Understanding Liver Cancer

Liver cancer describes several types of cancer that start in the liver or spread to it from elsewhere in the body. Important things to know:

  • Liver diseases such as chronic hepatitis or cirrhosis can greatly increase the risk of liver cancer.
  • Symptoms of liver cancer may not appear until later stages.
  • Liver cancer screening can help prevent cancer or catch it early in people with liver disease or a family history of liver cancer.
  • The earlier liver cancer is found, the better the chance for successful treatment.
     

Liver Anatomy

Medical Illustration of liver anatomy

What is liver cancer?

The liver, part of the digestive system, helps the body absorb, store and use nutrients from food. It also filters toxins, such as those in alcohol or drugs, from the blood. It renders them harmless or routes them into waste streams so they can be removed from the body.

Cancer develops when cells grow abnormally and out of control, spreading into surrounding tissue and crowding out healthy cells. Liver cancer has two major categories:

  • Primary liver cancer: This type begins in the liver.
  • Secondary (metastatic) liver cancer: This type spreads to the liver from another part of the body. In the U.S., it’s more common than primary liver cancer. Secondary liver cancers are named and treated based on where they came from. For example, pancreatic cancer that spreads (metastasizes) to the liver is called “pancreatic cancer with spread to the liver” and is treated as pancreatic cancer.

Who gets liver cancer?

Primary liver cancer is less common than other cancers. Still, the number of Americans with it more than tripled from 1975 to 2014. An estimated 42,000 people a year are diagnosed in the U.S.

Experts think the increase is tied to a rise in obesity and hepatitis C, a viral liver infection that can become chronic. Other risk factors include: 

  • Gender: Nearly three times as many men as women develop liver cancer.
  • Age: More than 83% of people with liver cancer are 55 or older at diagnosis. 
  • Race and ethnicity: Asian-Americans and Pacific Islanders have the highest rates of liver cancer. Native Americans, Native Alaskans, Latinos and African-Americans are also at higher risk. 
  • Exposure to certain substances: Certain chemicals, including arsenic and aflatoxin (a poison produced by fungi on improperly stored foods), can increase risk. 
  • Lifestyle factors: Heavy alcohol use, smoking, obesity and long-term use of anabolic steroids can increase risk. 

Liver cancer can also result from certain health conditions: 

  • Liver diseases: Risk increases in people who have chronic hepatitis (B, C or both), cirrhosis (long-term liver damage caused by hepatitis, alcohol abuse and other factors) or other liver diseases. 
  • Type 2 diabetes: People with this condition who also have chronic hepatitis and drink heavily may be more likely to develop liver cancer.
  • Metabolic syndrome: This set of conditions includes excess belly fat, high blood pressure, high blood sugar and abnormal levels of certain cholesterol types. 
  • Inherited disorders: Certain disorders caused by inherited genetic mutations can increase the risk of liver cancer. These conditions include alpha-1 antitrypsin deficiency, porphyria cutanea tarda, tyrosinemia and Wilson disease. OHSU’s medical geneticists can help you identify and manage your risk. 
     

Liver cancer outcomes

Survival rates for liver cancer largely depend on the extent of disease at diagnosis. More than half of patients with small, removable tumors and no other serious condition live at least five years after diagnosis, for example. Because liver cancer often isn’t found until after it has spread, though, overall outcomes are more discouraging.

It’s important to remember that survival rates are averages and can’t predict the outcome for any one person. They are also, by definition, based on treatments that were available five or more years ago.

Quality of life: It’s also important to know that at the OHSU Knight Cancer Institute, we are committed to giving you the best quality of life for as long as possible. If a cure isn’t possible, treatment can keep you comfortable and help you meet new goals.

Symptoms

Liver cancer often does not cause noticeable signs or symptoms in early stages. When symptoms do appear, they can vary depending on whether the cancer is primary or secondary. 

Several symptoms are similar to those of more common conditions. If you have any of these symptoms, see your doctor for an evaluation. 

