Liver cancer

Hepatocellular carcinoma

Hepatocellular carcinoma is a type of cancer that starts as a growth of cells in the liver. The liver is an organ that sits just under the rib cage on the right side of the belly. It is needed to help digest food, rid the body of waste products and make substances, among other tasks.

Hepatocellular carcinoma is the most common type of liver cancer. It starts in liver cells called hepatocytes. Hepatocellular carcinoma happens most often in people with chronic liver conditions, such as cirrhosis caused by hepatitis B or hepatitis C infection.

Hepatocellular carcinoma treatment may include surgery to remove the cancer or a liver transplant. Other treatments may include ablation, embolization, radiation therapy, immunotherapy and targeted therapy.

Symptoms

Hepatocellular carcinoma might not cause symptoms that are noticed right away. This liver cancer happens most often in people with liver scarring, called cirrhosis, caused by hepatitis B or hepatitis C infection. In these people, the cancer symptoms might be the same as the cirrhosis symptoms.

If signs and symptoms of hepatocellular carcinoma develop, they may include:

• Losing weight without trying.
• Loss of appetite.
• Upper abdominal pain.
• A growth in the abdomen.
• Yellowing of the skin and the whites of the eyes, known as jaundice.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

Causes

It's not always clear what causes hepatocellular carcinoma. This cancer starts as a growth of cells in the liver. Most people with this type of cancer have an ongoing liver condition, such as cirrhosis caused by hepatitis B or hepatitis C infection.

Hepatocellular carcinoma happens when cells in the liver called hepatocytes develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Risk factors

Factors that may increase the risk of hepatocellular carcinoma include:

• Older age. Hepatocellular carcinoma is more common in older adults.
• Infection with hepatitis B virus or hepatitis C virus. Ongoing or previous infection with the hepatitis B virus or hepatitis C virus increases the risk of hepatocellular carcinoma.
• Cirrhosis. Cirrhosis is a progressive and irreversible condition that causes scar tissue to form in the liver. It increases the chances of developing hepatocellular carcinoma.
• Certain inherited liver diseases. Some liver diseases that can run in families may increase the risk of hepatocellular carcinoma. Examples include hemochromatosis and Wilson's disease.
• Excess fat in the liver. Nonalcoholic fatty liver disease, also called metabolic dysfunction-associated steatotic liver disease, happens when fat builds up in the liver. People with this condition are at an increased risk of hepatocellular carcinoma.
• Diabetes. People with this blood sugar condition have a greater risk of hepatocellular carcinoma than those who don't have diabetes.
• Obesity. People with obesity have a higher risk of cirrhosis and excess fat in the liver. These conditions increase the risk of hepatocellular carcinoma.
• Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops, such as grains and nuts, can become contaminated with aflatoxins, which can end up in foods made of these products.
• Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase the risk of hepatocellular carcinoma.
• Smoking cigarettes. People who smoke cigarettes are at an increased risk of hepatocellular carcinoma.

Prevention

Reduce your risk of cirrhosis

Cirrhosis is scarring of the liver, and it increases the risk of hepatocellular carcinoma. You can reduce your risk of cirrhosis if you:

• Drink alcohol in moderation, if at all. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
• Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, ask a healthcare professional about healthy ways to lower your weight. Eat fewer calories and slowly increase the amount of exercise.

Get vaccinated against hepatitis B

Infection with the hepatitis B virus increases the risk of hepatocellular carcinoma. You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine. The vaccine can be given to almost anyone, including infants, children, adults and older adults.

Take measures to prevent hepatitis C

Infection with the hepatitis C virus increases the risk of hepatocellular carcinoma. No vaccine for hepatitis C exists, but you can reduce your risk of infection.

• Know the health status of any sexual partner. Don't engage in unprotected sex unless you're certain your partner isn't infected with hepatitis B, hepatitis C or any other sexually transmitted infection. If you don't know the health status of your partner, use a condom every time you have sexual intercourse.
• Don't use intravenous drugs, but if you do, use a clean needle. Reduce your risk of hepatitis C by not injecting legal or illegal drugs that may be sold on the streets. But if that isn't an option for you, make sure any needle you use is sterile, and don't share it. Contaminated needles are a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
• Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff members about their safety practices. If employees at a shop won't answer your questions or don't take your questions seriously, take that as a sign that the facility isn't right for you.

Seek treatment for hepatitis B or C infection

Treatments are available for hepatitis B and hepatitis C infections. Research shows that treatment can reduce the risk of hepatocellular carcinoma.

Ask about liver cancer screening

For most people, screening for liver cancer hasn't been proved to reduce the risk of dying of liver cancer, and it isn't generally recommended. People with conditions that increase the risk of liver cancer might consider screening. People with an increased risk include those who have:

• Hepatitis B infection.
• Hepatitis C infection.
• Liver cirrhosis.

Talk about the pros and cons of screening with your healthcare team. Together you can decide whether screening is right for you based on your risk. Hepatocellular carcinoma screening typically involves a blood test and an abdominal ultrasound every six months.

Diagnosis

To diagnose hepatocellular carcinoma, a healthcare professional might do a physical exam and ask questions about your health history. Other tests and procedures might include imaging tests, blood tests and removing some cells for testing.

Imaging tests

Imaging tests make pictures of the body. They can show the location and size of a hepatocellular carcinoma. Tests might include:

• Ultrasound.
• Computerized tomography scan, also called CT scan.
• Magnetic resonance imaging, also called MRI.
• Positron emission tomography scan, also called PET scan.

