Liver cancer is cancer that starts in the liver. Some cancers develop outside the liver and spread to the organ, but doctors only describe cancer that starts in the liver as liver cancer.

The liver sits below the right lung, just under the ribcage. It is one of the largest organs of the human body and has many essential functions, including removing toxins from the body.

The American Cancer Society (ACS) estimate that 42,030 people will receive a liver cancer diagnosis in 2019. Of these, 29,480 will be men, and 12,550 will be women. Since 1980, annual liver cancer diagnoses have trebled.

In this article, we explain the symptoms of liver cancer, how it develops, how to treat it, and risk factors that may contribute to experiencing this cancer. We also explain the best ways to avoid the disease.

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A person with liver cancer may experience abdominal pain, unexplained weight loss, and fatigue.

The symptoms of liver cancer do not usually become apparent until the disease reaches an advanced stage.

Liver cancer may cause the following:

  • jaundice, where the skin and eyes become yellow
  • abdominal pain
  • pain close to the right shoulder blade
  • unexplained weight loss
  • an enlarged liver, spleen, or both
  • swelling in the abdomen or fluid buildup
  • fatigue
  • nausea
  • vomiting
  • back pain
  • itching
  • fever
  • a full feeling after a small meal

Liver cancer might also cause swollen veins that are visible under the abdominal skin, as well as bruising and bleeding.

It can also lead to high levels of calcium and cholesterol and low blood sugar levels.

To help guide treatment and define the outlook of liver cancer, healthcare professionals divide its progression into four stages:

  • Stage 1: The tumor remains in the liver and has not spread to another organ or location.
  • Stage 2: Either there are several small tumors that all remain in the liver or one tumor that has reached a blood vessel.
  • Stage 3: There are various large tumors or one tumor that has reached a main, large blood vessel.
  • Stage 4: The cancer has metastasized, meaning it has spread to other parts of the body.

Once a doctor has diagnosed and identified the stage of cancer, a person will start to receive treatment.

Surgery that completely removes the tumors is the only way to improve the chance of recovery for people with treatable, early stage liver cancer.

Surgical options include the following.

Partial hepatectomy

When the tumor is small and occupies a limited section of the liver, a surgeon can remove this part of the organ only to stop the cancer growing and spreading.

Many people with liver cancer also have cirrhosis, or scarring of the liver, however. In this case, a surgeon needs to leave enough healthy tissue after hepatectomy for the liver to function.

If, during surgery, the surgeon decides that this course is not possible and the risk is too great, they may cancel the procedure halfway through.

Only people with otherwise healthy liver function are suitable for hepatectomy. Also, the procedure may not be a viable treatment option if cancer has already spread to other parts of the liver or organs in the body.

Liver surgery of this scale can lead to excessive bleeding and blood clotting issues, as well as infections and pneumonia.

Liver transplant

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There are a number of surgical options available to treat liver cancer.

Candidates for a liver transplant must have a tumor smaller than 5 centimeters (cm) or several tumors smaller than 3 cm each. Otherwise, the risk of cancer returning is too great to justify a high risk transplant.

A successful transplant reduces the risk of cancer returning and restores normal liver function. However, the immune system may 'reject' the new organ, attacking it as a foreign body.

There are limited opportunities to carry out transplants. Currently, there are around 15,000 people on waiting lists for a new liver across the United States.

The drugs that suppress the immune system and help the body adjust to a new liver can also leave a person susceptible to severe infections. Occasionally, these drugs may also contribute to the spread of tumors that have already metastasized.

Here, learn more about the survival rate for liver transplants.

Treatment for incurable tumors

Advanced liver cancer, including where it has spread to other areas of the body, has an extremely low survival rate. However, a cancer care team can take steps to treat the symptoms and slow the growth of the tumor.

Treatment options may vary, depending on the type of liver cancer.

  • Ablative therapy: A surgeon can use radio waves, electromagnetic waves and heat, or alcohol directly on the tumor to shrink it or prevent its growth. Destroying a tumor by freezing, which is known as cryoablation, may also be possible.
  • Radiation therapy: A cancer care team directs radiation at the tumor or tumors, killing a significant number of them. Side effects might include nausea, vomiting, and fatigue.
  • Chemotherapy: A medical team injects drugs into the bloodstream or a main blood vessel in the liver to kill cancer cells. In chemoembolization, a doctor surgically or mechanically blocks the blood vessel in conjunction with administering anticancer drugs directly into the tumor.

A doctor might suggest that an individual take part in clinical trials for medications and treatments that have not yet entered general use. These might ease symptoms, and people can ask their doctor about any ongoing clinical trials that may be suitable.

Doctors do not yet know the exact causes of liver cancer. However, most liver cancers have links to cirrhosis.

According to the ACS, chronic infections with hepatitis B or C viruses are the most common causes of liver cancer in the U.S.

People with either type of virus have a significantly increased risk of developing liver cancer over other healthy individuals, as both forms can result in cirrhosis.

Some inherited liver diseases, such as hemochromatosis, cause cirrhosis, and also increase the risk of liver cancer.

Other risk factors for liver cancer development include:

Type 2 diabetes: People with diabetes, especially if they also have hepatitis or regularly consume a lot of alcohol, are more likely to develop liver cancer.

Family history: If someone's mother, father, brother, or sister has had liver cancer, they have a higher risk of developing the disease themselves.

