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Liver Cancer 

Introduction
Primary liver cancer originates in the cells of the liver.  Metastasized liver cancer occurs when cancer from other locations in the body spreads to the liver.  Liver cancer that is identified and treated early is associated with the best outcomes.  In some cases, surgery or a liver transplant may cure liver cancer.  When a cure is not possible, radiation therapy may be used to relieve the symptoms of liver cancer and improve the quality of life.

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Anatomy
Your liver is one of the largest organs in your body, second only to your skin.  Your liver is located in your right upper abdomen and is protected by your ribcage.  Your liver performs over 100 functions—most of them are related to keeping you alive and healthy.
 
Your liver is divided into right and left lobes.  It is further divided into smaller lobes called the caudate and quadrate lobes.  The right lobe is the largest part of your liver.
 
About 25% of your total blood volume passes through your liver each minute.  Your liver receives blood from two sources, the portal vein and the hepatic artery.  Additionally, blood from your spleen drains into the splenic vein and connects with the portal vein.  Most of the blood received by your liver is from the portal vein.  Blood from the portal vein travels from your gastrointestinal tract before reaching your liver.  This way, your liver is the first to receive substances from digested food. 
 
Your liver receives toxins, alcohol, nutrients, germs, and medications from your digestive tract.  As a result, one function of the liver is to metabolize toxins, alcohol, nutrients, and medications.  The hepatic artery is the second source of blood supply to the liver.  Blood delivered through the hepatic artery comes directly from the heart.  It is higher in oxygen than blood from the portal vein. 
 
Once inside the liver, blood from the portal vein and the hepatic artery mix.  The blood flows through tiny blood vessels in the liver called sinusoids.  Components in the blood are delivered by the sinusoids to the hepatocytes.  Hepatocytes are the major cell type in the liver.  The hepatocytes metabolize nutrients, toxins, and drugs from the blood.  Blood leaves the liver through the hepatic vein.  The blood then flows through the vena cava and back to the heart. 
 
The hepatocytes perform numerous chemical processing functions that are necessary to keep you healthy and alive.  The hepatocytes play a role in blood clotting and secreting albumin.  Albumin helps to regulate the amount of fluids in your body.
 
The hepatocytes metabolize nutrients including carbohydrates, fats, cholesterol, and proteins.  Your liver functions to maintain appropriate ammonia and blood sugar (glucose) levels.  Correct levels of ammonia are necessary for good brain functioning.  Your cells use blood sugar for energy.  Your liver also stores vitamins, iron, and other minerals.
 
Another function of the hepatocytes is to filter certain compounds from the blood.  Blood arriving from the portal vein contains environmental toxins that were absorbed in the stomach.  The liver “detoxifies” or filters the toxins from the blood.  The toxins are secreted by your kidneys in urine or secreted into bile that leaves the liver.
 
Bile is a substance that is produced by your liver and stored in your gallbladder.  When you eat fatty foods, bile leaves your gallbladder via the common bile duct and travels to the duodenum, the first part of your small intestine.  There, the bile aids in breaking down fats for digestion.

Bile receives its yellow color from bilirubin.  Bilirubin is formed from the breakdown of old red blood cells.  Your spleen breaks down your old red blood cells.  The hepatocytes metabolize the hemoglobin in old red blood cells into a form of bilirubin that can be excreted with bile.  This form of bilirubin is called “conjugated bilirubin.”  It eventually is removed from your body in your urine or stools.  Only a very small amount returns to your bloodstream.
 
The liver is unique in that it can regenerate itself.  If part of the liver is removed, the liver can re-grow tissue.  You need a liver to live.  If the liver is severely damaged, it needs to be replaced.

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Causes
Primary liver cancer occurs when the cells in the liver grow abnormally and out of control, instead of dividing in an orderly manner.  The most common cause of primary liver cancer is cirrhosis, scarring of the liver.  In the United States, cirrhosis is most frequently caused by alcohol abuse.  Another type of cancer, metastatic cancer, results when cancer originates in another part of the body and spreads to the liver.  Colorectal, kidney, pancreatic, stomach, breast, esophageal, lung, melanoma, and many other types of cancers may spread to the liver.
 
There are several different types of primary liver cancer.  Hepatocellular carcinoma is the most common type.  Hepatocellular carcinoma has several subtypes.  Some may grow into one large tumor and some types may cause scattered tumors throughout the liver.  Cholangiocarcinomas are less common.  They originate in the bile ducts.  Fibrolamellar liver cancer is rare, but it has the best prognosis for all liver cancer types.

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Symptoms
Liver cancer does not always produce symptoms in the early stages.  The symptoms of liver cancer may seem vague or similar to that of noncancerous diseases.  You should contact your doctor if you develop the symptoms of liver cancer.  Early diagnosis and treatment is associated with the best outcomes.

Liver cancer may cause a persistent loss of appetite and weight loss without trying.  You may feel very full, even after eating a small amount of food.  You may have pain or tenderness in the right upper part of your abdomen or stomach area.  Your abdomen may be enlarged or appear swollen.  You may bruise or bleed easily.  Jaundice may cause your skin and eyes to have a yellow-green color. 