Blood tests

Blood tests can give your healthcare team clues about what's causing your symptoms. These tests might include tests that measure your liver function. Blood tests also can look for proteins made by cancer cells. These tests are called tumor marker tests.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. For hepatocellular carcinoma, the biopsy uses a needle to get the tissue sample. During a liver biopsy, a healthcare professional puts a needle through the skin and into the cancer. The health professional uses the needle to draw out a sample of cells from the liver.

The sample is tested in a lab to see if it is cancer. Other special tests give more details about the cancer cells. Your healthcare team uses this information to make a treatment plan.

Not everyone needs a biopsy to diagnose hepatocellular carcinoma. Sometimes healthcare teams make the diagnosis using the results of other tests.

Hepatocellular carcinoma staging

If you're diagnosed with hepatocellular carcinoma, the next step is to determine the cancer's extent, called the stage. Your healthcare team uses the cancer stage to help create your treatment plan.

The stages of hepatocellular carcinoma use the number 0 and the letters A through D. A stage 0 hepatocellular carcinoma is small and confined to the liver. As the cancer gets larger or spreads beyond the area it started in, the stages go from A to D.

Treatment

Treatment for hepatocellular carcinoma depends on the location and the extent of the cancer. Treatment also may depend on the condition of the liver. Surgery may be used to remove the cancer. In some people, a liver transplant may be an option. Other treatments may include ablation, embolization, radiation therapy, immunotherapy and targeted therapy.

Surgery

Treatment for hepatocellular carcinoma may start with surgery to remove part of the liver including the cancer or the whole liver with a transplant. Surgery options include:

• Surgery to remove the cancer. A partial hepatectomy is used for people whose cancer is in one part of the liver. This surgery removes the cancer and some healthy tissue around it. Whether this is an option for you depends on the location of your cancer within the liver, how well your liver functions and your overall health.
• Liver transplant surgery. Sometimes surgery to remove the cancer is combined with a liver transplant. A surgeon removes the cancer and all of the liver. Then the surgeon puts a healthy liver from a donor into the body. A liver transplant may be an option in otherwise healthy people whose cancer hasn't spread beyond the liver. Other treatments may be used to treat the cancer while waiting for a transplant.

Other liver procedures

Other procedures on the liver can help treat hepatocellular carcinoma. These treatments may be used in people who can't have surgery to remove the cancer. These other liver procedures for hepatocellular carcinoma include:

• Radiofrequency ablation. Radiofrequency ablation uses electric current and heat to hurt the cancer cells. During this procedure, a healthcare professional places small needles into the cancer. The needles deliver hot temperatures that hurt the cancer cells.
• Cryoablation. Cryoablation uses cold to hurt the cancer cells. During the procedure, a healthcare professional places small needles into the cancer. The needles deliver cold temperatures that hurt the cancer cells.
• Chemoembolization. Chemoembolization gives chemotherapy medicines directly to the cancer. It also uses medicine that blocks the flow of blood to the cancer. Blocking the blood flow to the cancer may cause the cancer to shrink, grow more slowly or not grow at all.
• Radioembolization. Radioembolization uses tiny beads that hold radiation. The healthcare team puts the beads into a blood vessel that goes to the liver. The beads give off radiation directly to the cancer.
• Radiation therapy. Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. The beams can target the cancer in the liver.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy may be used after surgery to kill any remaining cancer cells. For those with advanced hepatocellular carcinoma that can't be removed with surgery, immunotherapy may be an option.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Targeted therapy may be used after surgery to kill any remaining cancer cells. For those with advanced hepatocellular carcinoma that can't be removed with surgery, targeted therapy may be an option.

Palliative care

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team's goal is to improve quality of life for you and your family.

Palliative care specialists work with you, your family and your care team. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time you're getting strong cancer treatments, such as surgery, chemotherapy, immunotherapy, targeted therapy or radiation therapy.

The use of palliative care with other treatments can help people with cancer feel better and live longer.

Coping and support

With time, you'll find ways to cope with feelings that happen after a cancer diagnosis. Until then, here are some ideas for coping with hepatocellular carcinoma.

Learn enough about cancer to make decisions about your care

Ask your healthcare team about your cancer, including your test results, treatment options and, if you like, your prognosis. As you learn more about hepatocellular carcinoma, you may become more confident in making treatment decisions.

Keep friends and family close

Keeping your close relationships strong can help you deal with hepatocellular carcinoma. Friends and family can provide the practical support you may need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.

Find someone to talk with

Find someone who is willing to listen to you talk about your hopes and worries. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

Ask your healthcare team about support groups in your area. Other sources of information include the U.S. National Cancer Institute and the American Cancer Society.

Preparing for your appointment

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

If your healthcare professional thinks you might have hepatocellular carcinoma, you may be referred to a doctor who specializes in diseases of the liver, called a hepatologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down important personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements you're taking and the doses.
• Take a family member or friend along. Sometimes it can be very hard to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For hepatocellular carcinoma, some basic questions to ask include:

• Do I have hepatocellular carcinoma?
• What is the stage of my hepatocellular carcinoma?
• Has my hepatocellular carcinoma spread to other parts of my body?
• Will I need more tests?
• What are the treatment options?
• How much does each treatment increase my chances of a cure or prolong my life?
• What are the potential side effects of each treatment?
• How will each treatment affect my daily life?
• Is there one treatment option you believe is the best?
• What would you recommend to a friend or family member in my situation?
• Should I see a specialist?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

Don't hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

• When did your symptoms begin?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

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