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Liver Cancer

Cancer that starts in your liver is called liver cancer, or primary liver cancer.  Most liver cancer starts in another organ and then spreads to the liver, also called secondary liver cancer

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Research and clinical trials at UC Health and around the world have changed the way we treat cancer. With more treatment options and better survival rates than ever before, we offer hope in the face of cancer. At UC Health, we provide options to successfully treat liver cancer.

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A diagnosis of liver disease can feel overwhelming. We understand what you’re experiencing and are here to support you and your family every step of the way. Our experienced team includes experts on everything from your surgery to your medication to your emotional well-being.

To schedule an appointment, please call the Liver Transplant team at 513-584-9999.

We focus the expertise of the region’s most advanced gastrointestinal cancer team on delivering only the best results. Our nationally recognized cancer subspecialists offer you access to standard therapies as well as the latest treatments and leading-edge clinical trials.

To schedule an appointment, please call the UC Gastrointestinal Cancer team at 513-584-8900.

About This Condition

Understanding Liver Cancer

The liver is a large, pyramid-shaped organ that lies behind the ribs on the right side of the body. It’s under the right lung. It is divided into right and left lobes.

The liver helps break down nutrients. These include sugars, starch, fats, and proteins. It also stores some of these. The liver also makes proteins, such as albumin. This helps the body balance fluids. It also makes clotting factors, which 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 jobs is to filter out and destroy toxins in the body. When the liver isn’t working well, chemicals can build up inside the body and cause damage.

What types of cancer start in the liver?

The main types of primary liver cancer include:

  • Hepatocellular carcinoma. This is the most common liver cancer. It’s also called hepatoma. About four out of every five primary liver cancers are of this type. This type of cancer starts in the main liver cells called hepatocytes.
  • Intrahepatic cholangiocarcinoma. About 10–20% of all liver cancers are cholangiocarcinomas. These cancers start in the bile ducts. These are small tubes where bile leaves the liver and goes into the gallbladder and intestines during digestion. This type of cancer can also start in the bile ducts outside the liver.

  • Hepatoblastoma. This is a rare liver cancer often found in children.

  • Angiosarcoma. This is another uncommon form of liver cancer. It starts in blood vessels inside the liver.

Several types of non-cancerous (benign) tumors can also form in the liver. These include hemangiomas, hepatic adenomas, and focal nodular hyperplasia. These tumors don’t spread to other parts of the body. But they can still cause problems if they grow large enough.

Liver Cancer: Symptoms

Liver cancer often does not cause symptoms in its early stages. In fact, many liver cancers do not cause symptoms until they have grown fairly large.

People with liver cancer may have these symptoms.

  • Weight loss. Losing weight without trying may be a sign of liver cancer.
  • Change in eating habits. A sudden loss of appetite that lasts for a long time may be a sign of liver cancer. A feeling of being very full even after very small meals may also be a symptom.
  • Nausea or vomiting
  • A lump or mass in the upper-right side of your abdomen. Your liver might become enlarged. This can often be felt as a lump or mass under your right ribs.
  • Belly pain. Constant pain in the upper-right side of your stomach area may be a sign of liver cancer. Some people might also have pain in the area of the right shoulder blade.
  • Abdominal swelling. This can be caused by fluid building up in your abdomen. This is called ascites. Some people may have enlarged veins on the belly as well.
  • Jaundice or persistent itching. Yellowing of the whites of your eyes and skin (jaundice) is caused by the buildup of too much bilirubin. This is a chemical made by the liver. This can also cause severe itching.
  • Fever
  • Bleeding and bruising. Liver cancer can cause frequent bruising and severe bleeding. This bleeding can come from small cuts or even after activities, such as brushing your teeth.

When to see your healthcare provider

Many of these symptoms can be caused by other health problems. But it is important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have liver cancer.

Liver Cancer: Newly Diagnosed

Being told you have liver cancer can be scary, and you may have many questions. But you have people on your healthcare team to help.

Coping with fear

It’s normal to feel afraid. Learning about your cancer and about the treatment options you have can make you feel less afraid. This also helps you work with your health care team and make the best choices for your treatment. You can also ask to speak with a counselor.

Working with your healthcare team

You’ll likely have different types of doctors on your healthcare team. These might include:

  • Gastroenterologist. This is a doctor who specializes in treating diseases of the digestive system, including the liver.
  • Surgical oncologist (oncologic surgeon). This is a doctor who uses surgery to treat cancer.
  • Medical oncologist. This is a doctor who specializes in treating cancer with medicines, such as chemotherapy.
  • Radiation oncologist. This is a doctor who specializes in treating cancer with radiation.

Many other healthcare providers will be part of your team as well. They will answer any questions you may have. They’ll help you through each of the steps you’ll take before, during, and after treatment. Your team will let you know what tests you need and the results of those tests. They’ll guide you in making treatment decisions and help prepare you and your loved ones for what’s ahead.

Learning about treatment options

To decide the best course of treatment for you, your healthcare team needs to know as much as they can about your cancer. This may involve getting some tests and working with more than one healthcare provider. And you may decide that you want to get a second opinion to help you choose a treatment.

Getting support

Coping with cancer can be very stressful. Talk with your healthcare team about seeing a counselor. They can refer you to someone who can help. You can also join support groups to talk with other people coping with liver cancer. Ask your healthcare team about local or online support groups.