Common symptoms of primary liver cancer include:

  • Abnormal bruising or bleeding
  • Enlarged belly
  • Jaundice (yellowing of the skin or eyes)
  • Pain or tenderness in the belly, especially in the upper right area
  • Unexplained weight loss

People with secondary liver cancer may have additional symptoms: 

  • Confusion
  • Fever, possibly with sweating
  • Nausea or vomiting
  • Reduced appetite
     

Screening for liver cancer

Liver cancer screening can help prevent or catch liver cancer early, when it’s most treatable. It’s not used as widely as some other cancer screenings, though, because research does not show a benefit for the general population.   

Instead, liver cancer screening is meant for people with certain risk factors. You should get screened every six to 12 months if you have:

  • Hepatitis B and Asian or African ancestry, cirrhosis of the liver, or a family history of liver cancer.
  • Hepatitis C with cirrhosis of the liver.
  • Cirrhosis of the liver caused by autoimmune disease, heavy alcohol use, nonalcoholic fatty liver disease or inherited hemochromatosis.
  • Primary biliary cholangitis, a chronic disease that causes inflammation and eventual destruction of the liver’s bile ducts (tubes that send bile from the liver to the gallbladder).

OHSU doctors screen for liver cancer with these tests:

  • Blood tests to check for alpha-fetoprotein (AFP), a substance in the blood that can indicate liver cancer.
  • Imaging tests such as ultrasound, CT (computed tomography) scans or MRI (magnetic resonance imaging) to look for signs of cancer.

Types of liver cancer

Hepatocellular carcinoma: HCC is the most common liver cancer in adults. It develops in cells called hepatocytes, which make up about 80% of the liver. The most common type of HCC in the U.S. develops as several small cancer nodules throughout the liver, usually in people with cirrhosis. HCC can also occur as a single tumor that may not spread to other parts of the liver until later stages. A very rare subtype, fibrolamellar HCC, occurs mainly in teens and young adults without a history of liver disease.

Intrahepatic cholangiocarcinoma: Also known as bile duct cancer, this liver cancer grows in cells that line the liver’s bile ducts. Doctors usually diagnose and treat bile duct cancer similarly to HCC.

Angiosarcoma and hemangiosarcoma: These rare, fast-growing cancers develop in cells lining the liver’s blood vessels.

Hepatoblastoma: This very rare type affects children, typically younger than 4. Learn more about our expert care for childhood cancer at OHSU Doernbecher Children's Hospital.

The most common types of cancer that spread to the liver include: 

Liver cancer staging

Staging measures the extent of cancer and how likely it is to grow. This analysis helps your care team recommend the best treatment. Your team will take into account:

  • Physical exam
  • Imaging tests (such as CT, MRI or ultrasound)
  • Biopsy (taking a small sample of liver tissue to look at under a microscope), and how aggressive your cancer cells look
  • Any underlying liver disease, such as cirrhosis
  • Whether cancer affects your portal vein 

This information helps doctors determine:

  • The size and extent of the primary (original) tumor.
  • Involvement of nearby lymph nodes (small, bean-shaped structures that filter infection and disease as part of the immune system).
  • Any spread of cancer to other parts of the body, such as the lungs or bones.

These stages are for HCC, the most common primary liver cancer:

Medical Illustration of Tumor Sizes compared to everyday items, including a pea, a peanut, a walnut, and a lime

Stage I

There is only one tumor, and no veins or lymph nodes are affected.

  • Stage IA: The tumor is 2 centimeters or smaller.
  • Stage IB: The tumor is larger than 2 centimeters.

Stage II

One of the following:

  • A single tumor larger than 2 centimeters has grown into blood vessels.
  • There are multiple tumors, and none is larger than 5 centimeters.
     

Stage III

  • Stage IIIA: There are multiple tumors, and at least one is larger than 5 centimeters.
  • Stage IIIB: One of the following:
    • One or more tumors of any size have grown into a major branch of a large liver vein (portal or hepatic).
    • One or more tumors have directly invaded adjacent organs (other than the gallbladder) or the membrane covering the liver and other abdominal organs (visceral peritoneum).

Stage IV

  • Stage IVA: Cancer has spread to nearby lymph nodes.
  • Stage IVB: Cancer has spread to a distant part of the body.

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