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What are the types of liver cancer?
Liver cancer can begin in the liver or other parts of the body. Primary liver cancer begins in the liver. Metastatic liver cancer starts somewhere else in the body and metastasizes (spreads) to the liver.
The liver is a common place where cancer spreads. Its large size and high blood flow make it a prime target for tumor cells moving through the bloodstream. Colorectal, breast and lung cancers are the most common sources of metastatic liver cancer.
The information here focuses on primary liver cancer. The main types of primary liver cancer are:
Hepatocellular carcinoma (HCC): Most primary liver cancers are HCC. They begin in hepatocyte cells. Sometimes they begin as a single tumor; other times they start in multiple spots in the liver. The latter is more common in people with liver damage, such as cirrhosis, and is more prevalent in this country.
Fibrolamellar HCC is a rare subtype that often has a higher chance for successful treatment than other types of liver cancer.
Bile duct cancers (cholangiocarcinomas): One or two of every 10 cases of liver cancer start in the bile ducts, which are small tubes that carry bile to the gallbladder. They are treated in the same way as HCC.
Angiosarcomas and hemangiosarcomas begin in blood vessels in the liver. These fast-growing liver cancers usually are not diagnosed until they are in advanced stages.
Hepatoblastoma: A very rare type of liver cancer, this most often is found in children. The survival rate is more than 90% if the cancer is caught early.
In addition to cancerous tumors, some tumors in the liver are benign (non-cancerous) but grow large and cause problems. Usually these can be removed by surgery.
What does the liver do?
The liver is pyramid-shaped and located under your right ribs. It has two sections called lobes. It is different from most organs because it has two blood sources:
- The hepatic artery brings in oxygen-rich blood
- The portal vein supplies nutrient-rich blood from the intestines
The liver is vital. You can’t live without it. Some of its important functions are to:
- Break down and store nutrients from the intestine
- Manufacture some of the clotting factors your body needs to stop bleeding
- Make bile that helps the intestine absorb nutrients
- Help get rid of waste
Liver cancer usually does not cause symptoms in the early stages. When it does have symptoms, they vary from person to person. As the tumor grows, it may cause:
- Weight loss
- Pain in the right side of the upper abdomen or around the right shoulder blade
- Loss of appetite
- Swelling or bloating in the abdomen
- Hard lump below the ribs on the right side
- Tiredness or weakness
- Nausea or vomiting
- Jaundice, which causes yellow skin and eyes, and dark urine
- Feeling of fullness after a small meal
- Swollen veins on the abdomen
- Becoming sicker if you have hepatitis or cirrhosis
Certain types of liver cancer produce hormones that may cause:
- High blood-calcium levels that may cause constipation, nausea or confusion
- Low blood-sugar levels that may cause tiredness or faint feeling
- Enlarged breasts or shrinking of testicles in men
- High red-blood cell count that may cause redness in the face
These symptoms do not always mean you have liver cancer. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.
In rare cases, liver cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
Some people have an elevated risk of developing liver cancer. Review the liver cancer screening guidelines to see if you need to be tested.
Liver cancer often is challenging to diagnose. It usually has no symptoms in the early stages, and tumors often cannot be felt from outside the body. If you have been diagnosed with liver cancer, it is essential to find out exactly where the cancer is and if it has spread. This helps doctors choose the best treatment for you.
Advanced technology, techniques
MD Anderson has the most advanced and accurate technology to pinpoint liver cancer, including triple-phase CT scans dedicated to the liver. Many times, spots on the liver that indicate cancer are small, and fine imaging is required to find them.
We have special techniques to find even the smallest spots on the liver. And our staff includes pathologists, diagnostic radiologists and specially trained technicians who are highly skilled in diagnosing liver cancer.
Liver cancer diagnostic tests
If you have liver cancer symptoms, the first step is a physical exam. The doctor will:
- Feel your abdomen to examine the liver, spleen and nearby organs
- Check your abdomen for ascites, an abnormal accumulation of fluid
- Examine your skin and eyes for signs of jaundice
If the doctor suspects liver cancer, you may have one or more of the following tests to diagnose it and find out if it has spread.