Liver Cancer: Stages

What does the stage of cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The TMN system for liver cancer

Several systems can be used to divide liver cancer into stages. Doctors in different parts of the world might use different systems. In the U.S., the most commonly used system to stage liver cancer is the TNM system from the American Joint Committee on Cancer. Be sure to ask your healthcare provider to explain the stage of your cancer in a way you can understand.

The first step in staging is to find the value for each part of the TMN system. Here's what the letters stand for:

Here is what the letters mean in the TNM system:

  • T describes the size of the main (primary) tumor and how far it has spread inside the liver and nearby areas.
  • N says whether the cancer has reached the nearby lymph nodes.
  • M says whether the cancer has spread (metastasized) to other organs in the body, such as the lungs or bones.

Numbers or letters after T, N, and M provider more details about each of these factors. There are also 2 other values that can be assigned:

  • X means the provider does not have enough information to assess the extent of the main tumor (TX), or if the lymph nodes can cancer cells in them (NX).
  • O means no sign of cancer, such as no sign of the primary tumor in the liver (TO).

Once your doctor knows your T, N, and M status, he or she uses this information to assign the cancer an overall stage grouping. Stage groupings are determined by combining the T, N, and M values from the TNM system. These groupings give an overall description of your cancer.

A stage grouping can have a value of 1 to 4 and are written as Roman numerals, I, II, III, and IV. The higher the number, the more advanced the cancer. Letters and numbers can be used after the Roman numeral to give more details.

What are the stages of liver cancer?

These are the stage groupings of liver cancer and what they mean:

  • Stage I. The cancer has not spread to lymph nodes or to organs in other parts of the body. This stage is divided into 2 sub-groups:

    • Stage IA. There is only 1 tumor in the liver. It's 2 cm or less across and has not grown into any blood vessels.

    • Stage IB. There is only 1 tumor in the liver that's more than 2 cm across and has not grown into any blood vessels. It has not spread to lymph nodes or other parts of the body.

  • Stage II. Either there is only 1 tumor in the liver that's more than 2 cm across and has not grown into any blood vessels. Or, there's more than 1 tumor, but 1 of them is more than 5 cm across. There is no spread to lymph nodes or to organs in other parts of the body.

  • Stage III. The cancer has not spread to lymph nodes or to organs in other parts of the body. This stage is divided into 2 sub-groups.

    • Stage IIIA. There are many tumors in the liver and at least 1 is more than 5 cm across.

    • Stage IIIB. The cancer is growing into a branch of one of the main blood vessels in the liver (the portal or hepatic veins).

  • Stage IV. This stage is divided into 2 sub-groups.

    • Stage IVA. Tumors can be of any size, and the cancer has spread into lymph nodes near the liver. The cancer has not spread to organs in other parts of the body.

    • Stage IVB. The cancer has spread to distant organs, such as the lungs or bones. It may or may not have spread to nearby lymph nodes. The tumor or tumors can be any size.

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Your doctor will look at other factors, too. For example, before doing surgery to remove the tumor, your doctor will want to know how the rest of your liver is working. He or she will want to be sure that there would be enough healthy liver remaining after surgery. Make sure to ask any questions or talk about your concerns.

Liver Cancer: Treatment Questions

Talking with healthcare providers about your liver cancer can be overwhelming. It can be hard to take in all of the information. It helps to be prepared. Make a list of questions and bring them to your appointments. Write the answers down in a notebook. Make sure you ask how the treatment might change your daily life, including your diet, and how you will look and feel after treatment. Ask how successful the treatment is expected to be, and what the risks and possible side effects are. You may also want to ask a friend or family member to go with you. He or she can take notes and write down the answers, and also ask questions you may not think of. You can also ask your health care provider if you can record the conversation.

Below are some questions to ask during your checkups. Not all of these might apply to your situation. But asking the questions that do apply can help you get a better idea of what to expect.

Deciding on a treatment

  • Do I need any more tests before we decide on treatment?
  • What is the stage (extent) of my cancer? How does this affect my treatment options?
  • How well is the rest of my liver working?
  • What are my treatment options?
  • What treatment do you think is best for me? Why?
  • What are the goals of treatment?
  • What is the success rate of this treatment for my type and stage of cancer?
  • What is the average life expectancy for someone with my stage of cancer getting this treatment?
  • How much experience do you have treating cancers like mine?
  • Should I get a second opinion?
  • Are there any clinical trials I should look into?

Getting ready for treatment

  • How soon do I need to start treatment?
  • How long will each treatment take?
  • Where do I have to go for treatment?
  • Who will give me the treatment?
  • Does someone need to go with me during treatments?
  • Can I take my other medicines during treatment
  • How long will I be in treatment?

Coping during treatment

  • How will I feel during and after the treatment?
  • Will I be able to go to work and be around my family during treatment?
  • What side effects can I expect?
  • How long are the side effects likely to last?
  • Will treatment affect how active I can be?
  • Will there be side effects I need to call you about?
  • What can I do to ease the side effects?
  • Should I change my diet? What foods can’t I eat?
  • Are there support groups nearby that I can join?

After treatment

  • How will I feel after the treatment?
  • What type of follow-up will I need after treatment
  • How will we know if treatment worked?
  • What are my options if the treatment doesn't work or if the cancer comes back?

Making a decision

When you have answers from your healthcare provider, it’s time to think about your preferences. Think about what side effects you can and can’t tolerate. Talk about your concerns with your healthcare provider before making a decision about treatment.

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