Liver Cancer

A risk factor is something that increases the possibility of developing a disease. Certain conditions or behaviors can increase a person’s chances of developing liver cancer. Having cirrhosis is a risk factor for developing hepatocellular carcinoma (primary liver cancer). Cirrhosis is severe scarring of the liver due to a progression of damage to the liver, usually over many years. People often think that overuse of alcohol is the only way that cirrhosis can occur. In fact, drinking alcohol in excess is only one way in which a person can get cirrhosis.

Long-term (chronic) hepatitis B and hepatitis C infections are linked to liver cancer because they often lead to cirrhosis if they are undiagnosed and/or untreated. Hepatitis B is an exception to the norm in that it can lead to liver cancer without first causing cirrhosis in the progression of liver damage.

People with fatty liver may over time develop complications including cirrhosis, thereby putting them at risk for liver cancer. Certain conditions increase one’s chances of having fatty liver, including obesity, type 2 diabetes, high cholesterol, and high triglycerides.

People with certain hereditary and/or rare diseases may be prone to developing liver cancer. These include:

• Wilson Disease
• Alpha-1 antitrypsin deficiency
• Hemochromatosis
• Glycogen storage disease
• Advanced PBC
• Porphyria cutanea tarda
• Tyrosinemia

Environmental exposure to aflatoxins (poisonous cancer-causing agents produced by molds that grow in soil, decaying vegetation, hay, and grains) may lead to liver cancer.

Finally, long-term use of anabolic steroids has been linked to the development of liver cancer in some people.

People with any risk factor, or those who have been diagnosed with cirrhosis, should speak with their doctors about cancer screening and surveillance so that should cancer develop, it may be diagnosed sooner rather than later.

Understanding the risk factors for liver cancer is a big step in reducing your chances of getting liver cancer.

If you have a known liver disease, it is important to make and keep regular appointments with a medical provider who specializes in this field. Liver specialists are called gastroenterologists or hepatologists. You can still go to your primary care provider for your overall care and see the specialist for your liver care. If you are diagnosed with liver cancer, you will be referred to a liver cancer specialist. This type of specialist is called an oncologist.

Key steps you can take to keep your risk for liver cancer low include:

• Preventing exposure to hepatitis B (through blood and body fluids) and speaking to your doctor about getting the hepatitis B vaccine
• Preventing exposure to hepatitis C (through blood) from other people who may be infected (there is no vaccine for hepatitis C, but there is a treatment for people who are infected)
• Getting tested for hepatitis B and C if you may have been exposed
• Getting treatment for hepatitis B and/or C if you are infected
• Discussing your liver cancer risk with your doctor if you have other risks such as obesity, type 2 diabetes, high cholesterol, or if you drink heavily

Remember—people with cirrhosis should speak to their doctors about recommendations for regular surveillance and screenings for liver cancer. This can help detect cancer before symptoms start and the cancer becomes advanced.

People may not feel ill in the earliest stages of liver cancer, which is why it is very important to understand your risks and to talk to your doctor about liver cancer before you experience symptoms.

Once symptoms occur, they can include:

• Fatigue
• Bloating or feelings of fullness
• Pain on the right side of the upper abdomen or back and shoulder
• Nausea
• Loss of appetite
• Weight loss
• Weakness
• Fever
• Jaundice (yellowing of the skin and the whites of the eyes)

Liver cancer is diagnosed through a physical examination and special medical tests. Diagnosis may include ultrasounds, CT scans, and MRI. Sometimes doctors may perform a liver biopsy, a procedure in which a small piece of liver tissue is removed and studied to confirm the diagnosis of liver cancer. Doctors may often do genetic testing of the cancer to help determine the best type of treatment for the patient.

Liver cancer treatment depends on:

• The liver’s condition and the extent of cirrhosis
• The size, location, and number of tumors
• Whether the cancer has spread outside the liver or has remained within the liver
• The overall health of the patient and other risk factors for liver cancer

If the cancer has not spread and the rest of the liver is healthy, treatment options may include:

• Transplant (replacement of the liver)
• Partial hepatectomy or segmentectomy (surgery to remove a part of the liver or to remove a tumor from the liver)
• Radiofrequency ablation (inserting a thin probe through the skin and into the tumor to heat and destroy the cancer cells)

Sometimes the cancer may be contained within the liver but is not responsive to the above treatments. If this is the case, other treatments may include:

• Bland embolization, chemoembolization, or radioembolization of the blood vessels near the tumor (procedures to block the blood supply to the tumor, either with or without the use of anti-cancer medications)
• Radiation therapy (high-energy x-rays) to destroy cancer cells.

If the cancer has spread outside of the liver, or if it is still within the liver but not responsive to any of the above treatments, doctors may recommend some of the following treatments (either separately or in combination):

• Oral (by mouth) anti-cancer medications
• Immunotherapy (a type of treatment that helps your immune system fight cancer)
• Clinical trials (scientific studies to test new medications not yet available to the public

A successful liver transplant, also called a surgical resection, can cure liver cancer, but it is an option for only a small percentage of patients. Surgical resections are successful in only about one out of three cases. However, scientists are experimenting with several promising new treatments that could help prolong the lives of people with liver cancer.

ALF Patient Advocate Susan Ventura sat down with ALF National Medical Advisory Committee member Dr. Catherine Frenette, hepatologist at Scripps MD Anderson Center in San Diego to ask her our most frequently asked questions about cirrhosis and liver cancer. Make sure to watch this important, informative interview!

Learn more about rare forms of liver cancer, including cholangiocarcinoma, fibrolamellar carcinoma, hepatoblastoma, and angiosarcoma.

Clinical trials are research studies that test how well new medical approaches work in people. Before an experimental treatment can be tested on human subjects in a clinical trial, it must have shown benefit in laboratory testing or animal research studies. The most promising treatments are then moved into clinical trials, with the goal of identifying new ways to safely and effectively prevent, screen for, diagnose, or treat a disease.

Speak with your doctor about the ongoing progress and results of these trials to get the most up-to-date information on new treatments. Participating in a clinical trial is a great way to contribute to curing, preventing and treating liver disease and its complications.

Start your search here to find clinical trials that need people like you.