Liver Cancer

Liver cancer, also called hepatic cancer, happens when abnormal cells grow inside the liver, one of the largest organs in your body. If you have cancer in the bile ducts--a series of thin tubes that go from the liver to the small intestine--you will also be treated by liver cancer doctors.

Primary liver cancer is when abnormal cells start in the liver. Secondary liver cancer is when cancer cells spread to the liver from another part of your body, such as your pancreas, colon, stomach, breast, or lung.

Most people who have primary liver cancer also have an ongoing chronic liver condition.

Your liver lives in your upper abdomen just under your ribcage. It’s made of lobules, each with their own blood supply. Your liver cleans your blood of toxins like alcohol and medication byproducts, helps digest fats, and helps maintain blood sugar balance. Your liver also produces proteins to help your blood clot and breaks down old or damaged cells.

Bile ducts move bile, a liquid that helps digest fats, from your liver and gallbladder to the small intestine.

Both primary liver cancer and bile duct cancer are rare diseases.

The American Cancer Society estimates that about 33,000 new cases are diagnosed in the US each year. Of these, 24,600 are found in men and 8,590 in women. Liver cancer incidence has been rising slowly for several decades.

It is estimated that only about 8,000 people will be diagnosed with bile duct cancer in a given year.

Types of Liver Cancer

The most common type of liver cancer is called hepatocellular carcinoma, or HCC. HCC can start as a single tumor that takes a long time to spread to other parts of the liver. It can also present as many small cancerous nodules throughout the liver. HCC is most often found in patients with cirrhosis, or chronic liver damage.

Bile duct cancer, also called biliary cancer or cholangiocarcinoma, starts in the cells that line the bile ducts. If the bile ducts inside the liver are affected, it’s called intrahepatic bile duct cancer. If the bile ducts outside the liver are affected, it’s called extrahepatic bile duct cancer. It’s important that a specially trained liver pathologist identifies the type of bile duct cancer you have because they have different risk factors and genetic makeups.

Rare cancers. Angiosarcoma and hemangiosarcoma are rare cancers of the liver.

Risk Factors

Liver cancer and bile duct cancer can develop from factors that are out of your control. Gender, race, and chronic diseases like hepatitis B acquired from your mother at birth all play in liver cancer incidence. People of all ages get primary liver and bile duct cancers.

You can lower your risk of liver and bile duct cancer by preventing damage to your liver. This can include limiting alcohol consumption, stopping use of tobacco products, maintaining a healthy weight, and limiting your exposure to particular toxic chemicals.

Risk factors for liver cancer include:

Race/Ethnicity

People from Asia and sub-Saharan Africa have a high incidence of hepatitis B infection, which puts them at high risk for liver cancer. Bile duct cancer is most common in parts of Asia where people have high rates of liver parasite infections.

Cirrhosis

Most people who develop liver cancer have a history of cirrhosis. Cirrhosis is a condition where liver cells are damaged and replaced by scar tissue.

Chronic Viral Hepatitis

Long-term infection of the hepatitis B or C viruses can lead to cirrhosis of the liver and eventually to liver cancer. Hepatitis C is the more common cause of liver and bile duct cancer in the US.

Heavy Alcohol Use

Heavy drinking can cause cirrhosis.

Obesity

People who are obese can develop fatty liver disease, which can lead to cirrhosis.

Type II Diabetes

This condition can lead to inflammation, then cirrhosis.

Inherited Metabolic Diseases

People with hereditary hemochromatosis absorb too much iron from their food. They have a higher risk of developing cirrhosis and liver cancer. Other rare diseases that increase the risk of liver cancer include tyrosinemia, alpha1-antitrypsin deficiency, porphyria cutanea tarda, glycogen storage diseases, and Wilson disease.

Chemical Exposure

Vinyl chloride and Thorotrast. Vinyl chloride exposure can increase liver cancer risk. Arsenic, which naturally occurs in some drinking water, can also increase your risk.

Anabolic Steroids

Some athletes use these male hormones to increase strength and muscle mass. Long-term use can slightly increase your risk of liver cancer.

Parasites

Parasites can cause liver damage, as well as inflammation that is linked to bile duct cancer. These parasites are primarily found in Asia, Africa, and South America.

Smoking

Tobacco use is linked to many forms of cancer, including liver cancer.

Signs of Liver Cancer

Most people don’t have signs or symptoms of liver cancer until it’s in a later stage. Many of the symptoms of liver and bile duct cancer can look like other illnesses. They include:

  • Unexplained weight loss or loss of appetite
  • Feeling very full after eating very little
  • Nausea or vomiting
  • An enlarged liver
  • An enlarged spleen
  • Pain in the abdomen or near the right shoulder blade
  • Swelling or fluid build-up in the abdomen
  • Itching
  • Yellowing of the skin and eyes (jaundice)
  • Fever
  • Enlarged veins on the belly that are visible through the skin
  • Abnormal bruising or bleeding

People who have chronic hepatitis or cirrhosis may feel worse than usual and produce excess hormones that cause:

  • High blood calcium levels (hypercalcemia), and symptoms of nausea, confusion, constipation, weakness, or muscle problems
  • Low blood sugar levels (hypoglycemia) and symptoms of fatigue or fainting
  • Breast enlargement (gynecomastia) and/or shrinking of the testicles in men
  • High red blood cells counts (erythrocytosis) causing redness and flushed skin

Diagnosis

For people who are at high risk for liver cancer, it’s possible to diagnose the disease through screening tests. But most liver cancers are diagnosed with the following tests:

  • Liver function tests (LFTs), blood tests that assess how the liver is working.
  • Blood clotting tests that check for proteins that allow the blood to clot and prevent bleeding. A damaged liver may not make enough.
  • Viral hepatitis tests that look for hepatitis B or C virus infection. Both infections are linked to cirrhosis and liver cancer.
  • Kidney function tests, blood tests that assess how well your kidneys are working.
  • Complete blood count (CBC), which measures the levels of red blood cells, white blood cells (which fight infection), and platelets (which help your blood clot) and how well your bone marrow is making new blood cells.
  • Blood chemistry tests, which check the levels of minerals and other things in your blood that might be affected by liver cancer.
  • Alpha-fetoprotein blood (AFP) test, which can help determine your best treatment options or, during treatment, how well the therapy is working or if the cancer has come back.
  • CA 19-9 test, which looks for this marker for bile duct cancers and can help predict prognosis for people with all kinds of liver cancer.