What is liver cancer?

The liver is the largest internal organ in the body. It helps to regulate and store blood glucose (sugar). It breaks down drugs and toxins and produces important proteins. The liver also produces bile, which helps eliminate waste products and process fats.

A cancer is an abnormal group of cells that grows more rapidly than normal and grows out of control.

There are two types of liver cancer: primary and secondary. Liver cancer is called primary if the tumor starts from cells of the liver. Primary tumors of the liver are rare in North and South America and Europe, accounting for only 1% to 2% of malignant tumors. The two most common forms of primary liver cancer are:

• Hepatoma, which is often associated with cirrhosis and hepatitis B infections.
• Cholangiocarcinoma, a rare tumor developing in bile duct cells.

Secondary liver cancer results when a primary cancer from another organ, such as the lungs, breasts, or digestive tract, spreads (metastasizes) to the liver. Secondary liver cancer is 20 times more common than primary liver cancer. A secondary liver tumor may not be found until it causes symptoms.

How does it occur?

Although the exact cause of liver cancer is unknown, these factors may contribute to the disease:

• Liver cancer is more common among heavy alcohol drinkers than among those who don't drink.
• Liver cancer occurs more frequently in people with hepatitis B, cirrhosis, and other chronic liver ailments, than in those without these diseases. Fifty percent to 70% of malignant liver tumors in the U.S. are associated with cirrhosis.
• This cancer is more likely to occur in men than women and in people over 40 years old.

What are the symptoms?

Symptoms of liver cancer often mimic associated liver disease:

• Pain, especially in abdominal area
• Loss of weight
• Loss of appetite
• Pain or swelling in your upper-right abdomen
• Jaundice (yellowing of the skin and whites of eyes).

How is it diagnosed?

To diagnose liver cancer, a doctor will ask about your recent symptoms and examine you. He or she will check for weight loss, malnutrition, weakness, enlargement of the liver, and other signs.

The doctor may also order the following tests:

• Blood tests for anemia and liver functions
• Alpha fetoprotein level (an antigen sometimes occurs in the blood when liver cancer is present)
• Ultrasound exam of the liver (a technique which bounces high-frequency sound waves off body organs to produce images of organs that can reveal defects or abnormalities)
• CT scan
• Hepatic artery angiogram (a process in which you are given a local anesthetic and injected with a dye like substance; a series of x-ray pictures are taken and examined for signs of any abnormal growths in the liver)
• Biopsy (a procedure in which a doctor gives you a local anesthetic in the skin, then takes a small tissue sample from the liver through the skin with a hollow needle. Next, a pathologist examines the tissue sample under a microscope to see if there are cancer cells).

How is it treated?

The doctor, usually a cancer specialist (oncologist), will determine the treatment for liver cancer based on the stage of the disease when it is diagnosed.

If the doctor detects a liver tumor (hepatoma) at an early stage, surgery may result in a complete cure if you don't have cirrhosis. Many patients with liver cancer, however, are not good surgical candidates because of large tumor size, diminished liver function, or cirrhosis.

The doctor may recommend that you have an operation to remove all or part of the tumor, take anticancer drugs (chemotherapy) to destroy cancer cells and slow the spreading, or a combination of these treatments. In chemotherapy, you often take a number of different drugs at the same time. The doctor may also suggest radiation.

While the chemotherapy or radiation may not cure the cancer, they often are very helpful in temporarily decreasing the tumors size. This helps prevent some symptoms, including pain.

Side effects or complications of radiation and/or chemotherapy include:

• Nausea
• Vomiting
• Fatigue
• Hair loss, baldness
• Lower resistance to infections
• Sunburn like rash of the skin (less common).

The more the cancer has spread before diagnosis, the less chance for cure. Survival after diagnosis is sometimes only several months but may be longer.

How long will the effects last?

The effects of liver cancer will vary depending upon the stage at which the tumor was detected and when treatment began. Your age and physical condition are important factors as well because some treatments are not recommended for the frail elderly. They may be more susceptible to infections because chemotherapy and/or radiation can lower the body's resistance to disease.

How can I take care of myself?

• Call your doctor if you have pain or fullness in your upper right abdomen that won't go away, have lost weight for no apparent reason, have no or little appetite, continually feel bloated, or develop jaundice (yellow skin and eyes).
• Take the suggested medicines for nausea and vomiting to help with possible side effects of cancer-fighting treatments.
• Complete the full course of surgery, chemotherapy, and/or radiation treatments your doctor orders.
• If possible, join a support group for cancer patients to help you during your illness.
• Maintain a hopeful and positive outlook throughout your treatment and recovery.

What can be done to help prevent liver cancer from spreading or recurring?

You may be able to reduce the likelihood of spread or recurrence of liver cancer by following these guidelines:

• Avoid use of tobacco products, such as cigarettes, pipes, cigars, and chewing tobacco.
• See your doctor immediately if you notice a return of any previous symptoms or develop any new ones.
• Avoid alcoholic beverages.
• Eat small, frequent, well-balanced meals throughout the day. Avoid salt. Salt substitutes may be acceptable; check with your doctor. Take vitamin and mineral supplements with iron, folic acid, and thiamine, if recommended by your doctor.
• Be sure that restaurants and grocery stores where you buy food and areas where you prepare food are safe and clean.