Heavy alcohol use: Consuming more than six alcoholic drinks every day for an extended period can lead to cirrhosis. This, in turn, increases the risk of liver cancer.

Long term exposure to aflatoxins: A particular fungus creates a substance called aflatoxin. When mold grows on the following crops, it can lead to the presence of aflatoxins:

  • wheat
  • groundnuts
  • corn
  • nuts
  • soybeans
  • peanuts

The risk of liver cancer only increases following long term exposure to aflatoxins. These substances are less of a worry in industrialized nations where manufacturers regularly test for aflatoxins.

Low immunity: People with weakened immune systems, such as those with HIV or AIDS have a risk of liver cancer that is five times greater than other healthy individuals.

Obesity: Being obese raises the risk of developing many cancers. In people who go on to develop liver cancer, obesity can contribute to cirrhosis and fatty liver disease.

Gender: Around three times as many males get liver cancer as females, according to the ACS.

Smoking: Both former and current smokers have a higher risk of liver cancer than people who have never smoked.

Individuals who have a high risk for liver cancer should have regular screenings for liver cancer. They include those with:

  • hepatitis B or C
  • alcohol related cirrhosis
  • cirrhosis due to hemochromatosis, a disorder that involves deposits of iron salts in body tissue

Liver cancer becomes very difficult to cure if a doctor diagnoses it at a later stage.

Screening is the only effective way of catching liver cancer early because symptoms of early stage liver cancer are either subtle or nonexistent.

Read more on hemochromatosis.

The outlook for liver cancer is poor. People often identify liver cancer at a late stage.

Before liver cancer spreads from its original site, the 5-year survival rate is 31%. This means that 31% of people who doctors diagnose with liver cancer will survive to at least 5 years after diagnosis.

Once the cancer spreads to nearby tissues, the survival rate reduces to 11%.

At later stages, when liver cancer spreads to distant organs, this drops to 2%. This is why regular screening for people with a high risk of liver cancer is so important.

Treatment for liver cancer often involves intensive surgery with a high risk of complications. This can further affect the outlook for a person with liver cancer.

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A doctor may order imaging scans if they suspect liver cancer.

Early diagnosis drastically improves the chances of survival for people with liver cancer.

A doctor will start by asking about a person's medical history to rule out any potential risk factors. They will then do a physical exam, focusing on abdominal swelling and any yellow in the whites of the eyes. These are both reliable indicators of liver problems.

If a doctor suspects liver cancer, they will request further tests. These may include:

  • Blood tests: These include tests for blood clotting, levels of other substances in the blood, and proportions of red and white blood cells and platelets.
  • Viral hepatitis tests: The doctor will check for hepatitis B and C.
  • Imaging scans: An MRI or CT scan can provide a clear picture of the size and spread of the cancer.
  • Biopsy: A surgeon removes a small sample of tumor tissue for analysis. The results can reveal whether the tumor is cancerous or noncancerous.
  • Laparoscopy: This is an outpatient surgical procedure that takes place under general or local anesthetic. A surgeon inserts a long, flexible tube with a camera attached through a cut in the abdomen. The camera allows the doctor to see the liver and the surrounding area.

Once the doctor has assessed the stage, location, and type of liver cancer, they can decide the likelihood of safely and effectively treating it.

Liver cancer has a low survival rate in comparison to some other cancers. However, people can reduce their risk of experiencing the disease. They can also improve their chances of early detection.

There is no way to prevent liver cancer completely, but the following measures may help to reduce the risk.

Moderating alcohol intake: Regularly consuming high volumes of alcohol on a long term basis significantly increases the risk of cirrhosis and liver cancer.

Moderating or abstaining from drinking alcohol can significantly reduce the risk of developing liver cancer.

Limiting tobacco use: This can help avoid cancer of the liver, especially in people who have hepatitis B and C.

Having a hepatitis B vaccination: The following people should consider having the hepatitis vaccine:

  • people with a drug dependency who share needles
  • individuals who engage in unprotected sex with multiple partners
  • nurses, doctors, dentists, and other medical professionals whose jobs increase their risk of hepatitis B infection
  • those who frequently visit parts of the world where hepatitis B is common

There is no sure way to prevent hepatitis C and no vaccination against the virus. However, using a condom during sex may help reduce the risk of infection.

Maintaining a healthy body weight: Obesity is a risk factor as fatty liver disease and cirrhosis can lead to liver cancer and diabetes. Looking after physical health and maintaining a moderate body weight can help reduce liver cancer risk.

Treating underlying conditions: Some other conditions can lead to liver cancer, such as diabetes and hemochromatosis. Treating these before they develop into liver cancer can reduce the risk of complications.

It is best to seek consultation with a doctor if someone suspects they may have the early symptoms of liver cancer. Regular screening is vital for people with a high risk of the disease.

Q:

I struggle to stop drinking alcohol regularly. What steps can I take?

A:

Some tips to curb alcohol consumption include:

  1. Keep track of alcohol intake, such as in a diary or journal, and setting goals and limits on how much you will drink per day or week (your doctor may be able to help advise).
  2. Write down the most important reasons to limit drinking.
  3. Do not keep alcohol at home.
  4. Think about how to turn down a drink and stick to your limit before going out in social settings.
  5. Identify the triggers for drinking and find substitutes, such as activities you enjoy.
  6. Seek out support, whether from friends, a therapist or a group to hold yourself accountable.

It is best to consult your doctor or another professional for further advice.

Yamini Ranchod, PhD, MS Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.