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Liver Cancer

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(Malignant Hepatoma; Hepatocellular Carcinoma; Primary Liver Cancer)

Definition

The liver is located in the right side of the abdomen. It stores and metabolizes nutrients. It also filters and stores blood. Liver cancer is the growth of cancer cells in the liver.
Cancer occurs when cells in the body divide without control or order. If cells keep dividing uncontrollably, a mass of tissue forms. This is called a growth or tumor. The term cancer refers to malignant tumors. These tumors can invade nearby tissue and spread to other parts of the body.

Causes

The cause of liver cancer is not known. Research shows that certain risk factors are associated with the disease.

Risk Factors

Factors that may increase you chance of liver cancer include:
  • Sex: male
  • Age: 40 and older
  • Infection with the hepatitis B virus or the hepatitis C virus
  • Formation of scar tissue in the liver, also known as cirrhosis
  • Excessive alcohol consumption
  • Malnutrition
  • Obesity
  • Exposure to an infectious agent, such as a liver fluke, which are found in southern Pacific countries
  • Hemochromatosis—abnormal collection of iron in body tissues
  • Hereditary metabolic disorders such as alpha-antitrypsin (AAT) deficiency and tyrosinemia
  • Exposure to certain chemicals:
    • Aflatoxin—a substance made by a fungus that often infects wheat, peanuts, soybeans, corn, and rice in tropical and subtropical regions
    • Vinyl chloride and thorium dioxide—chemicals that are strictly controlled
    • Anabolic steroids—male hormones sometimes given for medical reasons, but also taken by athletes to increase strength
    • Arsenic—a toxic chemical
Liver Cancer Due to Cirrhosis
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Symptoms

Symptoms of liver cancer in the early stages are vague. They often go unnoticed.
Liver cancer can cause the following symptoms:
  • Loss of appetite
  • Unexplained weight loss
  • Fever
  • Fatigue
  • Weakness
  • Abdominal pain and swelling
  • Nausea
  • Dark urine
  • Excessive itchiness of the skin
  • Confusion and increased sleepiness
  • Yellowing of the skin and/or the whites of the eye
These may also be caused by other, less serious health conditions. See a doctor if you have these symptoms.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.
Your bodily fluids may be tested. This can be done with:
Your doctor may need to view images of your bodily structures. This can be done with:

Treatment

If liver cancer is found, staging tests are done. This will help find out if the cancer has spread and, if so, to what extent. Surgery is the only procedure used to try to cure liver cancer. Chemotherapy and radiation therapy can reduce symptoms associated with the cancer. They are not considered able to cure liver cancer by themselves.
  • Surgery—removal of the cancerous tumor and nearby tissue, and possibly nearby lymph nodes
  • Cryosurgery—destroys tumors by freezing them with a metal probe
  • Ethanol ablation—kills cancer cells by injecting alcohol directly into the tumor
  • Radiation therapy—the use of radiation to kill cancer cells and shrink tumors. Radiation may be:
    • External radiation therapy—Radiation is directed at the liver from a source outside the body.
    • Internal radiation therapy—Radiation is placed as close as possible to the cancer cells. Radiation seeds or compounds are delivered directly to the tumor through a special catheter that is placed in the hepatic artery, which delivers blood to the liver.
    • Radiofrequency ablation—This involves using heat to destroy the tumor. Imaging machines are used to guide the probe to the tumor site.
  • Chemotherapy—drugs enter the bloodstream and travel through the body to kill mostly cancer cells and some healthy cells; may be given by pill, injection, and via a catheter directly into the liver
  • Sorafenib—a new class of therapies targeting vascular endothelial growth factor receptor (VEGF); used for advanced liver cancer
  • Biological therapy—the use of medications or substances made by the body to increase or restore the body's natural defenses against cancer; also called biological response modifier (BRM) therapy

Prevention

To reduce your risk of getting liver cancer:
  • If you use needles to inject medication or drugs, always use a clean needle. Do not share needles with anyone.
  • Use condoms when having sexual intercourse if you or your partner is not in a monogamous relationship or if you don't know if your partner has hepatitis.
  • Have children vaccinated against hepatitis B.

RESOURCES

American Cancer Society http://www.cancer.org

American Liver Foundation http://www.liverfoundation.org

CANADIAN RESOURCES

BC Cancer Agency http://www.bccancer.bc.ca

Canadian Cancer Society http://www.cancer.ca

References

Liver cancer. American Cancer Society website. Available at: http://www.cancer.org/cancer/livercancer/index . Accessed April 29, 2013.

Liver cancer. National Cancer Institute. National Institutes of Health website. Available at: http://www.cancer.gov/cancertopics/types/liver . Accessed April 29, 2013.

Salem, R, Lewandowski, RJ, Mulcahy, MF, et al. Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology. 2010;138:52.

SHARP: study of heart and renal protection. Clinical Trials.gove website. Available at: http://clinicaltrials.gov/ct2/show/NCT00125593 . Updated January 31, 2012. Accessed April 29, 2013.

3/19/2010 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Saunders D, Seidel D, Allison M, Lyratzopoulos G. Systematic review: the association between obesity and hepatocellular carcinoma—epidemiologic evidence. Aliment Pharmacol Ther. 2010 Feb 18.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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