What is liver cell carcinoma, or hepatocellular carcinoma?

What is liver cell carcinoma?

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People may refer to liver cell carcinoma simply as liver cancer, because it is the most common type of liver cancer.

Liver cell carcinoma is a primary liver cancer, which means the cancer begins in the liver.

Symptoms

Liver cell carcinoma may not cause any noticeable symptoms in the early stages of the disease.

As the cancer grows, people may start noticing one or more of the following symptoms:

• discomfort or swelling in the abdomen
• a hard lump or discomfort in the upper abdomen on the right side, underneath the rib cage
• pain in the back or near the right shoulder blade
• unexplained weight loss
• yellowing of the skin and whites of the eyes
• gastrointestinal bleeding
• nausea or vomiting
• persistent itching
• bleeding or bruising easily
• loss of appetite
• feeling full after eating a small meal
• pale, chalky-looking bowel movements
• dark urine
• fatigue
• fever

Many of these symptoms can indicate another health condition, but it is important to determine the underlying cause.

If people experience any of the above symptoms for over 2 weeks, they need to contact a doctor for a checkup.

Causes

Liver cell carcinoma occurs when cells in the liver become cancerous.

It can develop in two ways. Firstly, small cancer nodules form in the liver rather than a single tumor. This is the most common growth pattern in the United States and usually affects people with cirrhosis.

The other way is when liver cells form one tumor, which grows bigger and then spreads to other areas of the liver as the disease progresses.

Risk factors

Risk factors for developing liver cell carcinoma include:

• obesity or being overweight
• long-term hepatitis B or hepatitis C infection
• drinking alcohol
• smoking cigarettes
• cirrhosis, a scarring of the liver that may be due to alcohol use or a hepatitis infection
• nonalcoholic fatty liver disease, when excess fat accumulates in the liver but is not due to alcohol
• diabetes
• hemochromatosis, when the body stores more iron than it requires
• eating aflatoxins, a type of toxin from a fungus that can grow on improperly stored foods, such as grains and nuts

Prevention

People can help protect against liver cancer and reduce the risk of liver cell carcinoma by:

• Getting a hepatitis B vaccination: Getting the hepatitis B vaccine at birth can help reduce the risk of liver cancer. The Centers for Disease Control and Prevention (CDC) also recommend hepatitis B vaccination for all adults at risk.

• Getting treatment for a hepatitis B infection: Medications, such as interferon, can help treat hepatitis B.
• Undergoing testing for hepatitis C: People who may be at risk of a hepatitis C infection can get a hepatitis C test and any necessary medical treatment.
• Reducing exposure to aflatoxin B1: People can avoid or replace foods high in aflatoxin B1, including maize, rice, figs, and other dried foods.
• Maintaining a moderate weight: Maintaining a moderate weight through diet and exercise may reduce the risk of liver cell carcinoma.
• Avoiding smoking: If people smoke, they can find a program or support system to help them quit smoking.
• Avoiding or limiting alcohol: Individuals can try avoiding excessive alcohol consumption.

Diagnosis

To diagnose liver cell carcinoma, a doctor will assess a person’s symptoms and medical history and carry out a physical exam. They may then take the following tests:

• Alpha-fetoprotein (AFP) testing: Liver tumors produce a protein called AFP. High levels of AFP may be a sign of liver cancer.
• Imaging tests: Doctors may use ultrasound, CT, or MRI scans or angiography to create detailed images of the liver, blood vessels, and other organs.
• Liver biopsy: If the results from AFP testing and imaging scans do not provide a clear diagnosis, doctors may take a liver biopsy. They will remove a part of the liver tissue for laboratory testing.

If liver cell carcinoma is present, doctors will stage the level of the cancer to determine how advanced the disease is and which treatment plan is most suitable.

Treatment

Treatment may vary for each individual depending on the stage of liver cell carcinoma.

If a tumor is less than 1 centimeter upon diagnosis, doctors will monitor the condition and carry out regular surveillance tests. If there are any signs of the cancer growing, people may then require treatment.

Treatment for liver cell carcinoma may include the following.

Surgery

People may have surgery to remove the cancerous part of the liver. Doctors may refer to this as a partial hepatectomy. The remaining liver will carry out necessary functions and may grow back.

Liver transplant

During a liver transplant, a surgeon will remove the entire liver and replace it with a healthy liver from a donor.

People may have a partial or entire liver from a deceased donor or a partial liver from a living donor, which may regrow.

People may have to wait until a suitable liver transplant is available. During this time, they may receive other treatments to help control liver cancer and prevent it from spreading.

Ablation therapy

Ablation therapy destroys cancerous tissue in the liver. Different methods of ablation therapy include:

• Radiofrequency ablation: A doctor inserts needles into the body to reach the tumor. High-energy radio waves heat the needles to kill cancer cells.
• Microwave therapy: Microwaves create high levels of heat to kill cancer cells or make them more susceptible to other cancer treatments.
• Percutaneous ethanol injection: A doctor will use a needle to inject ethanol into a tumor to destroy cancer cells.
• Cryoablation: A doctor may use an ultrasound to guide a special tool toward the tumor to freeze and kill cancer cells.
• Electroporation therapy: Doctors use an electrode to send electrical pulses into a tumor to destroy cancer cells.

Embolization therapy

If surgery or ablation therapy are unsuitable treatments, a person may need embolization therapy.

Embolization therapy uses substances to block blood flow through an artery that supplies the liver tumor with oxygen and nutrients to prevent it from growing.

Targeted therapy

Targeted therapy uses medications to specifically target cancer cells and destroy them. This approach may cause less damage to surrounding healthy tissues than chemotherapy or radiation therapy.

Targeted therapy drugs include:

• bevacizumab
• cabozantinib
• regorafenib
• lenvatinib
• sorafenib
• ramucirumab

Immunotherapy

Immunotherapy treatments promote the body’s immune system to fight cancer cells and may include:

• atezolizumab, alongside bevacizumab
• nivolumab and ipilimumab
• pembrolizumab

Radiation therapy

A machine delivers high-energy radiation from outside the body to the area of cancer to destroy cancer cells. Certain techniques help reduce any damage to surrounding healthy tissues.

Can chemotherapy treat liver cancer?

Chemotherapy is not the best option for treating liver cancer, as this therapy’s drugs do not shrink liver cancer tumors effectively.

The American Cancer Society (ACS) says that studies have shown that systematic chemotherapy does not help liver cancer patients to live longer.

Therefore, healthcare professionals do not recommend this method for liver cell carcinoma.

Outlook

The outlook for liver cell carcinoma can depend on various factors, such as the stage of cancer at diagnosis, overall health, age, and how the cancer responds to treatment.

According to the ACS, for people with cancer that has not spread outside of the liver, the 5-year relative survival rate is 35%.

However, this figure is from liver cancer diagnoses from 2011 to 2017. As treatments improve over time, the outlook for people with liver cancer may improve.

Summary

Liver cell carcinoma is the most common type of liver cancer. It starts in the liver when cells become cancerous and form nodules or a single tumor.

Treatments for liver cancer may include surgery, ablation therapy, or targeted therapy drugs. Treatments may help kill cancer cells and prevent liver cancer from spreading outside the liver.