Liver Cancer

Adult primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver. Having hepatitis or cirrhosis can affect the risk of developing adult primary liver cancer. Possible signs of adult primary liver cancer include a lump or pain on the right side. 

The prognosis and treatment options depend on  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, and alpha-fetoprotein (AFP) levels.

Our patients with liver cancer are treated at the Moores Gastrointestinal Cancer Unit. See the Gastrointestinal Cancer Unit for more information.

You can also review the tabs at top of this page for information on liver cancer symptoms and risks, diagnosis, and treatment.

Types of liver tumors

Benign liver tumors

Both benign (non-cancerous) and malignant tumors can form in the liver.

• The most common type of benign liver tumor is a hemangioma, which causes no symptoms and usually does not need treatment unless there are bleeding problems.
• Hepatic adenomas are benign tumors that may eventually cause symptoms, such as pain or a mass in the abdomen. Since these tumors carry a small risk of developing into liver cancer, your doctor may recommend surgical removal.
• Another benign growth is called a focal nodular hyperplasia (FNH). Because it is sometimes difficult to tell an FNH from a malignancy, your doctor may suggest surgical removal.

UCSD’s Liver Imaging Group is developing techniques to non-invasively diagnose benign liver tumors and reliably differentiate benign from malignant lesions, which will reduce the frequency with which benign lesions are mistaken for cancers.

Malignant liver tumors

Primary tumors are those that start in the liver. Many times, however, cancer found in the liver didn’t start there – it spread (metastasized) from somewhere else in the body. Secondary liver tumors are usually named for their site of origin, such as breast cancer or colon cancer.

Examples of primary liver tumors are:

• Hepatocellular carcinoma (HCC), which is also called hepatoma because tumors come from the hepatocyte liver cells, accounts for three out of every four cancers that start in the liver. Chronic liver damage, such as from cirrhosis or hepatitis, is a common cause of these tumors. Fortunately, the UCSD Liver Imaging Group is developing techniques to non-invasively assess chronic liver damage before it progresses to cirrhosis. In turn, this should help researchers develop therapies that prevent progression from chronic damage to cirrhosis. It is especially important to determine the extent (or stage) of HCC to determine the optimal treatment.
• Cholangiocarcinomas, which start in the small bile ducts within the liver, account for about 10 – 20% of primary liver tumors. Chronic inflammation of the bile ducts is a common cause of these tumors.
• Angiosarcomas and hemangiosarcomas are rare cancers that begin in blood vessels of the liver.
• Hepatoblastoma is a very rare liver cancer that develops in children, usually younger than four years of age. About 70% of children with this disease are treated successfully with surgery and chemotherapy.

Symptoms

• Loss of appetite and weight
• Upset stomach
• Pain or discomfort in the upper right abdomen and/or extending into the back or shoulder
• Jaundice (yellowing of the skin and whites of the eyes)
• Fatigue or general weakness

Risk factors

As with many cancers, the exact cause of liver cancer is not yet known.  However, physicians have identified several potential risk factors:

• Hepatitis B and/or hepatitis C
• A close relative with hepatitis and liver cancer
• Cirrhosis (a disease in which liver cells are damaged and replaced with scar tissue). In the U.S., the major causes of liver cirrhosis are alcohol abuse, hepatitis B and C, and fatty liver disease (an obesity-related condition). The mergence of fatty liver disease is alarming because it affects people of all ages, including children, and is now the major cause of cirrhosis in children and adolescents.
• Eating foods with afatoxin, a fungal poison that can grow in grains, soybeans and nuts not properly stored. However, this is generally not an issue in the United States.
• Metabolic diseases

Prevention tips

You can take an active role to prevent liver cancer. Limit alcohol consumption and avoid exposure to hepatitis B and C viruses. Ask your doctor about the vaccine that is available for hepatitis B. While there is no vaccine for hepatitis C, it is known that the virus can be spread by unprotected sex, dirty needles and blood transfusions. And, as always, physicians recommend a healthy diet and exercise to prevent fatty liver disease, and limited use of tobacco products.

In order to diagnosis liver cancer, your physician will take your medical history and provide a complete physical exam.  Among the tests ordered may be the following non-invasive (not surgical) procedures:

• CT scan: A series of detailed pictures of areas inside your body are taken from different angles
• Ultrasound: High-energy sound waves are bounced off internal tissues or organs, making echoes that form a picture of body tissues
• MRI scan: Using a magnet, radio waves and a computer to make a series of detailed pictures of areas inside your body.

Additional tests may include:

• Blood tests
• Diagnostic imaging
• Surgical biopsy
• Laparoscopy
• Combination of the above
• Alpha-fetoprotein blood test and ultrasound imaging of liver - the alpha-fetoprotein (AFP) blood test measures the level in the blood of a certain protein produced by the liver
• Removal of tissue for a biopsy or by laparoscopy (insertion of a small tube with an attached camera into the abdomen to survey the cancer site)

Diagnostic Imaging at UCSD

State-of-the-art diagnostic imaging is provided by UCSD’s Liver Imaging Group, which was formed by Dr. Claude Sirlin in 2004 to develop new techniques for non-invasive imaging of liver cancer and pre-cancerous liver conditions.  In collaboration with liver specialists, the group includes radiologists, physicists, computer scientists, biostatisticians and coordinators, as well as research and clinical trainees.  Since the group’s formation, its members have developed the technique of double-contrast magnetic resonance imaging to diagnose liver cancer. Two contrast agents are given to show liver tumors with high clarity, making possible the non-invasive diagnosis of small tumors not otherwise detectable.

