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Cancer Of The Liver

Alternate Names

  • hepatocellular carcinoma
  • hepatoma
  • Biliary System

Definition

Cancer of the liver occurs when cells in the liver undergo changes that make the cells grow and divide uncontrollably. This is called primary liver cancer. Cancer from other places in the body can also spread to the liver. Cancer that has spread to the liver is called liver metastasis.

What is going on in the body?

The liver is a complex vital organ that functions in producing important substances that are vital to the body. These substances include those that help the body digest foods Many important proteins such as enzymes and lipoproteins are produced in the liver.
Many blood system activities occur in the liver, such as production of clotting factors. The liver also helps filter out certain wastes and detoxifies drugs and other foreign substances. The waste products are then eliminated from the body. When the liver is affected by cancer, it can no longer serve these functions normally.
The liver will begin to fail when a significant portion is replaced by cancerous tissue. Cancer in the liver can also block the elimination of waste products. This causes the waste products to build up in the blood. If untreated, the liver will fail completely and the person will die. Primary liver cancer can spread to other parts of the body such as the lungs and bones.

Risks

What are the causes and risks of the disease?

Someone who has had hepatitis B or hepatitis C may be at higher risk for primary cancer of the liver. An individual who has had cirrhosis of the liver is at much higher risk. There may be other risk factors, such as the use of male and female hormones, for the development of this form of cancer. The relationship of those factors to liver cancer is controversial.

Prevention

What can be done to prevent the disease?

There is no known way to completely prevent primary liver cancer. It is helpful to reduce one's risk of hepatitis B risk by receiving the hepatitis B vaccine. Avoiding excessive alcohol use can prevent cirrhosis of the liver and thus, help reduce the risk of liver cancer.

Diagnosed

How is the disease diagnosed?

When a cancer of the liver is suspected, a liver biopsy is done to obtain a piece of tissue from the liver for examination in the laboratory. Specialized x-rays such as CT scans can help define the extent of the cancer in the liver. Liver function tests measure the function of the liver and help define the effect of the cancer or the liver.

Long Term Effects

What are the long-term effects of the disease?

Primary cancer of the liver is fatal within a few months of diagnosis if not effectively treated. Most primary liver cancers are discovered in an advanced stage. In the advanced stage, treatment may not be effective in slowing the growth significantly.

Other Risks

What are the risks to others?

Liver cancer is not contagious, and poses no risks to others.

Treatments

What are the treatments for the disease?

The most common therapies for liver cancer include:
  • surgery, if the cancer is small and does not affect a large part of the liver
  • liver transplant to replace the cancerous liver, if the cancerous area is very small
  • radiation therapy. Small primary inoperable liver cancers can occasionally be treated with localized radiation therapy to the tumor. Radiation can not be given to the whole liver.
  • chemotherapy, which can be used with radiation to enhance the effect of the radiation therapy. Chemotherapy alone may be used to reduce the tumor size and to relieve symptoms.
  • an injection of ethanol, which is a form of alcohol, into the liver. Ethanol damages the cancer and may achieve long-term control.

Side Effects

What are the side effects of the treatments?

Side effects varying depending on the treatment:
  • Surgery to remove small tumors requires a period of recovery.
  • Liver transplantation takes an extended recovery period.
  • Localized radiation therapy may be well tolerated. Occasionally, the person experiences nausea and fatigue.
  • Side effects of chemotherapy depend on the type of medication used. The most common side effects are increased fatigue, nausea, and mouth sores. These side effects are usually mild and can be effectively treated.
  • Injected ethanol can cause pain in the site of the cancer. Sometimes the person has a fever as a result of tissue breakdown as the cancer cells are destroyed.

After Treatment

What happens after treatment for the disease?

A person with primary liver cancer will need to be monitored closely. As the cancer progresses, comfort measures can be offered as symptoms develop.

Monitor

How is the disease monitored?

Some people with liver cancer have a high level of alpha-fetoprotein (AFP) in their blood. This substance indicates the presence of a tumor. If the person has a high level at diagnosis, the response to therapy can be followed by checking the level with sequential AFP blood tests. Specialized x-rays, such as abdominal CT scans, also help monitor the disease. Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Hepatocellular Cancer in Cancer Management: A Multidisciplinary Approach, Bower et al., PRR, 1996, pp.117-124.

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