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.

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Causes

Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but it is probably a combination of genetics and environment.

Risk Factors

Liver cancer is more common in men, and in people over 40 years old. Other factors that may increase your chances of liver cancer:

• Hepatitis B or hepatitis C infection
• HIV infection
• Formation of scar tissue in the liver— cirrhosis
• Alcohol use disorder
• Malnutrition
• Obesity
• Exposure to an infectious agent, such as a liver fluke, which is found in southern Pacific countries
• Abnormal collection of iron in body tissues— hemochromatosis
• 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
  • Toxins, such as arsenic

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— jaundice

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:

• Blood tests
• Biopsy
• Laparoscopy

Imaging tests evaluate the liver and other structures. These may include:

• Angiogram
• MRI scan
• CT scan
• X-ray

The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, liver cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.

Treatment

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. Some may have complete removal of the liver followed by a liver transplant.
• Cryosurgery—Destroys tumors by freezing them with a metal probe.
• Ethanol ablation—Kills cancer cells by injecting alcohol directly into the tumor.
• Embolization—Substances are injected to inhibit or decrease the liver's blood supply. Procedures include:
  • Arterial embolization—A catheter is into the hepatic artery, the liver's main blood supply. A substance is injected to stop blood flow.
  • Chemoembolization—Beads are used to disperse a chemotherapy drug in the hepatic artery. The drugs eventually close off the artery, blocking blood flow.
• Radiation therapy—The use of radiation to kill cancer cells and shrink tumors. Radiation may be:
  • External—Radiation is directed at the liver from a source outside the body.
  • Internal—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 arteries near the tumor. Radiation is given off over a slow period of time.
  • 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 help reduce your chances of liver cancer:

• Always use a clean needle if you use needles to inject medication or drugs. Do not share needles with anyone.
• Always use condoms when having sexual intercourse if you or your partner are not in a monogamous relationship, or if you do not know if your partner has hepatitis.
• Drink alcohol moderately, which is a maximum of 2 drinks per day for men and a maximum of 1 drink per day for women.
• Have children vaccinated against hepatitis B.
• Eat a healthy diet that includes white meat, fish, and plenty of vegetables.