Blood tests: One common blood test detects alpha-fetoprotein (AFP), which can be a sign of liver cancer. Other blood tests may measure how well the liver is working.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans: This is usually the most reliable test for evaluating the extent of liver cancer. Our technology includes the precise triple-phase CT scan.
- Angiogram: The doctor injects dye into an artery. This allows the blood vessels in the liver to be seen on an X-ray.
Biopsy: A sample of tissue from the tumor or the healthy part of the liver is removed and looked at under a microscope. Healthy tissue may be tested to see how well the liver is working. A biopsy may be obtained by:
- Fine needle aspiration (FNA): A thin needle is inserted into the liver to remove a small amount of tissue.
- Core biopsy: This is similar to FNA, but a thicker needle is used to remove small cylinder-shaped samples (cores).
- Laparoscopy: A small incision (cut) is made in the abdomen, and a thin, lighted tube (laparoscope) is inserted to view the tumor.
- Surgical biopsy: Tissue is removed during an operation.
Visit the Prevention section of our website to find out steps you can take to avoid cancer.
Liver cancer staging
If you are diagnosed with liver cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads. (source: National Cancer Institute)
Stage 1: There is one tumor, and it has not spread to nearby blood vessels.
Stage 2: One of the following is found:
- One tumor that has spread to nearby blood vessels
- More than one tumor, none of which is larger than 5 centimeters
Stage 3A: One of the following is found:
- More than one tumor larger than 5 centimeters
- One tumor that has spread to a major branch of blood vessels near the liver
Stage 3B: There are one or more tumors of any size that have either:
- Spread to nearby organs other than the gallbladder
- Broken through the lining of the peritoneal cavity
Stage 3C: The cancer has spread to nearby lymph nodes.
Stage 4: The liver cancer has spread beyond the liver to other places in the body, such as the bones or lungs. Tumors may be any size and also may have spread to nearby blood vessels and/or lymph nodes.
For adult primary liver cancer, stages also are grouped by how the cancer may be treated:
Localized resectable: The cancer is found in the liver only, has not spread and can be removed completely by surgery.
Localized and locally advanced unresectable: The cancer is found in the liver only and has not spread, but it cannot be removed completely by surgery.
Advanced: Cancer has spread throughout the liver or has spread to other parts of the body, such as the lungs and bone.
At MD Anderson, some of the world’s leading liver cancer experts concentrate extraordinary expertise on you. Your care is personalized to deliver the most advanced therapies with the least impact on your body.
Surgery is the main treatment for liver cancer. The surgeon must have a high level of skill for it to be successful. Because many people with liver cancer have underlying liver damage, this delicate surgery must remove enough of the tumor to treat the cancer while leaving enough of the liver to function.
Liver cancer surgery has the best outcomes when it is done by a surgeon who performs a large number of these procedures. As one of the nation’s largest cancer centers, MD Anderson’s surgeons have exceptional levels of experience and expertise.
At MD Anderson, you benefit from some of the most innovative treatments available for liver cancer. Many of them are available at only a few centers nationwide. Our therapies include:
- Proton therapy
- New forms of chemotherapy, including sorafenib, that target the blood vessels that keep tumors alive
- Hepatic artery infusion to deliver chemotherapy directly to the liver
- Targeted therapies to help your body fight the cancer
For the most part, liver cancer can be treated successfully only when it is found in an early stage, before it has spread. Your treatment will depend on:
- The size of the tumor
- Whether you have cirrhosis of the liver
- Your general health
At MD Anderson, your treatment for liver cancer is customized to your needs. One or more of the following therapies may be suggested to treat the cancer or help relieve symptoms.
Liver cancer surgery
The best chance for successful treatment of liver cancer is with surgery. If all of the cancer can be removed, the possibility of successful treatment is higher. However, complete removal of liver cancer often is not possible because the cancer is large or has spread to other parts of the liver or the body. Also, the liver may be damaged because of other conditions. Surgeons try to remove as much of the tumor as possible while keeping enough of the liver to function.
Since the liver plays a part in blood clotting, bleeding after surgery is a frequent side effect. And, since the remaining liver still is damaged, the cancer may reappear.
