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Liver

Reviewed April 2013

This information should not be used for self-diagnosis or in place of a qualified physician’s care.

         Table of Contents    
Liver cancer Diagnosis Library Resources
What causes it and who gets it? Types and Stages Recommended Websites
Can I help to prevent it? Treatment Videos/Presentations
Screening for liver cancer Follow-up after treatment Can I help with research at BCCA?
Signs and symptoms Living with cancer
  • Guidelines for treating this cancer have been developed by the Gastrointestinal (GI) Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines.
  • Other names/types of liver cancers: primary carcinoma of the liver, hepatocellular cancer, hepatocellular carcinoma, hepatoma, fibrolamellar carcinoma, angiosarcoma.
  • Primary liver cancer is very different from cancer that has spread from somewhere else in the body to the liver (secondary or metastatic liver cancer). There is a separate information page about secondary liver cancer.
  • The liver removes toxins from the blood, produces bile and enzymes to help with digestion, makes proteins that help the blood clot, controls the level of cholesterol in the body, and stores glycogen (sugar) which the body uses for energy.
  • The liver is the body's largest internal organ and can weigh up to four pounds.
  • The liver is located in the upper right side of the abdomen.

What causes it and who gets it?
Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

  • Primary liver cancer is rare in North America. Only one to two percent of all cancers in North America are primary liver cancers. In Africa and parts of Asia, liver cancer is one of the most common cancers.
  • Most people who get liver cancer in North America are of late middle age or older. In Africa, the disease usually occurs in young adulthood or early middle age.
  • Men are twice as likely as women to develop liver cancer.
  • Infection with hepatitis B or hepatitis C may increase the risk of liver cancer.
  • Cirrhosis of the liver (damage to the liver) is a major risk factor. A person with cirrhosis of the liver is 40 times more likely to develop cancer than a person with a normal liver. Cirrhosis can develop from exposure to toxins, alcoholism, and viral or parasitic infections.
  • Exposure to certain hazardous materials can be a risk factor. Some of these materials include, Thorotrast (once used in X-ray exams, but now discontinued), aflatoxin (produced by some moulds), A20 compounds, and PVCs (polyvinyl chlorides).
  • Hemochromatosis (a condition in which the liver stores too much iron) may increase the risk of liver cancer.
  • Oral estrogens, particularly those used in birth control pills, are only associated with a minimal risk of liver cancer, unless the woman has a history of liver cancer. Oral estrogens have been associated with benign liver tumours which may cause bleeding problems.
  • Oral steroid use may increase the risk of liver cancer.
  • Statistics

Can I help to prevent it?

  • Avoid excessive use of alcohol because it may lead to cirrhosis.
  • Get a vaccination against hepatitis B because it may lead to cirrhosis.
  • If there is a family history of Hepatitis B virus, babies should be vaccinated at birth, while still in the hospital, with follow up doses given by Public Health nurses.

Screening for this cancer

  • No effective screening program exists for this cancer yet.

Signs and symptoms

  • There are no obvious symptoms in the early stages of liver cancer.
  • Common symptoms that are often present in later stages include:
    • Unexplained weight loss
    • Loss of appetite
    • Abdominal pain and swelling
    • Fever
    • Jaundice (yellowing of the skin and whites of the eyes)
    • Fatigue
    • Weakness
    • Bone pain, a cough or gastrointestinal bleeding may be symptoms of metastasis

Diagnosis
These are tests that may be used to diagnose this type of cancer.

  • Liver cancer is generally not diagnosed until it has reached an advanced stage.
  • Blood test for Alpha-fetoprotein (AFP) has been thought to be a useful screening test, but elevated levels are found in a number of diseases including, cancer of testes, stomach, pancreas and lungs, as well as cirrhosis of the liver and normal pregnancy. Also 30% of people with liver cancer do not have an elevated AFP.
  • Liver function test
  • Liver scan
  • Angiography
  • Bone scan
  • Chest X-ray
  • Ultrasound
  • Laparoscopy
  • CT scan
  • PET scan
  • MRI scan
  • Abdominal exploratory surgery
  • Fine needle biopsy is usually only done if the tumour is inoperable.
    For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnosic Tests section.

