or spleen pushing against the stomach.
- Jaundice. Also known as yellowing of the skin or eyes.
- Nausea/vomiting. This can also include coughing up blood.
- Pain or swelling in the abdomen. This is caused by swelling of the spleen or liver or fluid accumulation in the abdomen.
- Unexplained weight loss. Many people who develop liver cancer notice unplanned weight loss due to loss of appetite.
Risk factors for liver cancer
There are several factors that might increase the chance of developing liver cancer. These risk factors include:
- Chronic viral hepatitis. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) is the most common risk factor for liver cancer.
- Cirrhosis. An irreversible condition that causes damage to liver cells and creates scar tissue. Cirrhosis is a progressive disease that increases the chances of developing liver cancer.
- Diabetes. People with diabeteshave a greater risk of liver cancer than other people.
- Excessive alcohol use. Alcohol abuse over many years can lead to irreversible liver damage linked with an increased risk of liver cancer.
- Gender. Hepatocellular carcinoma is more common in men than in women.
- Inherited liver diseases. Hereditary hemochromatosis and Wilson’s disease can increase the risk of developing liver cancer.
- Race. Of all racial groups in the United States, Asian Americans and Pacific Islanders have the highest incidence rates of liver cancer.
- Weight. Non-alcoholic fatty liver diseaseis common among obese people. Non-alcoholic steatohepatitis, a subtype of this disease can cause cirrhosis and lead to an increased risk of liver cancer.
Frequently asked questions (FAQs) about liver cancer
No. Cirrhosis is an irreversible condition that causes damage to liver cells and creates scar tissue. Cirrhosis is a progressive disease that increases the chances of developing liver cancer.
When liver cancer metastasizes, it most commonly spreads to the lungs and bones. The speed of the spread depends upon the type of liver cancer the patient has. Hemangiosarcoma and angiosarcoma, for example, spread quickly, while hepatocellular carcinoma takes longer to spread.
According to the American Cancer Society, more than 42,200 new cases of primary liver cancer are diagnosed and there are an estimated 30,200 deaths from the disease each year. Primary liver cancer is more prevalent in men than women, with an 8.3% higher incidence rate and a 5.7% higher death rate compared to women. Since 1980, liver cancer incidence rates have more than tripled, and death rates have more than doubled.
In Colorado, there are an estimated 600 new cases and 420 deaths from primary liver cancer each year.
Liver cancer is much more common in countries in Southeast Asia and sub-Saharan Africa than in the United States. In many of these countries it is the most common type of cancer. Each year more than 800,000 people are diagnosed with liver cancer around the world. Liver cancer is also the leading cause of cancer deaths worldwide, accounting for more than 700,000 deaths each year.
Yes. Although hemangiomas are benign (non-cancerous), they have similar characteristics to forms of liver cancer and therefore are sometimes misdiagnosed as such. To avoid this, your radiographic images should be read by a subspecialty radiologist.
The National Cancer Institute (NCI) publishes survival statistics for different types of cancer.
The NCI’s SEER database tracks 5-year relative survival rates for liver cancer in the United States, based on how far the cancer has spread.
This database does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.). Instead, it groups cancers into localized, regional, and distant stages:
- Localized. There is no sign that the cancer has spread outside of the liver.
- Regional. The cancer has spread outside the liver to nearby structures or lymph nodes.
- Distant. The cancer has spread to distant parts of the body, such as the lungs or bones.
In general, survival rates for liver cancer patients are higher for those who undergo surgery to remove their cancer, no matter the cancer stage.
Liver cancer is caused by DNA changes or mutations that occur within healthy cells.
Normal cells in the body go through a life cycle, where they grow and divide to form new cells, and then die when the body no longer needs them. Cells contain DNA that tells the cell what to do. When a cell’s DNA is damaged, cells continue to grow and divide where they aren’t needed by the body. This buildup of cells becomes a tumor.
Certain chemicals can cause damage to the DNA in the liver cells and this damage can cause abnormal or mutated cells to grow. The hepatitis virus and chronic hepatitis infections are also known to cause liver cancer.
Diagnosis of liver cancer
For high-risk patients, some liver cancers can be screened for before the development of symptoms. Exams, tests, and procedures to diagnose liver cancer include:
In some cases, to help make a definitive diagnosis, a small amount of liver tissue will be removed and tested in a laboratory for liver cancer. This procedure is called a biopsy and is conducted by inserting a needle into the liver to obtain the tissue sample. Note: not all patients with liver cancer require a biopsy. The three types of biopsies include:
- Laparoscopic biopsy is a procedure where a scope is used during a laparoscopy to remove tissue samples. The scope allows the doctor to see the surface of the liver to take specimens from abnormal-appearing areas.
- Needle biopsy is a procedure where a long hollow needle is inserted into the liver to remove a small amount of tissue.
- Surgical biopsy is done during surgery where either a portion of a tumor (incisional biopsy) or the entire tumor and some surrounding tissue (excisional biopsy) is removed.
To check liver kidney and liver function, number of blood cells, and help diagnose cancer or other conditions, a blood test may be ordered. There are a number of different blood tests that can help identify liver cancer. These tests include:
- The alpha-fetoprotein blood test (AFP) looks for elevated levels of this protein. Elevated levels of AFP can sometimes indicate cancer is present.
- A blood chemistry test checks the levels of calcium, glucose, and cholesterol which can all be affected by the presence of liver cancer.