The main types of surgery for liver cancer are:
Liver transplant: The diseased liver is removed, and then it is replaced with a healthy liver from a donor. If you have cirrhosis or if the tumor is large, a liver transplant likely will be the main treatment option. Liver transplant has a risk of serious infection and other health issues.
Partial hepatectomy: The part of the liver where the tumor is located is removed surgically (see illustration).
Tumor ablation: A local treatment in which heat (radiofrequency ablation) or extreme cold (cryosurgery or cryotherapy) is used to freeze or burn the liver cancer away. Ablation may be used when surgical removal of the tumor is not possible.
Embolization: Tiny pellets of plastic or another material are injected into the arteries that carry blood to the tumor. The pellets block blood flow, which makes it harder for liver cancer to grow.
Liver cancer radiation therapy
Because radiation may destroy normal liver tissue as well as cancer cells, it can be used only in low doses for liver cancer. Radiation therapy cannot cure liver cancer, but it may be used to shrink the tumor or relieve pain.
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
Liver cancer proton therapy
The Proton Therapy Center at MD Anderson is one of the largest and most advanced centers in the world. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.
Proton therapy delivers high radiation doses directly to the liver cancer tumor site, with no damage to nearby healthy tissue. For some patients, this therapy results in a higher chance for successful treatment with less impact on your body.
Liver cancer chemotherapy
Chemotherapy usually is not used to treat liver cancer because of a low response rate. However, MD Anderson researchers are investigating new drugs, such as sorafenib, that target the blood vessels that keep tumors alive.
Our experts also are working on new ways to give chemotherapy drugs directly into the liver, delivering higher doses of drugs than usually possible with fewer side effects. These include:
Chemoembolization: A needle is inserted into an artery in the groin, and then a tiny tube is threaded into an artery leading to the liver. A high dose of medicine then is given. Afterward, the artery is blocked to prevent it from feeding blood to the liver.
Hepatic artery infusion: A catheter (tube) is placed in the liver. Drugs are infused into a special implanted pump that delivers them continuously.
Liver cancer targeted therapy
MD Anderson offers targeted therapies for some types of liver cancer. These innovative new drugs stop the growth of cancer cells by interfering with proteins and receptors or blood vessels that supply the tumor with what it needs to grow.
Why choose MD Anderson for your liver cancer treatment?
Your treatment plan is personalized to include the most advanced therapies, while focusing on your quality of life. Liver cancer treatment options may include:
- New forms of chemotherapy, including sorafenib, that target the blood vessels that keep tumors alive
- Hepatic artery infusion to deliver chemotherapy directly to the liver
- Proton therapy
- Targeted therapies to help your body fight liver cancer
A team of experts, including medical, surgical and radiation oncologists, specialized pathologists, as well as a specially trained support staff, collaborate and communicate frequently about your case. For you, this means comprehensive, but focused, care for liver cancer.
Our physicians have at their fingertips the most modern techniques and technology to diagnose and treat liver cancer. And they use them with extraordinary skill.
Surgery for liver cancer often is complex and challenging. Your best chance for a successful outcome is with a surgeon who has a high degree of experience and skill in these highly specialized procedures.
Because MD Anderson is one of the nation's most active cancer centers, our surgeons use the latest methods to perform a large number of delicate liver cancer surgeries each year, with higher chance for successful treatment than many other cancer centers.
And, at MD Anderson you're surrounded by the strength of one of the nation's largest and most experienced comprehensive cancer centers, which has all the support and wellness services needed to treat the whole person – not just the disease.
As one of the nation's leading research centers, MD Anderson is able to offer clinical trials of new treatments for liver cancer.
I feel there has to be some reason why I was left here. I think part of it was to share my story.
BY Molly Adams
The liver is your body’s largest organ. It’s responsible for digestion, blood clotting and helping get rid of toxins. But unlike other organs, it has two blood sources. This makes the liver vulnerable to cancer cells moving through the bloodstream. The cancers that most commonly spread to the liver through the bloodstream are colorectal, breast and lung cancers.