    Types and stages

    Types
    • Hepatocellular Carcinoma
      • 90 % of liver cancers are hepatocellular carcinomas arising from the liver cells (30-70% of patients have cirrhosis).
      • 7 % arise in the liver's bile ducts.
    • Fibrolamellar Carcinoma
      • Fibrolamellar is an unusual type of hepatocellular carcinoma which generally occurs in young women.
      • This type of cancer has a somewhat better prognosis than other hepatocellular carcinomas.
    • Angiosarcoma
      • Angiosarcomas are very rare, but of growing importance because they are associated with polyvinylchloride (PVCs) and other similar industrial toxins.
    Stages
    Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

    T describes the site and size of the main tumour (primary)
    N describes involvement of lymph nodes
    M relates to whether the cancer has spread (presence or absence of distant metastases)

    • It should be noted that TNM staging alone is not enough to accurately form a prognosis, as presence of viral hepatitis, extent of cirrhosis, grade, and remaining liver function are other important factors for prognosis and treatment.
        Stage I       A single tumour and it has not spread to nearby blood vessels.
    Stage II A single tumour and it has spread to nearby blood vessels, or more than one tumour 5 cm or smaller.
    Stage IIIA  More than one tumour larger than 5 cm, or one tumour that has spread to a branch of the portal or hepatic vein(s).
    Stage IIIB The cancer has spread to nearby organs other than the gallbladder or has broken through the lining of the peritoneal (abdominal) cavity.
    Stage IIIC The cancer has spread to nearby lymph nodes.
    Stage IV The cancer has spread to distant parts of the body.

    Treatment
    Cancer therapies can be highly individualized – your treatment may differ from what is described below.

             Surgery

    • Surgery is the only way to cure primary liver cancer.
    • Surgery is most likely to succeed with a single tumour confined to one lobe that can be entirely removed.
    • Unfortunately, most often the cancer has spread through the liver or the liver may already be damaged by cirrhosis or other disease and cannot be removed.
    • Normally, with healthy tissue, the liver has an amazing ability to re-grow, even if up to 80% of the liver is removed. This usually occurs in young patients with benign tumours or with accident victims, rather than in cancer patients.

    Radiotherapy

    • Radiation is generally not used to treat liver cancer. However, it may be used to manage painful bone metastases.

    Chemotherapy

    • Chemotherapy may be given to relieve symptoms.

    Chemoembolization

    • Chemoembolization may be used in selected patients with good liver function.
    • Chemotherapy drugs are delivered via catheter through the hepatic artery directly to the tumour and then the artery is blocked so the drugs will stay in the liver longer.

    Cryosurgery

    • Cryosurgery uses liquid nitrogen to destroy cancer cells by freezing them.
    • Cryosurgery is used to control cancer only, not to cure it.
    • Patients who qualify for cryosurgery are ones who have a few, slightly larger lesions which are on the surface of the liver.

    Alcohol Injection

    • Alcohol may be injected directly into the tumour to kill cancer cells.
    • This method may be used to treat smaller lesions if they are not operable.

    Radiofrequency Ablation

    • Radiofrequency ablation uses radiofrequency waves which produce alternating current to locally heat the tumour cells in the liver, resulting in the death of tumour cells.
    • The radiofrequency waves are delivered to the localized liver tumour(s) with a needle probe inserted directly into the tumour(s). The procedure uses ultrasound to accurately guide the probe.
    • It is usually limited to treatment of three tumours in the liver, or occasionally up to five tumours that are accessible to the needle probe through the skin, or during a surgical operation, laparotomy or laparoscopy.

    Follow-up after treatment
    • Guidelines for follow-up after treatment are covered on our website.
    • You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
    • Follow-up testing is based on your type of cancer and your individual circumstances.
    • The BCCA Survivorship Research Centre focusses on the issues that cancer survivors can face.

    Living with Cancer

    We know that cancer and its treatment can present unique challenges: from everyday concerns like diet, money and housing, to emotional concerns. The needs of our patients and their families and friends can be very diverse. Please explore this very useful part of our website. Here is some of what's included in this section: Library Resources
    • The BC Cancer Agency Library has many resources about cancer, coping, talking to children and more. Please visit the Library in your Centre, call a librarian, or visit the Library online to see the many resources available.
    • Get a bibliography of books, videos and other items available through our library.
    • Pathfinders are a good starting point to resources on types of cancer and living with cancer. They list books, videos, pamphlets, websites and support services.

    Recommended websites
    The BC Cancer Agency has selected and evaluated these useful websites for your further information.

    Liver Cancer 
    Websites for cancer survivors, and how to stay healthy after treatment.

    Videos
    View BC Cancer Agency videos on cancer-related topics.

    Can I help with research at BC Cancer Agency?

    Patients play a vital role in research to fight cancer. Here are a few ways that you can help:



    This information is awaiting Tumour Group approval.