As non-invasive diagnostic imaging techniques have become more sophisticated, they can be used to gather important information about a newly diagnosed tumor, including its exact size and density. These techniques can also be used to gauge how well a tumor will respond to treatment.

The Liver Imaging Group also operates a magnetic resonance imaging (MRI) scanner in the MR3T facility in Hillcrest, where Dr. Sirlin personally monitors all clinical and research examinations performed.

Since the risk of liver cancer is relatively low for healthy individuals, these tests are not used to screen the general population.

Stages of Primary Liver Cancer

• Stage I: One tumor and it has not spread to nearby blood vessels
• Stage II: One tumor has spread to nearby blood vessels or more than one tumor exists, none of which is larger than 5 centimeters
• Stage IIIA: Either more than one tumor larger than 5 centimeters, or one tumor that has spread to a major branch of blood vessels near the liver
• Stage IIIB: One or more tumors of any size that have either spread to nearby organs other than the gallbladder, or broken through the lining of the peritoneal cavity
• Stage IIIC: The cancer has spread to nearby lymph nodes
• Stage IV: The cancer has spread beyond the liver to other areas of the body such as the bones or lungs.  The tumors may be any size and may also have spread to nearby blood vessels and/or lymph nodes.

Your care is provided by multiple specialists at UCSD. You may receive neoadjuvant therapy, which is chemotherapy (drugs), radiation therapy -- or a combination of the two -- delivered prior to surgery, with a goal of shrinking the tumor and making surgery less radical. UCSD has every specialist to handle all treatment options available to liver cancer patients.

• Interventional radiologist Dr. Steven Rose may perform radiofrequency ablation, which destroys tumors by heating them to high temperatures
  
• Surgeon Dr. Andrew Lowy may extract a portion of your liver with a minimally invasive procedure that allows a faster recovery. Our liver surgery team is also experienced in the use of minimally invasive ablation of liver tumors.
  
• Or, if your entire liver needs to be removed, there is no one with more experience in taking livers out and putting new ones in than transplant surgeons Drs. Alan Hemming and Ajai Khanna 
  
• Each patient is different. Your treatment depends on the size and stage of your specific cancer.  Your medical team will help you decide which option is best for your unique circumstances. Treatment options may include:

Surgery

• Cryosurgery uses an instrument to freeze and destroy abnormal tissue
  
• Partial hepatectomy is removal of a small portion of tissue, an entire lobe or a larger section where cancer is found
  
• Total hepatectomy involves removal of the entire liver, followed by a liver transplant
  
• Radiofrequency ablation is a minimally invasive procedure where a needle electrode is placed in the tumor and a heated radiofrequency current is passed into the tumor.  This can be done laparoscopically or with an open operation, depending upon the size and location of the tumor
  

See additional information on liver surgery.

Chemotherapy

• Systemic chemotherapy is the administration of chemotherapeutic agents intravenously or orally to treat the cancer
  
• Regional chemotherapy involves a small pump placed in the body so that anticancer drugs can be put directly into the blood vessels feeding the tumor
  
• Transarterial chemoembolization is a method of administering anticancer drugs and a substance that blocks blood flow to the tumor
  
• Percutaneous ethanol injection is a treatment where pure alcohol is injected through the skin, into liver cancers.  Alcohol induces destruction by drawing water out of the tumor
  

Radiation therapy

• External radiation therapy uses a machine outside the body to send radiation toward the cancer
  
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters that are placed directly into or near the cancer
  
• Radiosensitizers may be given with radiation therapy to make the cancer cells more sensitive to radiation therapy
  
• Radiolabeled antibodies are another method of delivering radiation to the tumor
  
• Selective Internal Radiatin Therapy, or SIRT uses millions of microscopic radioactive spheres that are injected into the liver tumor through one of three arteries, the spheres then lodge in the tumor, where the radiation destroys the cancer and controls new growth
  

This treatment is designed for patients with advanced colorectal cancer that has spread to the liver, as well as hepatocellular carcinoma. The addition of SIR-spheres, along with chemotherapy, acts to halt the progress of the disease and offers the patient a better quality of life and increased life expectancy.

Clinical trials

We offer innovative clinical trial options for the treatment of liver cancer. Researchers are conducting trials involving metastic liver cancer and offer state of the art treatment approaches.

These aggressive treatment strategies are available for the treatment of colorectal cancer metastases to the liver. Our physicians are now treating patients who have inoperable liver cancer with a state-of-the-art internal radiation therapy that uses millions of microscopic radioactive beads to help destroy tumors from the inside out.