(Malignant Hepatoma; Hepatocellular Carcinoma; Primary Liver Cancer)
Liver cancer is growth of cancer cells in the liver. The liver is an organ in the right side of the abdomen. It helps with digestion. It also filters and stores blood.
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Cancer happens when cells divide without control or order. These cells grow together to form a tumor. They can invade and damage nearby tissues. They can also spread to other parts of the body.
It is not clear what causes changes in the cells. It is likely a combination of genes and environment.
Liver cancer is more common in men and older adults. Other things that raise the risk are:
There may be no symptoms in the early stages of liver cancer.
When symptoms happen, they may be:
- Yellowing of the skin or whites of the eye—jaundice
- Loss of hunger and weight
- Tiredness and weakness
- Belly pain, swelling, or nausea
- Dark urine
The doctor will ask about symptoms and past health. A physical exam will be done.
Tests may include:
- Blood tests
- Biopsy—a sample of tissue is taken and tested
- Laparoscopy—a scope is used to look inside the liver
Imaging tests will check for tumors and the spread of cancer. They may include:
The exam and test results are used to diagnose the cancer. They are also used for staging. Staging outlines how far and fast cancer has spread. Liver cancer is staged 1 to 4. The lower the stage number, the less the cancer has spread.
The goal is to remove the cancer, if possible. Treatment depends on the stage of the cancer. It also depends on the person's health.
Options may be:
- Surgery to try to cure the cancer, such as:
- Removing the tumor, nearby tissue, and possibly nearby lymph nodes
- A liver transplant—for those with tumors that cannot be removed with surgery
- Other procedures—for smaller tumors, or when surgery is not a good option—such as:
- Radiofrequency ablation—uses heat to destroy the tumor
- Cryotherapy—freezes and destroys tumors
- Ethanol ablation—kills cancer cells by injecting alcohol into the tumor
Embolization may be used for larger cancers that cannot be removed with surgery. It involves injecting substances into an artery in the liver. This decreases the liver's blood supply to cancer cells.
Other liver cancer treatments may include:
- External or internal radiation—to kill cancer cells and shrink tumors. This option may be used for cancer that:
- Cannot be treated with other options
- Has spread to other areas, such as the bones or brain
- Is large and painful
- Blocks the main blood vessel to the liver
- Targeted therapy—drugs that attack cancer cells.
- Immunotherapy—drugs that help the body fight off cancer.
- Chemotherapy by mouth, injection, or IV— to kill cancer cells. This option may be used if other treatments cannot help and surgery cannot be done.
The risk of liver cancer may be reduced by:
- Having children get the hepatitis B vaccine
- Drinking alcohol moderately
- Eating a healthy diet
- Practicing safe sex
- Using clean needles—if injecting medicines or drugs
- Embolization therapy for liver cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/liver-cancer/treating/embolization-therapy.html.
- General information about adult primary liver cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/liver/patient/adult-liver-treatment-pdq.
- Hepatocellular carcinoma in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/hepatocellular-carcinoma-in-adults.
- Hepatocellular carcinoma in children. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/hepatocellular-carcinoma-in-children.
- Jiang Y, Han QJ, et al. Hepatocellular carcinoma: mechanisms of progression and immunotherapy. World J Gastroenterol. 2019;25(25):3151-3167.
- Liver cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/liver-cancer.html.
- Management of hepatocellular carcinoma in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/management-of-hepatocellular-carcinoma-in-adults.
- Mohei Abouzied, MD, FACP
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