Liver cancer types

Every liver cancer patient is different. The cancer experts at Cancer Treatment Centers of America^® (CTCA) have extensive experience in staging and diagnosing the disease and developing a treatment plan tailored to each patient’s specific type of liver cancer.

Liver cancer has several types, each based on the type of cells that becomes cancerous. They include:

Hepatocellular carcinoma (HCC), also called hepatoma, is the most common type of liver cancer, accounting for approximately 75 percent of all liver cancers. HCC starts in the main type of liver cells, called hepatocellular cells. Most cases of HCC are the result of infection with hepatitis B or C, or cirrhosis of the liver caused by alcoholism.

• HCC is more common in men.
• About 42,230 U.S. adults are expected to be diagnosed with liver cancer in 2021, according to the American Society of Clinical Oncology.
• HCC is thought to account for about three-fourths of all liver cancer cases.
• Conditions that increase the risk for liver cancer include hepatitis B or C, cirrhosis (scarring in the liver) and non-alcoholic fatty liver disease. Other factors, such as heavy alcohol use, obesity, tobacco use or diabetes, may also increase risk. Certain environmental agents or genetic diseases are also risk factors.

HCC may start as a single growing tumor that possibly spreads throughout the liver at more advanced stages, or it shows up as multiple small tumors. The second type is more common and is associated with cirrhosis.

Possible treatments include:

• Surgery to remove the tumor
• Liver transplantation
• Radiation therapy
• Ablation, which uses targeted heat to destroy cancer cells

Other targeted medications or therapies are also available.

Fibrolamellar HCC is a rare type of HCC that is typically more responsive to treatment than other types of liver cancer. Fibrolamellar cancer is treated similarly to HCC.

• This cancer is most common in women younger than age 35.
• About 1 percent of all hepatocellular carcinomas are fibrolamellar HCC, according to the American Cancer Society (ACS).

Cholangiocarcinoma (bile duct cancer) occurs in the small, tube-like bile ducts within the liver that carry bile to the gallbladder. Cholangiocarcinomas account for 10-20 percent of all liver cancers. Intrahepatic bile duct cancer begins in ducts located in the liver. Extrahepatic bile duct cancer develops in ducts outside the liver.

• Risk factors include having a chronic inflammatory condition in the liver, such as primary sclerosing cholangitis (PSC), bile duct stones, cirrhosis or hepatitis B or C infection. Other rare liver diseases and inflammatory bowel disease may increase your risk as well. Heavy alcohol use, obesity and older age also are factors.
• About 8,000 patients are diagnosed with bile duct cancer each year in the United States, according to the ACS.
• The five-year survival rate for all stages of bile duct cancer starting inside the liver (intrahepatic bile duct cancers) is 9 percent, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program database. For those that start outside the liver (extrahepatic bile duct cancers), the rate is 10 percent.

Though they may not present themselves until more advanced stages, possible symptoms include:

• Jaundice (yellowing of skin and whites of eyes)
• Itching
• Fever
• Abdominal pain

Bile duct cancer is treated similarly to HCC.

Angiosarcoma, also called hemangiocarcinoma, accounts for about 1 percent of all liver cancers. Angiosarcomas begin in the blood vessels of the liver and grow quickly. They are typically diagnosed at an advanced stage.

• Risk factors include exposure to certain environmental chemicals (such as vinyl chloride, arsenic or thorium dioxide) or certain inherited diseases (such as hereditary hemochromatosis).
• About one in a million people are estimated to be diagnosed with angiosarcoma each year in the United States, according to the National Cancer Institute (NCI).

Angiosarcoma in the liver may have no symptoms or feel like a lump in the abdomen.

These cancers are typically very difficult to treat, but chemotherapy or radiation may be used to slow their progression.

Secondary liver cancer, also known as a liver metastasis, develops when primary cancer from another part of the body spreads to the liver. Secondary liver cancers are more common than primary liver cancers, according to a 2016 study published in SAGE Journals.

Most liver metastases originate from colon or colorectal cancer. More than half of patients diagnosed with colorectal cancer develop secondary liver cancer.

Cancer may also spread to the liver from the lung, breast, stomach, pancreas, kidney, esophagus or skin. The liver is one of the most common places for cancer to spread.

Symptoms vary depending on how much of the liver is affected. Possible symptoms include:

• Fatigue
• Loss of appetite
• Jaundice
• Fever
• Swelling or pain in the abdomen

Surgery, ablation or radiation therapy may be used to treat liver metastases.

Secondary liver cancer is considered part of your primary cancer. For example, if the cancer started in the lungs then spread to the liver, your secondary liver cancer would still be treated as lung cancer.

Hepatoblastoma, though rare, is the most common liver cancer in pediatric patients. It occurs in the lobes of the liver.

• About one-third of cases are associated with an inherited disorder, such as Beckwith-Wiedemann syndrome, Edward syndrome, Aicardi syndrome, Down syndrome or other genetic abnormalities.
• Hepatoblastoma has been associated with low birth weight, preeclampsia in the mother, or maternal smoking before or during pregnancy.

It’s usually diagnosed within the first three years of life. The main symptom is a large, painful abdominal mass. Blood chemistry tests or imaging methods, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, may be used to identify a hepatoblastoma.

The most common treatment path starts with neoadjuvant chemotherapy, which means chemotherapy intended to reduce, not completely get rid of, the tumor. After this, the tumor may be removed with surgery in many cases.

The survival rate is between 70 percent to 80 percent, according to F1000Research.