Liver

Overview

Primary liver cancer is cancer that starts in the liver. The most common type of primary liver cancer is hepatocellular carcinoma, which occurs in the tissue of the liver. When cancer starts in other parts of the body and spreads to the liver, it is called liver metastasis.

Risk Factors

When you get a diagnosis of cancer, it’s natural to wonder what may have caused the disease. Doctors can’t always explain why one person gets liver cancer and another doesn’t. However, we do know that people with certain risk factors may be more likely than others to develop liver cancer. A risk factor is something that may increase the chance of getting a disease. Studies have found the following risk factors for liver cancer:

  • Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV): Liver cancer can develop after many years of infection with either of these viruses. Around the world, infection with HBV or HCV is the main cause of liver cancer.
  • HBV and HCV infections may not cause symptoms but blood tests can show whether either virus is present. If so, the doctor may suggest treatment. Also, the doctor may discuss ways to avoid infecting other people.
  • Heavy alcohol use: Having more than two drinks of alcohol each day for many years increases the risk of liver cancer and certain other cancers. The risk increases with the amount of alcohol that a person drinks.
  • Aflatoxin: Liver cancer can be caused by aflatoxin, a harmful substance made by certain types of mold. Aflatoxin can form on peanuts, corn, and other nuts and grains. In parts of Asia and Africa, levels of aflatoxin are high. However, the United States has safety measures limiting aflatoxin in the food supply.
  • Iron storage disease: Liver cancer may develop among people with a disease that causes the body to store too much iron in the liver and other organs.
  • Cirrhosis: Cirrhosis is a serious disease that develops when liver cells are damaged and replaced with scar tissue. Many exposures cause cirrhosis, including HBV or HCV infection, heavy alcohol use, too much iron stored in the liver, certain drugs, and certain parasites.
  • Obesity and diabetes: Studies have shown that obesity and diabetes may be important risk factors for liver cancer.

The more risk factors a person has, the greater the chance that liver cancer will develop. However, many people with known risk factors for liver cancer don’t develop the disease.

Symptoms

Early liver cancer often doesn’t cause symptoms. When the cancer grows larger, people may notice one or more of these common symptoms:

  • Pain in the upper abdomen on the right side
  • A lump or a feeling of heaviness in the upper abdomen
  • Swollen abdomen (bloating)
  • Loss of appetite and feelings of fullness
  • Weight loss
  • Weakness or feeling very tired
  • Nausea and vomiting
  • Yellow skin and eyes, pale stools, and dark urine from jaundice
  • Fever

These symptoms may be caused by liver cancer or other health problems. If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated as early as possible.

Diagnosis

If you have symptoms that suggest liver cancer, your doctor will try to find out what’s causing the problems. You may have one or more of the following tests:

Physical exam
Your doctor feels your abdomen to check the liver, spleen, and other nearby organs for any lumps or changes in their shape or size. Your doctor also checks for ascites, an abnormal buildup of fluid in the abdomen. Also, your skin and eyes may be checked for signs of jaundice.

Blood tests
Many blood tests may be used to check for liver problems. One blood test detects alphafetoprotein (AFP). High AFP levels could be a sign of liver cancer. Other blood tests can show how well the liver is working.

CT scan
An x-ray machine linked to a computer takes a series of detailed pictures of your liver and other organs and blood vessels in your abdomen. You may receive an injection of contrast material so that your liver shows up clearly in the pictures. On the CT scan, your doctor may see tumors in the liver or elsewhere in the abdomen.

MRI
A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside your body. Sometimes contrast material makes abnormal areas show up more clearly on the picture.

Ultrasound test
The ultrasound device uses sound waves that can’t be heard by humans. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture (sonogram) of your liver and other organs in the abdomen. Tumors may produce echoes that are different from the echoes made by healthy tissues.

Biopsy
A biopsy usually is not needed to diagnose liver cancer, but in some cases, the doctor may remove a sample of tissue. A pathologist uses a microscope to look for cancer cells in the tissue.

Treatment

Treatment options for people with liver cancer are surgery (including a liver transplant), ablation, embolization, targeted therapy, radiation therapy, and chemotherapy. You may have a combination of treatments. The treatment that’s right for you depends mainly on the following:

  • Number, size, and location of tumors in your liver
  • How well your liver is working and whether you have cirrhosis
  • Whether the cancer has spread outside your liver

Other factors to consider include your age, general health, and concerns about the treatments and their possible side effects.

At this time, liver cancer can be cured only when it’s found at an early stage (before it has spread) and only if people are healthy enough to have surgery. For people who can’t have surgery, other treatments may be able to help them live longer and feel better. Many doctors encourage people with liver cancer to consider taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of liver cancer.

Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.

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