Liver Cancer

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
• Fever
• Jaundice, which causes yellow skin and eyes, and dark urine
• Feeling of fullness after a small meal
• Itching
• 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.
• Ultrasound
• 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.

Leading-edge therapies

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
• Chemoembolization
• 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.