About Liver Cancer
What is liver cancer?
Cancer in the liver develops when abnormal liver cells or bile ducts cells (in the liver or leaving the liver) grow out of control. Malignant, also called cancerous, liver tumors can spread to nearby tissues or other parts of the body.
Liver cancer symptoms can mimic those of other conditions and, as a result, sometimes there is a delay in diagnosis. If you or a loved one experiences liver cancer symptoms, don't wait to see a doctor.
What causes liver cancer?
While we don't know what causes most liver cancer cases, we are aware of factors that can increase your risk. People with cirrhosis, or liver scarring, have a greater chance of developing liver cancer. Among the causes of cirrhosis are heavy alcohol use and long-term hepatitis B and C infections.
Obesity (leading to a fatty liver) is also a risk factor. Finally, prolonged exposure to certain chemicals such as aflatoxin, vinyl chloride, and arsenic can increase liver cancer risk, though this is very uncommon.
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Liver cancer symptoms
People with liver cancer may not experience symptoms until the tumor grows large enough to push on nearby organs. Signs of liver cancer include:
- Abdominal (stomach or belly) swelling or bloating
- Blood-tinged vomit, frequent bruising, or severe bleeding from small cuts or after activities like brushing your teeth
- Jaundice (yellowing of the skin and eyes)
- Lump, mass, or fullness under the ribs on the right side
- Nausea or vomiting
- Pain in the abdomen or near the right shoulder blade
- Sudden loss of appetite and weight loss
Cancer that spreads to the liver from elsewhere in the body (metastatic liver cancer) can cause additional symptoms, including:
Patients with known liver disease often undergo surveillance imaging (“screening”) with the intent of identifying liver cancer early when it is most likely to be curable. If you or a family member is diagnosed with liver disease, ask your primary care physician, gastroenterologist, or hepatologist about screening.
Primary liver cancer types include:
- Hepatocellular carcinoma (HCC), sometimes called hepatoma, is the most common type of primary liver cancer, arising from the liver cells themselves (hepatocytes)
- Cholangiocarcinoma (bile duct cancer) originates in the ducts (tubes) that carry bile from the liver to the gallbladder and small intestines.
- Hepatoblastoma is a rare tumor that affects infants and children, sometimes causing the release of hormones that result in early puberty. Stanford’s Lucile Packard Children’s Hospital treats this condition.
- Angiosarcoma (soft tissue sarcoma) is rarer still, and is thought to start in the liver's blood vessels.
Metastatic liver cancer can originate from any type of cancer that spreads but usually comes from cancer in the:
- Colon, rectum, or small intestines
Benign (noncancerous) liver tumors usually do not cause symptoms. Many people do not know they have a benign tumor until they have an imaging test for another condition. Types of benign liver tumors include:
- Hemangioma is a mass of abnormal blood vessels that usually does not need treatment. Sometimes, infants with large liver hemangiomas need surgery to prevent clotting and heart failure.
- Hepatocellular adenoma starts in the hepatocytes (type of liver cell) and usually does not cause symptoms. Sometimes a hepatocellular adenoma will rupture and bleed into the abdominal cavity, requiring surgery.
- Focal nodular hyperplasia is a growth with several cell types and may cause symptoms. These tumors can look like liver cancers, so doctors may remove them when the diagnosis is unclear.
Liver cancer risk factors
We don't know what causes most instances of liver cancer. However, some factors may increase your risk, including:
- Cirrhosis, a condition in which scar tissue replaces healthy liver tissue
- Chronic (long-term) liver infection from the hepatitis B virus (HBV) or hepatitis C virus (HCV), which can lead to cirrhosis
- Heavy alcohol use, which can lead to cirrhosis
- Obesity, which can contribute to fatty liver disease and cirrhosis
- Use of anabolic steroids (male hormones) to increase strength and muscle mass
- Exposure to certain rare chemicals such as:
- Aflatoxin: A chemical from a fungus that grows on foods that were stored in hot, humid places
- Arsenic: A chemical in water that comes from some wells and natural sources
- History of certain diseases such as:
- Diabetes, particularly when combined with fatty liver and/or alcohol consumption
- Alpha1-antitrypsin deficiency
- Glycogen storage diseases
- Porphyria cutanea tarda
- Wilson's disease
Liver Cancer Stages
When your care team determines your liver cancer diagnosis, they also assess what stage of cancer you have. We use the TNM staging system, which describes:
- Size of the tumor (T)
- Whether cancer has spread to nearby lymph nodes (N)
- Whether cancer has spread (metastasized) to distant lymph nodes or organs (M)
Liver cancer stages range from 1 (the earliest stage) to 4 (the most advanced stage) and include:
- Stage 1: A single mass that has not spread to any blood vessels
- Stage 2: A single mass that has invaded nearby blood vessels or multiple tumors that are less than 5 centimeters (approximately 2 inches) wide
- Stage 3 includes:
- Stage 3A: Multiple tumors with at least one larger than 5 centimeters (approximately 2 inches) and no spread to the lymph nodes or to areas outside the liver
- Stage 3B: Cancer that has spread to one of the liver's main blood vessels (the portal or hepatic vein) but not to the lymph nodes or other organs
- Stage 3C: Tumors that have spread to nearby organs (other than the gallbladder), or one tumor that extends into the liver's outer tissue layer, without spreading to the lymph nodes or distant organs
- Stage 4 includes:
- Stage 4A: A single tumor or multiple tumors that have spread into nearby lymph nodes but not distant organs
- Stage 4B: Tumors that have spread to distant organs, such as the lungs, bones, or brain, with or without invading nearby blood vessels and lymph nodes
Our doctors start by taking a thorough physical examination and learning about your medical history, lifestyle, and substances you have been exposed to. Sharing your family's medical history can also provide valuable insights.
Based on your symptoms and history, you and your doctor discuss the tests you need. We use several diagnostic methods, including:
- Computed tomography (CT) scan
- FibroScan®: Advanced ultrasound technology that helps doctors determine if you need a biopsy
- Liver disease testing
- Magnetic Resonance Imaging (MRI)
If your care team finds evidence of liver cancer, you and your doctor will discuss the right treatment plan for you. We offer a variety of treatments personalized to your specific diagnosis and needs.
We're here to help you and your family each step of the way. You can find support through our Cancer Care Services for every aspect of your care—physical, emotional, spiritual, and social.
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