When cancer starts in the liver, it’s called hepatocellular carcinoma. This type of liver cancer can start as a single tumor or as multiple spots on the liver caused by heavy drinking, obesity or a long-term hepatitis infection. These conditions cause scarring and permanent damage, known as cirrhosis of the liver.
To learn more about liver cancer symptoms, diagnosis and treatment, we spoke with Emma Holliday, M.D. Here’s what she had to say.
What are common symptoms of liver cancer?
Many patients don’t experience any symptoms in the early stages of liver cancer. When symptoms do develop, they may include abdominal pain or bloating, fatigue, nausea, vomiting, and yellowing of the skin or eyes, known as jaundice. Keep in mind that these symptoms vary from person to person.
Are some people more likely to develop liver cancer?
Hepatocellular carcinoma is more common in men than women, and the average age of diagnosis is 63.
Patients with cirrhosis of the liver are more likely to develop hepatocellular carcinoma, so it’s important to understand what can lead to cirrhosis:
- Alcohol consumption: Alcohol should be avoided. Talk with your doctor about what that means for you.
- Chronic hepatitis infection: Hepatitis B and C increase your risk, so it’s important to seek treatment if you have either of these infections. New antiviral medications can treat both types.
- Non-alcoholic fatty liver disease: This is caused by a buildup of fat in the liver. You can lower your risk by maintaining a healthy weight, eating a plant-based diet and staying active.
- Genetic conditions: Hemachromatosis, Wilson disease, Alpha 1-antitrypsin deficiency, porphyria and other rare conditions can lead to cirrhosis. If you have a family history of liver cancer, talk with your doctor about whether you should meet with a genetic counselor.
What are screening options are available for liver cancer?
National guidelines recommend routine screening liver cancer screening for patients with cirrhosis. This includes a blood test for a cancer marker called alphafetoprotein as well as an ultrasound looking for any suspicious liver masses. This screening regimen is typically done every six months. Your doctor can advise if this is right for you.
How is liver cancer diagnosed?
Talk to your doctor if you have any liver cancer symptoms. Your doctor may order a CT scan or an MRI along with an alphafenoprotein blood test to look for cancer. In some cases, CT scans or MRI results, along with blood test results, may be enough to make a diagnosis. But if the images aren’t clear, your doctor may remove a tissue sample for closer examination by doing a biopsy.
How is liver cancer treated?
The type of liver cancer treatment your doctor recommends will depend on the tumor’s size and location, whether you have cirrhosis, and your overall health.
Sometimes surgery isn’t an option, especially if the tumor is too large to be removed safely or is in a difficult location. In these cases, your doctors may recommend radiation therapy, which uses an external beam of X-rays or protons to destroy tumors. They may also suggest radiofrequency ablation, which uses a needle-thin probe to deliver electric currents directly to the tumor, heating it until it’s destroyed.
Another approach is to prevent blood flow from reaching tumors through a process called chemoembolization. A needle is inserted into an artery in the groin, and a tiny tube is threaded into the artery that leads to the liver to deliver drugs to the tumor. Afterward, the artery is blocked to prevent blood flow to the liver. In some cases, patients may instead undergo radioembolization, where the doctor injects liquid containing tiny radioactive spheres that treat the tumor.
What’s next for liver cancer treatment? Tell us about promising research developments and clinical trials here at MD Anderson.
Unfortunately, liver cancer is one of the most rapidly increasing types of cancer in the U.S. But we’re hopeful for the future based on new research. At MD Anderson, we have several clinical trials exploring new liver cancer treatments.
One clinical trial is comparing chemotherapy with a type of radiation called stereotactic body radiotherapy, which delivers a high dose of radiation precisely to the tumor while limiting exposure to healthy cells.
Another clinical trial is comparing proton therapy with intensity-modulated radiotherapy, and others are looking at T-cell therapy for patients with advanced liver cancer. MD Anderson is also investigating using microscopic glass beads called TheraSpheres to target tumors with internal radiation in a treatment called radioembolization.
What advice do you have for liver cancer patients?
There are many liver cancer treatment options, but not all options are right for all patients. And weighing through these treatment options can be overwhelming, so make sure you find a team of doctors you trust who can answer your questions and help you choose the right treatment for you.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.