Frequently Asked Questions About Liver Cancer
Q. What is liver cancer?
A. The liver is the largest internal organ of the body. It is located on the right side of the abdomen, beneath the right lung, and is protected by the lower ribcage. The liver performs many functions that are necessary for survival. Several types of tumors, both benign (non-cancerous) and malignant (cancerous) can develop in the liver. The most common type of liver cancer is hepatocellular carcinoma (HCC). It accounts for 84 percent of primary liver cancers (cancer that originates in the liver). The liver can also develop metastatic or secondary tumors. These tumors have spread from cancer in another part of the body, like the breast, colon or pancreas. This is not called "liver cancer"; it is instead named for the part of the body where the cancer originated (e.g., metastatic breast cancer). In the United States, metastatic liver tumors are more common than primary liver cancer.
Q. What are the causes and risk factors for liver cancer?
A. It is difficult to discover what causes cancer from one person to another, but researchers have found several factors that increase a person’s likelihood of developing liver cancer. Some risk factors for liver cancer include:
- Viral hepatitis – Researchers have linked the infection of hepatitis-B virus (HBV) and hepatitis-C virus (HCV) with the development of liver cancer. It is estimated that 10-20 percent of people with HBV will develop liver cancer, and HBV is present in about one fourth of cases of liver cancer in the United States.
- Exposure to aflatoxin – This is a carcinogenic (cancer-causing) substance that can be found in molds that may contaminate peanuts, corn, grains and seeds. In tropical and subtropical regions, measures have been taken to change and improve storage in order to reduce exposure to aflatoxins.
- Cirrhosis – The National Cancer Institute estimates that 5-10 percent of people with cirrhosis (a progressive disorder that leads to scarring of the liver) will develop liver cancer. Cirrhosis caused by viral hepatitis B and C, alcohol abuse and certain genetic disorders puts people at higher risk for developing liver cancer.
- Exposure to vinyl chloride and thorium dioxide (Thorotrast) – Exposure to these chemicals is more likely to cause angiosarcoma of the liver, a different type of cancer than HCC. They increase the risk of developing HCC to a far lesser degree.
- Birth control pills – Types of oral contraceptives used in the past were linked to some varieties of liver cancer, but rarely to HCC. Most of these types of oral contraceptives are no longer available, and it is unknown if those now in use increase risk for HCC.
- Anabolic steroids – Long-term steroid use can slightly increase the risk for liver cancer.
- Arsenic – In some parts of the world, drinking water contaminated with arsenic causes increased risk for developing liver cancer.
Q. What are the symptoms for liver cancer?
A. These symptoms might be caused by liver cancer:
- Unexplained weight loss
- Anorexia (persistent lack of appetite)
- Early satiety (feeling very full after a small meal)
- Persistent abdominal pain
- Increasing abdominal girth (swelling of the "stomach" area) with or without breathing difficulty
- Sudden jaundice (yellow-green coloration of the skin and eyes) with no apparent reason
- Dramatic change in the overall condition of a patient with chronic hepatitis or cirrhosis
- Liver enlargement or a mass that can be felt in the area of the liver
Most of these symptoms are non-specific and may be caused by other cancers or less serious conditions. The only way to find out is to receive a medical evaluation. The sooner the symptoms are diagnosed, the sooner appropriate treatments can begin and the more effective treatment is likely to be.
Q. How will my doctor know if I have liver cancer?
A. If liver cancer is suspected, the doctor will conduct a physical examination and a medical history. During a medical history, the patient will be asked questions about incidence of cancer in his/her family and other possible risk factors. Further tests help a doctor determine if cancer is causing symptoms. Some tests may include alpha-fetoprotein (AFP) blood test, ultrasonography (ultrasound), computed tomography (CT), magnetic resonance imaging (MRI), angiography, laparoscopy and biopsy.
Q. What about treatment? What should I ask?
A. Three kinds of treatment are used to treat liver cancer:
- Surgery – taking out the cancer in an operation
- Chemotherapy – using antidrugs to kill cancer cells
- Radiation therapy – aiming high-energy rays at the cancer to destroy it
A doctor will usually combine methods to treat the cancer most effectively. These are some questions a person may want to ask his/her doctor before treatment begins:
- What is my diagnosis?
- What is the stage of the disease?
- What are my treatment choices? Which do you recommend for me? Why?
- What are the chances that the treatment will be successful?
- Would a clinical trial be appropriate for me?
- What are the risks and possible side effects of each treatment?
- How long will my treatment last?
- Will I have to change my normal activities?
- What is the treatment likely to cost?
Q. What are the side effects of treatment?
A. It is hard to limit the effects of therapy so that only cancer cells are destroyed. Because treatment often damages healthy cells and tissues, it can cause unpleasant side effects. The side effects of cancer treatment vary, depending on the type of treatment. Also, each patient reacts differently.
The side effects of surgery depend on the extent of the operation, the patient's general health and other factors. Pain for the first few days after surgery is to be expected, but it can be controlled with medicine. People should feel free to discuss pain relief with the doctor or nurse.
Because it affects the whole body, chemotherapy is useful for treating liver metastases from other tumors. Chemotherapy damages rapidly dividing cells, like cancer cells. Unfortunately, other cells in the body, like hair follicle cells, cells lining the digestive tract, and blood-producing cells of bone marrow are also affected by chemotherapy, causing hair loss, nausea and vomiting, mouth sores, bruising and bleeding, increased chance of infection, and fatigue. Doctors can alleviate some of these symptoms with medication, so patients with side effects should inform their cancer care team. Recently, hepatic artery infusion has been studied as a treatment for HCC. This is a type of regional chemotherapy in which drugs are injected directly into the artery that supplies blood to the liver.
Radiation therapy is not often used because the entire liver, not just the tumor, is negatively affected by the radiation, and no real effect on survival has been shown.
Q. Will I be able to adjust to this disease well?
A. Each cancer patient’s experience is different, and a person’s adjustment to cancer treatment depends on a number of factors. With liver cancer, treatment is sometimes aimed at improving the quality of life of the patient rather than curing the cancer. So even if the cancer is incurable, patients can still maintain a fair quality of life for as long as possible.
It is important for people to seek support during and after cancer treatment. Taking advantage of a social support system, such as a cancer support group, helps patients by providing a forum of information and experiences. Maintain an open dialogue with your cancer care team to address any concerns you have.