Liver cancer

Liver cancer is the 13th most common cancer in the United States, with about 42,230 new cases expected to be diagnosed in 2021. The liver is a critical organ the body cannot live without. It helps filter impurities and produces bile, which helps the body digest food and process fats. Damage to the liver from illness or disease may increase the risk of liver cancer and impact treatment options for the diseases.

At Cancer Treatment Centers of America® (CTCA), our medical oncologists, surgical oncologists, interventional radiologists and other experts have years of experience delivering the range of cancer treatments available for liver tumors. Our whole-person care model is designed to support patients throughout their treatment journey and includes supportive care services to help them manage side effects and maintain their quality of life.

The liver lives in the upper right portion of the abdomen, where it takes up considerable space beneath the diaphragm and above the stomach. In fact, it’s the largest internal organ in the human body. The liver’s main job is to clean the blood and help remove toxins and waste. It breaks down substances such as alcohol and drugs.

The liver also performs more than 500 essential tasks for the body, including:

• Metabolizing fats, carbohydrates and protein
• Storing vitamins and minerals from food
• Aiding with digestion

Liver cancer begins in the cells of the liver. Some cells may start rapidly dividing and form one or more tumors that interrupt the organ’s function.

Liver cancer is one of the most common cancers in the world and is now the fastest-growing cause of cancer death. It also occurs more frequently in men, with the disease affecting men about three times more often than women. The incidence rate of the disease is also increasing exponentially.

• Liver cancer diagnoses increased by 75 percent worldwide between 1990 and 2015.
• In the United States, the number of diagnoses has more than tripled since 1980.

The American Cancer Society estimates 42,230 new cases of liver cancer and intrahepatic bile duct cancer, which forms in the bile duct branches in the liver, will be diagnosed in the United States in 2021.

A person may be at higher risk for liver cancer if one or more of these risk factors below apply.

• Long-term hepatitis B or C infections: Hepatitis infections are the strongest risk factor for liver cancer. These viruses are spread through unprotected sex, during childbirth from a mother with hepatitis to a child, through infected needles, or from contact with infected blood.
• Cirrhosis: When the liver is damaged, normal tissue is replaced by scar tissue, called cirrhosis, preventing the liver from functioning normally. This typically occurs from heavy alcohol use.
• Hereditary hemochromatosis: This metabolic disease, passed down family lines, causes over-absorption and buildup of iron in the liver and body.
• Primary biliary cirrhosis: This autoimmune disease affects the bile ducts in the liver.
• Ethnicity and gender: Asian-Americans and Pacific Islanders have the highest rates of liver cancer in the United States. Overall, men are more often diagnosed than women.
• Other factors such as obesity and cigarette use.

Blood tests or an ultrasound may help catch cancer early, when it’s most treatable. For those with a higher risk for liver cancer, doctors may recommend regular screening.

Learn more about the risk factors for liver cancer

Symptoms of liver cancer may not be noticeable until the disease has progressed to an advanced stage.

Liver cancer symptoms may include:

• Discomfort in the upper abdomen on the right side, where the liver is located
• Abdominal swelling
• Hard lump on the right side just below the rib cage
• Back pain or pain near the right shoulder blade
• Jaundice (yellowing of the skin and whites of the eyes)
• Easy bruising or bleeding
• Fatigue
• Nausea and vomiting
• Issues with eating: Not having an appetite, feeling full after a small meal, or losing weight with no known reason
• Pale bowel movements or dark urine

Learn more about liver cancer symptoms

Liver cancer is primary or secondary. Primary liver cancer begins in the liver. Secondary liver cancer is metastatic, meaning it started somewhere else and moved into the liver. For example, lung cancer that spreads to the liver is still called lung cancer, and doctors may treat the cancer in the liver as part of a lung cancer treatment plan. In the United States, secondary liver cancer is more common than primary liver cancer.

Hepatocellular carcinoma (HCC), typically related to cirrhosis or chronic liver damage, is the most common form of primary liver cancer. The liver is mostly made up of blood vessels, and this is where cancer usually starts. This cancer may develop as one large tumor, but it’s more common for multiple small tumors to form throughout the liver.

Other types of primary liver cancer include:

Cholangiocarcinoma (bile duct cancer) forms in bile ducts inside or near the liver. About 10-20 percent of primary liver cancers are cholangiocarcinomas.

Angiosarcoma and hemangiosarcoma are rare, fast-moving cancers that affect the thin layer of cells that line blood vessel walls in the liver.

Hepatoblastoma is a childhood cancer that affects fetal liver cells.

Learn more about liver cancer types

Doctors may order tests to determine how much primary liver cancer has progressed, called the stage of cancer. MRI, PET or CT scans are imaging tests that may help find cancerous cells in the body. After doctors analyze the patient’s test results, they may determine the cancer’s stage and discuss the most appropriate treatment options to consider.

There are several types of liver cancer staging systems, and some are used more than others in different parts of the world. A patient’s care team is the best resource for understanding the stage of any particular type of cancer.

Learn more about liver cancer stages

Diagnosis of liver tumors may include:

• Biopsy
• Imaging tests, such as ultrasound, computed tomography (CT) scan, positron emission tomography/computed tomography (PET/CT) scan, or magnetic resonance imaging (MRI) 
• Laboratory tests
• Bone scan

Learn more about diagnosing liver cancer

Many treatment options are used for liver cancer, including surgery, radiation therapy and immunotherapy. The appropriate option may depend on how much liver damage has been caused by cancer or other conditions, and whether the cancer has spread elsewhere in the body, among other factors.

Treatment options for liver cancer include:

• Surgery
• Ablation
• Embolization therapy
• Radiation therapy
• Immunotherapy
• Chemotherapy
• Targeted drug therapy
• Clinical trials
• Gastroenterology procedures

Learn more about liver cancer treatments