Liver cancer: What you should know

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.

If the cancer is early stage and your liver is healthy, surgery may be an option. If the tumors are small and haven’t spread to nearby blood vessels, your doctor may suggest a liver transplant.

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. 

Chemotherapy and immunotherapy may also be options for some patients.

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.