Risk Factors

Doctors can't always explain why one person gets liver cancer and another doesn't. However, certain risk factors may make a person more likely than others to develop liver cancer. A risk factor is something that may increase the chance of getting a disease.

Having a risk factor does not mean that a person will get liver cancer. Many people who get liver cancer have none of these risk factors, and many people who have known risk factors never have cancer. People with one or more of these risk factors should talk with their doctor about cancer risk.

Risk factors for liver cancer include the following:

• 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. Although HBV and HCV infections are contagious diseases, liver cancer is not. A person can't catch liver cancer from another person.
• Heavy alcohol use: Having more than two drinks of alcohol each day for many years increases the risk of liver cancer. 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. The United States has safety measures to limit 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 things can cause cirrhosis, including HBV or HCV infection, heavy alcohol use, too much iron stored in the liver, certain drugs, and certain parasites.
• Obesity: Being obese may increase the risk of liver cancer.
• Diabetes: Having diabetes may increase the risk of liver cancer.

Symptoms

Early liver cancer often doesn't cause symptoms. As the cancer grows, the most common symptoms are the following:

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

Most often, these symptoms are not due to cancer. People with these symptoms should tell their doctor so any health problems can be diagnosed and treated as early as possible.

Screening and Diagnosis

Currently, there are no screening methods for liver cancer.

If symptoms suggest liver cancer, the doctor will try to find out what's causing the problems.

The doctor may order one or more of these exams and tests:

• Physical exam: The doctor feels the abdomen to check the liver and other nearby organs for any lumps or changes in their shape or size. The doctor also checks for abnormal buildup of fluid in the abdomen. Also, the doctor may check the skin and eyes for signs of jaundice.
• Blood tests: Many blood tests may be used to check for liver problems. One blood test detects alpha-fetoprotein (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 the liver and other organs and blood vessels in the abdomen. The patient may receive an injection of contrast material so that the liver shows up clearly in the pictures. On the CT scan, the 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 the body. Sometimes contrast material is given by injection into the blood vessels. The 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. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture (sonogram) of the liver and other organs in the abdomen. Tumors may produce echoes that are different from the echoes made by healthy tissues.
• Biopsy:A biopsy is usually not needed to diagnose liver cancer, but in some cases, the doctor may remove a sample of tissue. The removal of tissue to look for cancer cells is called a biopsy. This tissue is sent to a lab where a doctor looks at the tissue under a microscope for signs of cancer. The doctor may obtain tissue in one of several ways:
  • A needle through the skin: The doctor inserts a thin needle into the liver to remove a small amount of tissue. CT or ultrasound may be used to guide the needle.
  • Laparoscopic surgery: The surgeon makes a few small incisions in the abdomen. A thin, lighted tube (laparoscope) is inserted through the incision. The laparoscope has a tool to remove tissue from the liver.
  • Open surgery: The surgeon can remove tissue from the liver through a large incision.

Staging

If liver cancer is diagnosed, the doctor needs to learn the extent (stage) of the disease to help choose the best treatment.

Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

The doctor may order one or more of these staging tests:

• CT scan of the chest: An x-ray machine linked to a computer takes a series of detailed pictures of the chest. The patient may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes abnormal areas easier to see. A CT scan can often show whether liver cancer has spread to the lungs.
• Bone scan: The patient get an injection of a small amount of a radioactive substance that collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.
• PET scan: The patient receives an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes pictures of the sugar used by cells in the body. Cancer cells use sugar faster than normal cells, so areas with cancer look brighter on the pictures. A PET scan shows whether liver cancer may have spread.

Stages of Liver Cancer

Stage I: There is one tumor in the liver.

Stage II: There is more than one tumor in the liver or there is one tumor that has spread to nearby blood vessels.

Stage III: In stage III liver cancer, one of the following is found:

• There is more than one tumor in the liver that is larger than 5 centimeters.
• There is one tumor that has spread to blood vessels near the liver.
• There are one or more tumors that have broken through the lining of the abdomen.
• There are one or more tumors that have spread to nearby organs.
• The cancer has spread to nearby lymph nodes.

