Liver Cancer

What is liver cancer?

Cancer starts when cells change (mutate) and grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. They can spread to other parts of the body, too. This is called metastasis.

The liver is a large organ that's behind your ribs on the right side of your body. It's just under your lungs. It helps break down and store nutrients, like sugars, starch, fats, and proteins. It also makes clotting factors that keep you from bleeding. One of the liver’s key jobs is to filter toxins out of your blood.

Liver cancer is cancer that starts in your liver. There are different kinds of liver cancer. But the most common type in adults is called hepatocellular carcinoma. It starts in the main liver cells called hepatocytes.

Who is at risk for liver cancer?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change.

The risk factors for liver cancer include:

• Hepatitis B or C infection
• Heavy alcohol use
• Obesity (This leads to fat buildup in the liver, called nonalcoholic fatty liver disease.)
• Hereditary hemochromatosis
• Scarring of the liver (cirrhosis)
• Being male
• Food tainted with mold that makes a poison called aflatoxin
• Type 2 diabetes
• Exposure to certain chemicals such as vinyl chloride
• Long-term use of anabolic steroids
• Smoking

Talk with your healthcare provider about your risk factors for liver cancer and what you can do about them.

Can liver cancer be prevented?

Many liver cancers could be prevented by not exposing yourself to known risk factors. Here are some things you can do that may lower your risk for liver cancer:

• Don’t do things that increase your risk for hepatitis B or C infection. This includes sharing needles with other illegal drug users, having many sex partners, and having unprotected sex.
• Get the hepatitis B vaccine.
• If you have hepatitis B or C, get treated.
• Limit the amount of alcohol you drink.
• Get to and stay at a healthy weight.
• Don’t smoke. Ask your healthcare provider for help quitting.

Are there screening tests for liver cancer?

There are no regular screening tests for liver cancer in people at average risk. Screening tests are done to check for disease in people who don’t have symptoms.

If you have a high risk for liver cancer because of cirrhosis, chronic hepatitis, or other reasons, talk with your healthcare provider about regular testing for liver cancer. Blood tests, ultrasounds, or other imaging tests can be used to look for early signs of liver cancer.

What are the symptoms of liver cancer?

Liver cancer often does not cause symptoms until the tumor is large. Common symptoms of liver cancer can include:

• Weight loss without trying
• No desire to eat
• Feeling full after eating only a small amount
• Nausea and vomiting
• A lump or mass in the upper-right side of your belly (abdomen)
• Ongoing pain in the upper-right side of your stomach or the right shoulder blade
• Belly bloating or swelling
• Yellow skin or eyes (jaundice)
• Itching
• Fever
• Easy bleeding and bruising
• Extreme tiredness or weakness
• Dark urine

Many of these may be caused by other health problems. Still, it’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is liver cancer diagnosed?

Your healthcare provider will ask you about your health history, your symptoms, risk factors, and family history of disease. A physical exam will be done.

You may also have one or more of these tests:

• Blood tests
• Ultrasound
• Imaging tests, like a CT or MRI scan
• Liver biopsy

After a diagnosis of liver cancer, you’ll need more tests. These help your healthcare providers learn more about your overall health and the cancer. They're used to find out the stage of the cancer. The stage is how much cancer there is and how far it has spread (metastasized) in your body. It's one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what this means for your treatment. Be sure to ask your healthcare provider to explain the details of your cancer to you in a way you can understand.

How is liver cancer treated?

Your treatment choices depend on the type of liver cancer you have, test results, and the stage of the cancer. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and possible risks and side effects.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. You may have one treatment or a combination of treatments. Tests will be done during treatment to see how well it's working.

Liver cancer can be treated with:

• Surgery
• Tumor ablation or embolization
• Radiation
• Targeted therapy
• Immunotherapy
• Chemotherapy (seldom used)

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects? 

Cancer treatment such as targeted therapy, immunotherapy, and radiation can cause side effects like fatigue, nausea, skin changes, and flu-like symptoms.

Talk with your healthcare provider about side effects linked to your treatment. There are often ways to manage them. There may be things you can do and medicines you can take to help prevent or control many treatment side effects.

Coping with liver cancer 

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on the mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are some tips:

• Talk with your family or friends.
• Ask your healthcare team or social worker for help.
• Speak with a counselor.
• Talk with a spiritual advisor, such as a minister or rabbi.
• Ask your healthcare team about medicines for depression or anxiety.
• Keep socially active.
• Join a cancer support group in person or online.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.
• Drink plenty of water, fruit juices, and other liquids.
• Keep physically active.
• Rest as much as needed.
• Talk with your healthcare team about ways to manage treatment side effects.
• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse
• Signs of an infection, such as a fever
• Side effects of treatment that affect your daily function or don’t get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.

Key points about liver cancer

• Hepatocellular carcinoma is the most common kind of liver cancer in adults. It starts in the main cells in the liver, the hepatocytes.
• Liver cancer may not cause symptoms until it's quite large.
• Symptoms vary, but they can include bloating, belly pain, loss of appetite, weight loss, itching, and yellowing of the skin and eyes.
• Blood tests, ultrasound, imaging scans, and sometimes a biopsy can be used to diagnose liver cancer.
• Treatment can include surgery, tumor ablation, embolization, targeted therapy, and immunotherapy. Radiation and chemotherapy aren't commonly used.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.