Adult Primary Liver Cancer Treatment (PDQ®)
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General Information About Adult Primary Liver CancerKey Points:
Adult primary liver cancer is a disease in which malignant (cancer) cells form in
the tissues of the liver.
The liver is one of the largest organs in the body. It has four lobes and fills the upper right side of the abdomen inside the rib cage. Three of the many important functions of the liver are:
- To filter harmful substances from the blood so they can be passed from the body in stools and urine.
- To make bile to help digest fat that comes from food.
- To store glycogen (sugar), which the body uses for energy.
Anatomy of the liver; drawing shows the right and left front lobes of the liver, bile ducts, gallbladder, stomach, spleen, pancreas, colon, and small intestine. The two back lobes of the liver are not shown.
There are two types of adult primary liver cancer.
The two types of adult primary liver cancer are:
The most common type of adult primary liver cancer is hepatocellular carcinoma.
This summary refers to the treatment of primary liver cancer (cancer that begins in the liver). Treatment of cancer that begins in other parts of the body and spreads to the liver is not discussed in this summary.
Primary liver cancer can occur in both adults and children. However, treatment for children is different than treatment for adults. (See the PDQ summary on Childhood Liver Cancer Treatment for more information.)
Having hepatitis or cirrhosis can affect the risk of adult primary liver cancer.
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. The following are risk factors for adult primary liver cancer:
- Having hepatitis B or hepatitis C.
Having both hepatitis B and hepatitis C increases the risk even more.
- Having a close relative with both hepatitis and liver cancer.
Having cirrhosis, which can be caused by:
- Hepatitis (especially hepatitis C).
- Drinking large amounts of alcohol for many years or being an alcoholic.
- Eating foods tainted with aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts, that have not been stored properly).
- Having hemochromatosis, a condition in which the body takes up and stores more iron than it needs. The extra iron is stored in the liver, heart, and pancreas.
Signs and symptoms of adult primary liver cancer include a lump or pain on the right side.
These and other signs and symptoms may be caused by adult primary liver cancer or by other conditions. Check with your doctor if you have any of the following:
- A hard lump on the right side just below the rib cage.
Discomfort in the upper abdomen on the right side.
- A swollen abdomen.
Pain near the right shoulder blade or in the back.
- Jaundice (yellowing of the skin and whites of the eyes).
- Easy bruising or bleeding.
- Unusual tiredness.
- Nausea and vomiting.
- Loss of appetite.
- Weight loss for no known reason.
Tests that examine the liver and the blood are used to detect (find) and diagnose adult primary liver cancer.
The following tests and procedures may be used:
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
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- The stage of the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body).
- How well the liver is working.
- The patient’s general health, including whether there is cirrhosis of the liver.
Stages of Adult Primary Liver CancerKey Points:
After adult primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body.
The process used to find out if cancer has spread within the liver or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography,
computerized tomography, or computerized axial tomography.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- PET scan (positron emission tomography scan): A procedure to find malignanttumorcells in the body. A small amount of radioactiveglucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if primary liver cancer spreads to the lung, the cancer cells in the lung are actually liver cancer cells. The disease is metastatic liver cancer, not lung cancer.
The Barcelona Clinic Liver Cancer Staging System may be used to stage adult primary liver cancer.
There are several staging systems for liver cancer. The Barcelona Clinic Liver Cancer (BCLC) Staging System is widely used and is described below. This system is used to predict the patient's chance of recovery and to plan treatment, based on the following:
- Whether the cancer has spread within the liver or to other parts of the body.
- How well the liver is working.
- The general health and wellness of the patient.
- The symptoms caused by the cancer.
The BCLC staging system has five stages:
- Stage 0: Very early
- Stage A: Early
- Stage B: Intermediate
- Stage C: Advanced
- Stage D: End-stage
The following groups are used to plan treatment.
BCLC stages 0, A, and B
Treatment to cure the cancer is given for BCLC stages 0, A, and B.