Stage IV: Cancer cells have spread to distant organs.

For adult primary liver cancer, stages are also grouped according to how the cancer may be treated. There are three treatment groups:

• Localized resectable: The cancer is found in the liver only and can be completely removed by surgery.
• Localized and locally advanced unresectable: The cancer is found in the liver only but cannot be completely removed by surgery.
• Advanced: Cancer has spread throughout the liver or has spread to other parts of the body.

Treatment

At Huntsman Cancer Institute, liver cancer is treated by a team of specialists, including gastroenterologists (doctors who specialize in treating problems of the digestive organs), surgeons, medical oncologists (doctors who treat cancer with medicine), radiation oncologists (doctors who treat cancer with radiation), nurses, dietitians, and social workers.

Common treatment options for liver cancer include the following:

• Surgery
• Ablation (non-surgery treatments to control liver cancer, such as alcohol injections to kill cancer cells)
• Embolization (injections of particles that block the tumor's blood supply)
• Targeted therapy (drugs taken by mouth to slow tumor growth and reduce the tumor's blood supply)
• Chemotherapy
• Radiation therapy
• Clinical trials

A patient may have a combination of treatments. The treatment that's right for each patient depends on many factors:

• The number, size, and location of tumors in the liver
• How well the liver is working and whether the patient has cirrhosis
• Whether the cancer has spread to lymph nodes or other parts of the body
• The patient's age and general health

The health care team can describe all of the 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. Side effects may not be the same for each person, and they may even change from one treatment session to the next.

Surgery

Surgery is an option for people with an early stage of liver cancer. The surgeon may remove the whole liver or only the part that has cancer. If the whole liver is removed, it is replaced with healthy liver tissue from a donor. The surgeon can talk about the types of surgery and which may be right for the patient.

Ablation

Methods of ablation destroy the cancer in the liver. They are treatments to control liver cancer and extend life. They may be used for people waiting for a liver transplant. Or they may be used for people who can't have surgery.

Methods of ablation include the following:

• Radiofrequency ablation: The doctor uses a special probe that contains tiny electrodes to kill the cancer cells with heat. Ultrasound, CT, or MRI may be used to guide the probe to the tumor
• Percutaneous ethanol injection: The doctor uses ultrasound to guide a thin needle into the liver tumor. Alcohol (ethanol) is injected directly into the tumor and kills cancer cells.

Embolization

For those who can't have surgery or a liver transplant, embolization or chemoembolization may be an option.

• Embolization: The doctor inserts a tiny catheter into an artery in the leg and moves the catheter into the hepatic (liver) artery. The doctor injects tiny sponges or other particles into the catheter which block the flow of blood through the artery. Without blood flow from the hepatic artery, the tumor dies. Although the hepatic artery is blocked, healthy liver tissue continues to receive blood from the hepatic portal vein.
• Chemoembolization: The doctor injects an anticancer drug (chemotherapy) into the artery before injecting the tiny particles that block blood flow. Without blood flow, the drug stays in the liver longer.

Targeted therapy

People with liver cancer who can't have surgery or a liver transplant may receive targeted therapy. Targeted therapy slows the growth of liver tumors. It also reduces their blood supply. These drugs are taken by mouth.

Chemotherapy

Chemotherapy uses drugs to kill and control cancer cells throughout the body. Learn more about this treatment in our introduction to chemotherapy video.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. Radiation therapy only affects cells in the treated area.

Doctors use two types of radiation therapy to treat liver cancer:

• External radiation: The radiation comes from a large machine outside the body. The machine aims beams of radiation at the cancer. Patients go to a hospital or clinic for treatment. This type of treatment uses computers to closely target the cancer, which protects healthy tissue near the liver.
• Internal radiation therapy: The radiation comes from tiny radioactive spheres. A doctor uses a catheter to inject the tiny spheres into the hepatic artery. The spheres destroy the blood supply to the liver tumor.

Some people may receive both types of radiation therapy.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.

There are several places you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to HCI patients and their families.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.