Liver Cancer, The Cancer Information Network

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When cells in the liver become abnormal, grow out of control, and form a cancerous tumor, the disease is called primary liver cancer. Primary liver cancer is also called malignant hepatoma or hepatocellular carcinoma.

Primary liver cancer is not the same disease as cancer that spreads (metastasizes) to the liver from another part of the body (secondary liver cancer). The liver is often the site of secondary tumors that result from the spread of cancer from another organ, such as the colon or breast. When cancer spreads, the cancer cells in the secondary tumor are like those of the original cancer. This original cancer is called the primary cancer, and is named for the part of the body in which it began. When the disease spreads, it keeps the name of the primary cancer. Thus, cancer that begins in the colon or breast and spreads to the liver is called metastatic colon cancer or metastatic breast cancer.

Possible Causes of Liver Cancer

In the United States, primary liver cancer is uncommon. About 5,000 new cases are diagnosed in this country each year, accounting for less than 1/2 of 1 percent of all cancers.

In other parts of the world, however, primary liver cancer is one of the most common types of cancer and causes more deaths than any other type of cancer. Worldwide, this disease is a major health problem. Rates are highest in Asia and Africa and are believed to be related to infection with the hepatitis-B virus (HBV).

Scientists estimate that 10 to 20 percent of people infected with HBV will develop liver cancer. Infection with this virus is common in developing countries. Many infants are infected with HBV at birth because of the high rate of infection among women of childbearing age. This is an important factor because scientists feel that the longer one has been infected with the virus, the greater the likelihood of developing liver cancer. Evidence of HBV infection is also found in nearly one-fourth of Americans with liver cancer. The use of a vaccine against HBV is recommended to protect health care workers and others who are often exposed to this virus. Researchers have found that people with certain other liver diseases have a higher-than-average chance of developing primary liver cancer. For example, about 5 percent of people diagnosed as having cirrhosis of the liver (a progressive disorder that leads to scarring of the liver) eventually develop liver cancer. However, it has not been determined that cirrhosis is actually a precancerous condition; some research suggests that lifestyle factors, such as alcohol consumption and malnutrition, cause both cirrhosis and liver cancer.

Aflatoxins, a group of chemicals produced by a mold that sometimes contaminates certain foods�such as peanuts, grains, and seeds�are known carcinogens (cancer-causing agents) for liver cancer. As a precautionary measure, the U.S. Food and Drug Administration monitors the safety and quality of these foods and products that contain them. If such foods become moldy after they are purchased, they should be discarded.

Vinyl chloride, an industrial gas used mainly in the manufacture of plastics and formerly used as an aerosol propellant, has been identified as a cause of angiosarcoma, another form of liver cancer. This rare type of cancer also has been found in workers exposed to the x-ray contrast material Thorotrast (no longer in use). There also have been reports of angiosarcomas in people who have taken anabolic steroids and birth control pills, although this is a very rare occurrence.

Symptoms of Liver Cancer

Liver cancer is difficult to detect in an early stage because its first symptoms usually are vague. As with other types of cancer, this disease can cause a general feeling of poor health. Liver cancer can lead to loss of appetite, weight loss, fever, fatigue, and weakness. As the tumor grows, patients may have pain that begins in the upper abdomen on the right side and reaches into the back and shoulder. Some patients can feel a mass in the upper abdomen.

Liver cancer can also lead to abdominal swelling and a feeling of fullness or bloating. Patients may have episodes of fever and nausea. Some patients develop jaundice, a condition in which the skin and the whites of the eyes become yellow, and the urine may become dark. Symptoms such as these can be caused by primary or secondary cancer in the liver, by a benign (noncancerous) liver tumors or by other conditions. Symptoms should be reported to the doctor so a diagnosis can be made.

Diagnosis of Liver Cancer

To make a diagnosis, the doctor takes a complete medical history, does a careful physical examination, and orders certain tests.

� Special blood tests are used to see how well the liver is functioning. Blood tests can also be used to check for tumor markers, substances often found in abnormal amounts in patients with liver cancer.
� X-rays of the chest and abdomen, angiograms (x-rays of blood vessels), and CT scans (x-rays put together by computer) may all be part of the diagnostic process.
� Liver scans using radioactive materials can help identify abnormal areas in the liver.
� The diagnosis is confirmed with a biopsy. Tissue from the liver is removed (through a needle or during an operation) and checked under a microscope for the presence of cancer cells.

Treatment of Liver Cancer

Liver cancer is very difficult to control unless the tumor is found when it is very small. However, treatment can relieve symptoms and improve the quality of the patient's life.

The doctor may recommend surgery, chemotherapy (treatment with anticancer drugs), radiation therapy (treatment with high-energy rays), biological therapy (treatment using substances that help the body fight the cancer), or a combination of these treatment methods.

In addition, researchers are conducting clinical trials (treatment studies) to try to find more effective treatments and better ways to use current treatments. Participation in a clinical trial is an option for many patients with liver cancer. Information about ongoing trials is available through a National Cancer Institute (NCI) database known as PDQ. Patients and their doctors may call NCl's Cancer Information Service (CIS) at CANCER to learn more about PDQ.

Information specialists in CIS offices use PDQ and other resources to answer questions about cancer prevention, detection, diagnosis, treatment, rehabilitation, and research. In addition, the CIS staff can send free printed material and may know about cancer-related services in local areas. Spanish speaking staff members are available.