Liver Cancer

Liver cancer is cancer that begins in the cells of your liver. Your liver is the largest organ inside your body. It is football-sized and sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach. It helps your body digest food, store energy, and remove toxins.

Not all cancers that affect the liver are considered liver cancer. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer.

Liver cancer is much more common in countries in sub-Saharan Africa and Southeast Asia than in the United States. Liver cancer occurs more often in men than in women. The average age at diagnosis of liver cancer is 63, and more than 95% of people diagnosed with liver cancer are 45 years of age or older.

You may not have symptoms until liver cancer is advanced, which makes it harder to treat. Treatment may include surgery to remove the liver or transplant a healthy liver, radiation therapy, or chemotherapy.

Most people do not have signs and symptoms in the early stages of liver cancer. Symptoms often do not appear until the cancer is advanced. When signs and symptoms do appear, they may include:

• losing weight without trying
• loss of appetite
• upper abdominal pain
• nausea and vomiting
• general weakness and fatigue
• abdominal swelling
• yellow discoloration of your skin and the whites of your eyes (jaundice)
• white, chalky stools

It is not clear exactly what causes liver cancer. In general, cancer occurs when cells in your liver develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the liver that can grow to invade nearby structures and spread to other parts of the body.

Factors that increase your risk for primary liver cancer include:

• having hepatitis B or C
• heavy alcohol use
• having cirrhosis, or scarring of the liver
• having hemochromatosis, an iron storage disease
• being obese
• having diabetes

Doctors use tests that examine the liver and the blood to diagnose liver cancer.

• Blood tests may reveal abnormal function of the liver.
• A biopsy can remove a piece of the liver to examine it and look for signs of cancer.
• Procedures to create images of the liver such as computerized tomography (CT) and magnetic resonance imaging (MRI) can reveal cancer.

Once your doctor diagnoses your liver cancer, he or she works to find the extent (stage) of your cancer.

If you have or have had liver cancer, you can take steps to manage the stress that accompanies the diagnosis.

• Learn about liver cancer so you can make informed decisions about your care.
• Have a schedule of follow-up tests and go to each appointment.
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Accept help and support from family and friends and talk with a counselor, social worker, or clergy member.

After liver cancer is found and staged, your physician will discuss treatment options with you. The treatments will be based on your overall health and the extent and location of the cancer.

Liver cancer treatment options may include:

Surgery to remove a portion of the liver. In certain situations, your doctor may recommend surgery to remove the liver cancer and a small portion of healthy tissue that surrounds it if your tumor is small and your liver function is good.
Liver transplant surgery. During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery is only an option for a small percentage of people with early-stage liver cancer.

Freezing cancer cells. Cryoablation uses extreme cold to destroy cancer cells.

Heating cancer cells. Radiofrequency ablation uses electric current to heat and destroy cancer cells.

Injecting alcohol into the tumor. During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol causes the tumor cells to die.

Injecting chemotherapy drugs into the liver. Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. During the procedure, chemotherapy drugs are injected into the hepatic artery — the artery from which liver cancers derive their blood supply — and then the artery is blocked. This serves to cut blood flow to the cancer cells and to deliver chemotherapy drugs to the cancer cells. The drugs most commonly used include floxuridine (FUDR), cisplatin (Platinol-AQ), mitomycin C (mutamycin, Novaplus), and doxorubicin (Adriamycin, Doxil).

Radiation therapy. This treatment uses high-powered energy beams to destroy cancer cells and shrink tumors.

Targeted drug therapy. Targeted drugs work by interfering with a tumor's ability to generate new blood vessels. Drugs such sorafenib (Nexavar) may be used to control advanced liver cancer.