Some liver tumors can produce hormone problems that interfere with the function of other organs, causing hypercalcemia, hypoglycemia, and gynecomastia.  Hypercalcemia means high blood calcium levels.  Hypercalcemia can cause weakness, low blood sugar levels, fainting, confusion, and coma.  Hypoglycemia results from low blood sugar levels.  Hypoglycemia can cause weakness, headache, visual changes, anxiety, personality changes, and coma.  Gynecomastia causes breast enlargement in men. 

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Diagnosis
A doctor can begin to diagnose liver cancer by reviewing your medical history, completing a physical examination, and conducting some tests.  You should tell your doctor about your risk factors.  Your doctor will carefully examine your abdomen and conduct blood tests to show how your liver is functioning.  Imaging tests may be used to help identify the type and location of liver tumors.

Ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans are used to show pictures of your liver.  An angiography may be used to show the blood supply that leads to the liver.  A laparoscopy uses a thin tube that transmits images to a video monitor.  The laparoscope is inserted through a small incision in the abdomen. A biopsy is usually the only way to determine if cells are cancerous or not.  A biopsy involves obtaining a tissue or fluid sample for examination.  

If you have liver cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests.  Staging describes the cancer and how it has metastasized.  Cancer that has spread from its original site to other parts of the body is termed metastasized cancer.  Staging is helpful for treatment planning and recovery prediction. 

There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one.  Generally, lower numbers in a classification system indicate a less serious cancer, and higher numbers indicate a more serious cancer.  The stages may be subdivided into classifications that use letters and numbers.

Your doctor will also use terms to describe how your cancer may be treated.  Localized resectable liver cancer describes cancer that may be cured with surgery.  Unresectable cancer may not be cured with surgery and describes widespread liver cancer or cancer that has spread outside of the liver.  Your doctor will also describe the amount of liver cirrhosis, which is considered during treatment planning.

 

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Treatment
Treatment of liver cancer depends on the stage and type of liver cancer, as well as the amount of liver cirrhosis.  At this time surgery to remove the cancer or liver transplantation to replace the liver are the only cures for liver cancer.  Tumor ablation, embolization, and chemoembolization are methods used for people that may not be candidates for surgery.  These methods do not cure cancer, but they can shrink the tumor and reduce symptoms.  Liver cancer cells usually do not respond well to chemotherapy treatment.  Radiation therapy may be used to shrink the size of tumors or kill cancer cells to provide symptom relief.  For some patients with small tumors liver transplant may provide a cure. 
 
Stereotactic radiosurgery (SRS) involves a single high-dose radiation treatment.  SRS spares healthy tissues because the radiation precisely targets the cancer.  Sophisticated software controls the radiation treatment beams to match the exact shape of a tumor or lesion.  The beams may be moved to penetrate the cancer from different angles.  The procedure is painless and usually performed on an outpatient basis.
 
The experience of cancer and cancer treatments can be a very emotional experience for people with cancer and their loved ones.  It is important to embrace positive sources of support.  Some people find comfort in their families, friends, co-workers, counselors, and faith.  Cancer support groups are a helpful resource where you can receive support, information, and understanding from people with similar experiences.  Ask your doctor for support groups near you.

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Prevention
You may help prevent liver cancer by reducing the risk factors that you can control.  It can be helpful to stop smoking and abusing alcohol.  You should maintain a healthy weight and blood sugar level.

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Am I at Risk

Risk factors may increase your likelihood of developing liver cancer, although some people that develop liver cancer do not have any risk factors.  People with all of the risk factors may never develop the disease; however, the chance of developing liver cancer increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for liver cancer:
_____ Liver cancer is more common in men than women.
_____ Liver cancer is more common in developing countries in Africa and Asia than it is in the United States.
_____ Cirrhosis is the most frequent cause of liver cancer in the United States.  Smoking, alcohol abuse, Hepatitis B and C, hemochromatosis, and chronic inflammation can contribute to cirrhosis.
_____ Smoking tobacco increases the risk of liver cancer.  People that smoke and abuse alcohol have the greatest risk.
_____ Viral liver diseases, such as Hepatitis B and C, or certain inherited liver diseases increase the risk of liver cancer.  Hepatitis A does not appear to increase the risk of liver cancer.
_____ Diabetes increases the risk for liver cancer.
_____ It appears that obesity may increase the risk for liver cancer.
_____ Cancer causing substances called aflatoxins are produced by a fungus in contaminated food products such as peanuts, wheat, soybeans, corn, and rice.  Long-term exposure to aflatoxins increases the risk of liver cancer.  This is more of a concern in countries outside of the United States.  In the United States, products are tested for aflatoxins. 
_____ Vinyl chloride and thorium dioxide (thorotrast) are industrial chemicals that may increase the risk of liver cancer. 
_____ Anabolic steroids used by some athletes can increase the risk of liver cancer.
_____ Arsenic exposure increases the risk of liver cancer.
_____ Many types of cancer can metastasize or spread to the liver, including colorectal, kidney, pancreatic, stomach, breast, esophageal, lung, and melanoma cancer.

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Complications
The prognosis for liver cancer is generally poor.  Liver cancer can cause death. Liver cancer that is diagnosed and treated early is associated with the best outcomes.

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Advancements
Researchers are studying surgical, radiation therapy, and chemotherapy methods of improving treatments for liver cancer.  They hope to develop blood tests that may identify liver cancer earlier. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.