BCLC stages C and D
Treatment to relieve the symptoms caused by liver cancer and improve the patient's quality of life is given for BCLC stages C and D. Treatments are not likely to cure the cancer. [Back to top]
Treatment Option OverviewKey Points:
There are different types of treatment for patients with adult primary liver cancer.
Different types of treatments are available for patients with adult primaryliver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Six types of standard treatment are used:
A partial hepatectomy(surgery to remove the part of the liver where cancer is found) may be done. A wedge of tissue, an entire lobe, or a larger portion of the liver, along with some of the healthy tissue around it is removed. The remaining liver tissue takes over the functions of the liver and may regrow.
In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.
Ablationtherapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer:
Embolization therapy is the use of substances to block or decrease the flow of blood through the hepatic artery to the tumor. When the tumor does not get the oxygen and nutrients it needs, it will not continue to grow. Embolization therapy is used for patients who cannot have surgery to remove the tumor or ablation therapy and whose tumor has not spread outside the liver.
The liver receives blood from the hepatic portal vein and the hepatic artery. Blood that comes into the liver from the hepatic portal vein usually goes to the healthy liver tissue. Blood that comes from the hepatic artery usually goes to the tumor. When the hepatic artery is blocked during embolization therapy, the healthy liver tissue continues to receive blood from the hepatic portal vein.
There are two main types of embolization therapy:
- Transarterial embolization (TAE): A small incision (cut) is made in the inner thigh and a catheter (thin, flexible tube) is inserted and threaded up into the hepatic artery. Once the catheter is in place, a substance that blocks the hepatic artery and stops blood flow to the tumor is injected.
- Transarterial chemoembolization (TACE): This procedure is like TAE except an anticancer drug is also given. The procedure can be done by attaching the anticancer drug to small beads that are injected into the hepatic artery or by injecting the anticancer drug through the catheter into the hepatic artery and then injecting the substance to block the hepatic artery. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. This type of treatment is also called chemoembolization.
Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Adult liver cancer may be treated with a targeted therapy drug that stops cells from dividing and prevents the growth of new blood vessels that tumors need to grow.
See Drugs Approved for Liver Cancer for more information.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation therapy is given in different ways:
- External radiation therapy uses a machine outside the body to send radiation toward the cancer.
- 3-D conformal radiation therapy uses a computer to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while preventing damage to normal tissue as much as possible. This type of radiation therapy is being studied in clinical trials.
- Stereotactic body radiation therapy uses special equipment to position a patient and deliver radiation directly to the tumors. The total dose of radiation is divided into smaller doses given over several days. This type of radiation therapy helps prevent damage to normal tissue. This type of radiation therapy is being studied in clinical trials.
- Proton-beam radiation therapy is a type of high-energy radiation therapy that uses streams of protons (small, positively-charged particles of matter) to kill tumor cells. This type of radiation therapy is being studied in clinical trials.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI Web site.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.[Back to top]
Treatment Options for Adult Primary Liver Cancer
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Stages 0, A, and B Adult Primary Liver Cancer
Treatment of stages 0, A, and B adult primaryliver cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 adult primary liver cancer (BCLC), stage A adult primary liver cancer (BCLC) and stage B adult primary liver cancer (BCLC). For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.[Back to top]
Stages C and D Adult Primary Liver Cancer
Treatment of stages C and D adult primaryliver cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage C adult primary liver cancer (BCLC) and stage D adult primary liver cancer (BCLC). For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.[Back to top]
To Learn More About Adult Primary Liver Cancer
For more information from the National Cancer Institute about adult primary liver cancer, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:[Back to top]
Changes to This Summary (01/13/2014)
The PDQcancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version. [Back to top]
About This PDQ Summary
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Purpose of This Summary
This PDQ cancer information summary has current information about the treatment of adult primary liver cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.[Back to top]
Reviewers and Updates
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.
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Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials are listed in PDQ and can be found online at NCI's Web site. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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Permission to Use This Summary
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The best way to cite this PDQ summary is:
National Cancer Institute: PDQ® Adult Primary Liver Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/adult-primary-liver/Patient. Accessed <MM/DD/YYYY>.
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