- Blood clotting tests measures the levels of blood clotting factors to determine if the liver has been damaged. A low blood clotting factor count can lead to an increased risk of bleeding.
- A complete blood count (CBC) is a test that measures the levels of red blood cells, white blood cells, and platelets in the blood. Lower levels of red blood cells mean the bone marrow is not functioning properly, elevated levels of white blood cells mean there is an infection the body is trying to fight off, and a low platelet count means the blood has low clotting factors.
- Kidney function tests look at the blood urea nitrogen (BUN) and creatinine levels to determine how well the kidneys are functioning.
- A liver function test (LFT) helps reveal liver function abnormalities which may lead to a liver cancer diagnosis.
To look inside the body and help find suspicious looking areas of the liver, imaging tests like an ultrasound, CT scan, MRI scan, or angiogram may be ordered.
- Ultrasound is usually the first test to look at the liver and its condition. An ultrasound can show tumors forming in the liver.
- An angiogram is an x-ray test that uses a dye injected into an artery to look at the blood vessels in the liver.
- A CT scan uses x-rays to take detailed images of the body and can help identify several types of liver tumors. A CT scan can provide detailed information about the size, shape, and location of tumors in the liver.
- MRI scans use radio waves and magnets to take images of the body. MRIs can be used to look at the blood vessels in the liver to see blockages.
Liver cancer staging
UCHealth follows the American Joint Committee on Cancer (AJCC) TNM system, which is based on three key pieces of information:
- The extent (size) of the tumor (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?
- The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
- The spread (metastasis) to distant sites (M): Has the cancer spread to distant lymph nodes or distant organs such as the bones or lungs?
Cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand.
Treatment and recovery
Treatment for liver cancer is tailored to each patient and is dependent on the stage of the cancer, where it is located, and other health concerns.
Liver cancer care teams may include multiple health care specialists including surgical oncologists, liver transplant surgeons, interventional radiologists, pathologists, medical oncologists, radiologists, and radiation oncologists.
Treatment of liver cancer mainly relies on the classification of whether or not the cancer is resectable (able to be removed with surgery).
Ablation uses an electric current to destroy liver tumors without removing them. This procedure can only be performed on small tumors when surgery is not an effective option.
Note that ablation is less likely to cure liver cancer than surgery.
- Cryoablation uses liquid nitrogen to freeze and destroy cancer cells.
- Ethanol ablation is a procedure where concentrated alcohol is injected into the tumor to kill the cancer cells.
- Microwave ablation uses electromagnetic waves to heat and kill cancer cells.
- Radiofrequency ablation uses high-energy radio waves to heat up the tumor and kill the cancer cells.
In this procedure, a substance is injected into an artery in the liver to block the blood flow to a tumor, helping to kill off the cancer cells. During this procedure, the doctor will place a small tube into the blood vessels that feed the tumor and inject microscopic beads directly into the tumor’s blood supply. The beads attack the tumor in two ways: by reducing the blood supply and releasing radiation or chemotherapy.
The three types of embolization:
- SIRT (selective internal radiation therapy) is another term for radioembolization.
- TACE (transarterial chemoembolization) is a kind of chemoembolization.
- Y-90 refers to a radioactive isotope called Yttrium-90, which fills the microscopic beads that are inserted into the tumor’s blood supply.
Radiation is a treatment that uses high-energy rays or particles that destroy cancer cells and shrink tumors. Radiation is a good option for patients with severe damage to the liver from cirrhosis or hepatitis infections. Two common approaches:
- External beam radiation therapy (EBRT). This is when the radiation is from a source outside the body, similar to an x-ray but with stronger radiation. The procedure is painless, with multiple treatments over several weeks.
- Stereotactic body radiation therapy (SBRT) is another radiation option that focuses the radiation to a specific area to avoid nearby healthy tissue.
Full resection or removal of a liver tumor with a small portion of healthy tissue offers the most favorable outlook. A tumor’s resectability depends on the size and location in the liver, how well the liver functions, and the patient’s overall health.
Partial hepatectomy is a procedure during which part of the liver is removed if the patient has good liver function and is healthy enough for surgery, usually if the liver cancer is at Stage I or Stage II.
A liver transplant is an option for a small percentage of patients with tumors that cannot be removed surgically. During a liver transplant, the diseased liver is removed and replaced with a healthy donor liver.
Our experts are among the nation’s leaders in minimally invasive techniques for the surgical treatment of liver cancer. The minimally invasive approach involves inserting a camera and delicate surgical instruments into the body through multiple small incisions instead of one large opening. Sometimes a surgical robot may be utilized to allow for more precision and flexibility than would be feasible with conventional surgical instruments.
After a minimally-invasive procedure, your recovery is often faster and less painful than with conventional surgery.
Five-year liver cancer survival rates
Number of Patients Diagnosed – UCHealth 561 – State of Colorado – 1,693
Number of Patients Surviving – UCHealth 139 – State of Colorado – 288
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)
Center for Disease Control and Prevention (CDC). Liver Cancer (https://www.cdc.gov/cancer/liver/index.htm)
National Cancer Institute (NCI). Liver and Bile Duct Cancer (https://www.cancer.gov/types/liver)
MedlinePlus: National Library of Medicine. Liver Cancer (https://medlineplus.gov/livercancer.html)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Liver Cancer (https://www.ncbi.nlm.nih.gov/books/NBK448337/)