What is Liver Cancer?

Cancer begins when abnormal cells grow together and form masses called tumors. Liver cancer can start in the normal cells of the liver. Most often though, cancer spreads to the liver through the blood, which can carry cancer cells from another area of the body. This is called metastatic cancer to the liver or secondary cancer.

Liver cancer affects the largest organ inside the body. The football-sized liver lies under the right ribs and lung. The liver breaks down food for energy, repairs tissues and helps blood clot to stop bleeding. The liver also filters alcohol, drugs and toxins in the blood before they are excreted. Because cancer cells travel through the bloodstream and pass through the liver, this organ is prone to cancer.

There are three types of liver cancer:

• Hepatocellular carcinoma is the most common type and can be life-threatening.
• Intrahepatic cholangiocarcinoma is less common and it affects the bile ducts.
• Hepatoblastoma is a rare cancer typically found in children.

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of liver cancer. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Liver cancer symptoms can include:

• Bone Pain
• Diarrhea
• Difficulty breathing
• Loss of appetite
• Pain in the upper abdomen or near the right shoulder blade
• Pain or cramps in the middle of the abdomen
• Stools that are white and chalky
• Swelling in the abdomen
• Unexplained fever
• Weight loss for no known reason
• Yellowish color of skin and eyes (jaundice)

Diagnosis

An early diagnosis of liver cancer can be missed. The rib cage covers the liver, so a small tumor can go unnoticed. To diagnose liver cancer, a healthcare provider will perform a physical examination and order tests to diagnose the symptoms. We use advanced diagnostic procedures and technology to effectively inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Angiogram: In this test, a contrast material is injected to show the details of the blood vessels of the liver on an X-ray.

Biopsy: A sample is removed from the tissue or tumor for laboratory testing. Testing can tell the physician whether the tissue is cancerous and, if so, what type of cancer is present. Testing will also reveal the cancer’s grade and its potential to become aggressive. This can be performed with a needle or through a surgical procedure.

Blood test: Blood tests are used to determined organ function, check for infection or anemia, and to determine potential causes of the symptoms. Blood tests can also check for an increased level of proteins that can indicate liver cancer. This is not a perfect test because an increased level can be caused by other conditions, too.
Computed tomography (CT) scan: A series of detailed pictures of the liver, taken from different angles, are created by a computer linked to an X-ray machine.
Laparoscopy: During this procedure, a doctor uses a thin, lighted, flexible tube called a laparoscope to see inside the liver to see if cancer has spread within the abdomen or to take a small tissue sample to examine for cancer.
Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the liver and to measure a tumor’s size.
Ultrasound: This exam uses soundwaves to take pictures of the liver and the surrounding area to look for a tumor.

Causes

Liver cancer can be caused by genetic, lifestyle and environmental factors that include:

• Alcohol abuse
• Cirrhosis
• Diabetes
• Non-alcoholic liver disease
• Smoking

Risk Factors

Risk factors that can contribute to liver cancer include:

Age: Liver cancer is rarely found in people under the age of 60.

Gender: Men have a higher risk of liver cancer than women.

Chronic infection: Hepatitis B virus or hepatitis C virus infections can increase risk of liver cancer.

Diseases: Some diseases linked to liver cancer include diabetes, cirrhosis, gall stones, iron overload, fatty liver disease, alpha-1 antitrypsin deficiency, acute intermittent porphyria and Wilson’s disease.

Environmental toxins: Contaminated drinking water can increase the risk of liver cancer.

Exposure to molds on crops: This contamination (aflatoxin) of crops such as corn and peanuts stored improperly occurs most often in Africa and Asia.

Genetic disorders: People with hemochromatosis, a genetic condition in which the body absorbs too much iron from food, can increase the risk of liver cancer.

Race: In the United States, Asian Americans and Pacific Islanders have a higher risk of liver cancer.

Prevention 

While some risk factors like age and heredity cannot be controlled, there are ways you can help to prevent liver cancer:

Avoid and treat hepatitis infections: Avoiding hepatitis infection through safe sex practice and not sharing needles can help prevent the infection that increases risk of liver cancer. People with hepatitis should be treated and follow doctor recommendations.

Don’t smoke: Smoking is a known cause of most cancers.

Eat a low-fat diet: Eat a healthy low-fat diet that includes plenty of fruit and vegetables, and exercise daily.

Limit alcohol: Limiting alcohol can prevent cirrhosis, a risk factor for liver cancer.

Prognosis

The earlier liver cancer is diagnosed, the better the outcome. Prognosis can be determined by the stage of the cancer. The stage of the cancer is determined by the size of the tumor and extent of local growth, whether lymph nodes are involved and whether the cancer has spread. The cancer stage and the patient’s medical history are used to determine the plan of care.

Treatment and Recovery

Liver cancer treatment depends on how large the tumor is, general health and whether cirrhosis of the liver is present. Sometimes, multiple types of treatments are necessary, including:

Surgery

For early-stage tumors, surgery can be performed to remove the tumor. For people with liver cancer and cirrhosis, treatment depends on the function of the liver. For people with a small localized liver cancer who have significant cirrhosis, a select few may be candidates for liver transplantation. Other surgical treatments can include:

Cryoablation: In this procedure, a small incision is made and a special, thin tube is inserted into the liver where the tumor is. The tool freezes and kills the kidney tumor.

Radiofrequency ablation: In this procedure, a small incision is made and a special probe is inserted into the liver tumor. The probe applies high heat to kill the cancer cells.

Chemoembolization of the liver tumor: In this procedure, cancer-killing chemotherapy medication is injected directly into the tumor.

Radiation

Radiation treatments can include:

Radioisotope embolization of the liver tumor: In this procedure, tiny radioactive beads are injected into the blood vessels near the liver tumor. Over a period of days, the radiation kills cancer cells at the tumor site.

Radiation therapy: In this procedure, high-energy radiation in small doses is directed to the tumor to kill cancer cells.

Systemic Treatment

Chemotherapy: Chemotherapy uses special drugs designed to kill cancer cells. Chemotherapy can be administered directly to the area of the liver with cancer. Chemotherapy is given for advanced cancer to control tumor growth.

Targeted therapy: Targeted therapy uses specific drugs that block signals in cancer cells and prohibit them from growing, spreading and surviving.

Recovery After Surgery

Recovery after a surgical procedure will depend upon the type of procedure and your overall health. Your doctor will tell you when you may be physically active again and about what activities to avoid during recuperation.

Complications

If liver cancer is not diagnosed and treated early, the cancer can spread to other organs. Other complications can include liver failure and kidney failure. If surgery has been performed, postoperative complications can include infection, bleeding, blood clots and malnutrition. If the cancer is advanced, it can cause nausea, vomiting, weight loss and physical decline.

Related Conditions

Paraneoplastic syndromes caused by substances excreted by the cancer can include:

• Hypoglycemia (low blood sugar)
• An increase in the number of red blood cells 
• Increased blood calcium
• Severe watery diarrhea

Skin changes can include:

• Muscle weakness and skin rash
• Skin blisters on the scalp 
• Sudden eruption of pigmented skin lesions
• Dark, velvety discoloration in skin folds and creases
• Multiple round or oval sharply demarcated scaling patches
• Fragile skin that blisters easily when exposed to sunlight