Liver Cancer: Frequently Asked Questions

Here are some answers to frequently asked questions about liver cancer.

Where is the liver in the body, and what does it do?

The liver is the largest solid organ in the body. It is located behind the ribs on the right side of the body, under the right lung. It is important for many metabolic functions.

Can a person live without a liver?

No. The liver stores nutrients that help feed the body when a person has not eaten for a few hours. It also changes other nutrients into more basic elements before sending them to other parts of the body to be used. The liver helps break down sugars, starch, fats, and proteins.

The liver also makes albumin, a protein that helps the body balance fluids. The liver makes clotting factors. They help blood thicken or clot when a person is bleeding. Bile made in the liver is important for digesting food and for other bodily functions.

One of the liver’s most important functions is to collect and destroy poisons in the body. The liver breaks down and removes medicines. When the liver is not working well, chemicals can build up inside the body and cause damage.

What is liver cancer?

Liver cancer is cancer that starts in the cells of the liver. It is not the same as cancers that start somewhere else in the body and then spread to the liver. Healthcare providers call those cancers liver metastases (or secondary liver cancers). 

Liver cancer is rare in the United States and Europe. It is the most common form of cancer in some African and East Asian countries, though. There are several kinds of liver cancers:

• Hepatocellular carcinoma (by far the most common type) 

• Intrahepatic cholangiocarcinoma

• Hepatoblastoma

• Angiosarcoma

Who gets liver cancer?

In 2016, the American Cancer Society estimates there will be 39,230 new cases of primary liver cancer, and 2,000 to 3,000 people will develop bile duct cancer. Men are more likely to get liver cancer than women. Liver cancer is more common in some African and East Asian countries than in North America and Europe. In some areas of Africa and Asia, it is the most common type of cancer.

What are the symptoms of liver cancer?

A person can have liver cancer for months or years before having symptoms of the disease. People do not usually show symptoms of liver cancer until the cancer grows large enough to push against other parts of the liver or against other organs in the stomach.

People with liver cancer may have any or all of these symptoms:

• Weight loss

• A sudden lack of appetite that lasts for a long time or a feeling of being very full after eating a small meal.

• Lump or mass in the upper-right side of the stomach

• Pain in the stomach

• Swollen stomach (bloating)

• Jaundice (yellowing of the eyes and skin)

• Fever

All these symptoms can be caused by many other medical problems. If you have any of these symptoms, you should see your healthcare provider as soon as possible.

How is liver cancer diagnosed?

If you think you might have liver cancer, you should have a medical exam. Many tests may be needed to confirm liver cancer. The steps to diagnosing liver cancer might include a medical history, physical exam, blood tests, imaging tests, and a liver biopsy (removing small pieces of tumor for lab tests). Imaging tests for liver cancer can include ultrasound, MRI (magnetic resonance imaging) and CT (computed tomography) scan. In some cases, the diagnosis of liver cancer can be made by MRI alone (without a liver biopsy). If the diagnosis is in doubt, however, a biopsy is performed. 

Should everyone get a second opinion for a diagnosis of liver cancer?

A: Many people with cancer get an opinion from a second healthcare provider who is a liver specialist. There are many reasons to get a second opinion. Here are some of those reasons:

• Not feeling comfortable with the treatment decision

• Being diagnosed with a rare type of cancer

• Having several treatment choices

• Not being able to see a cancer expert

Many people have a hard time deciding on a liver cancer treatment. It may help to have a second healthcare provider review the diagnosis and treatment choices before starting treatment. It is important to remember that in most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion. Most other insurance companies will pay for a second opinion if asked.

How can I get a second opinion?

A: There are many ways to get a second opinion:

• Ask a primary healthcare provider. He or she may be able to suggest a specialist who is a liver expert. This may be a hepatologist, surgeon, liver transplant surgeon, medical oncologist, interventional radiologist, or radiation oncologist. Sometimes these healthcare providers work together at cancer centers or hospitals. Never be afraid to ask for a second opinion. 

• Call the National Cancer Institute’s Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.

• Seek other choices. Check with a local medical society, a nearby hospital or medical school, or a support group to get names of healthcare providers who can give you a second opinion. Or ask other people who’ve had cancer for their recommendations. You may also call a cancer center directly to ask for an appointment. 

How is liver cancer treated?

You may have one treatment or many treatments together:

• Surgery. Surgery offers the best chance to cure liver cancer, but unfortunately only a small percentage of people can have surgery. If the cancer is small and in only one part of the liver (and the rest of the liver is healthy enough), the part of the liver containing the cancer can be removed in an operation called a hepatectomy. Another choice for some people might be to remove the entire liver and replace it with a liver transplant. 

• Tumor ablation and embolization. These techniques can be used to treat some tumors in the liver. Ablation is the use of extreme heat (such as in radiofrequency ablation, or RFA), cold (cryoablation), or other methods to destroy tumors rather than removing them. For embolization, a substance is injected into a blood vessel to try to cut off a tumor's blood supply. Sometimes this is combined with radiation (radioembolization) or chemotherapy (chemoembolization).

• Radiation therapy. Radiation therapy uses high-energy X-rays to kill cancer cells. It is used mainly when surgery or or treatments aren't likely to be good choices.

• Targeted therapy. This type of therapy uses medicines that target proteins or cell functions that help cancer cells grow. It is used mainly for advanced liver cancers that can't be treated with other methods.

• Chemotherapy. The goal of chemotherapy is to stop cancer from growing or spreading. It does this by using medicines to either kill the cells or stop them from dividing. Chemotherapy can be used to treat advanced liver cancer. It is not usually as helpful as targeted therapy. 

Healthcare providers are always finding new ways to treat liver cancer. These new methods are tested in clinical trials. Before beginning treatment, you should ask your healthcare provider if there are any clinical trials you should consider.

Q: What’s new in liver cancer research?

A: Here’s an overview of some new prevention and treatment methods being studied:

• Ways to prevent hepatitis infections that cause liver cancer

• Medicines that treat chronic hepatitis.

• New forms of targeted therapy, including medicines that can be taken in higher doses

• Local chemotherapy with beads or oil injected into or near the tumor. The goal is to have fewer side effects than systemic chemotherapy. This goes into the bloodstream and throughout the entire body.

• Radiation using radioactive beads or external beam radiation therapy. 

• Improved identification of which people with this cancer might benefit from liver transplants. Advances continue to be made in transplantation.

• Gene therapy (research only). This may improve a person’s chance of surviving liver cancer.

What are clinical trials?

Clinical trials are studies of new cancer treatments. Healthcare providers do clinical trials to learn how well new treatments will work. They also do trials to test for side effects. A promising treatment is compared to the current treatment to see if it works better or has fewer side effects.

People who participate in these studies may benefit from new treatments before the FDA approves them. Research studies also help further our understanding of cancer and help future cancer patients.