Liver Cancer Basics
- Worldwide, liver cancer is the third most common cause of cancer-related death.
- Most liver cancers arise from hepatocytes (cells that form the liver) and are termed HCCs (hepatocellular carcinoma).
- The most common risk factor for HCC are viral hepatitis, a type of liver inflammation. Chronic alcohol use, obesity, and type 2 diabetes are also major risk factors.
- Early symptoms can be hard to detect as they are often subtle — but they can include stomach pain on the right side, a yellowing of the skin and eyes known as jaundice, itchy skin, fatigue.
This highlights the importance of understanding risk factors for the disease, as they can lead to early detection and potentially lifesaving interventions. It also shows the importance of understanding when you are at risk and when testing and monitoring are a good idea.
Read MoreWhat causes liver cancer?
Hepatocytes are the main type of cells that form the liver. Most liver cancers are termed HCCs (hepatocellular carcinoma) because they are related to problems within these cells. “It’s usually caused by chronic inflammation in the liver — it could be because of genetics or it could be because of environmental factors [which] can lead over a lifetime to develop HCC,” adds Dr Kinkhabwala.The most common risk factor for HCC is viral hepatitis, a type of liver inflammation caused by a viral infection. The most common types are hepatitis A, hepatitis B, and hepatitis C.
In the US, hepatitis C is more commonly linked to the development of liver cancer than any other type of hepatitis.
“There are other risk factors too, such as chronic alcohol use and now, an emerging public health crisis, is the development of obesity and diabetes in the population,” Dr. Kinkhabwala explains. “Which causes inflammation in the liver and over time can actually cause liver cancer. So fatty liver is now becoming much more important in the United States as one of the causes of liver cancer,”
Other risk factors include:
- Gender (HCC is much more common in men than in women)
- Race/ethnicity (In the United States, Asian Americans and Pacific Islanders have the highest rates of liver cancer, followed by Hispanics/Latinos, Native Americans, African Americans, and whites)
- Cirrhosis (a disease in which liver cells become damaged and are replaced by scar tissue)
- Heavy alcohol use
- Tobacco use
- Obesity and other “metabolic” diseases
- Type 2 diabetes
What are the signs and symptoms of liver cancer?
“Early symptoms are very difficult to appreciate because they’re very subtle,” Dr Kinkhabwala explains. “Many times, patients may not realize that they have a small cancer in the liver until it could be too late.”
Often, early liver cancer symptoms can be very vague and many other diseases can also cause the same symptoms.
The first sign there is trouble is often abdominal pain mostly in the right side close to the rib cage where the liver sits in the body.
Patients can also develop jaundice, which is yellowing of the eyes or dark urine, and which is also caused by an elevated bilirubin in the blood. Bilirubin is a yellow pigment produced when red blood cells break down. It is processed by the liver and plays a role in digestion and gives urine its yellow color .
And some patients can also develop swelling in the abdomen, which is related to liver failure.
But many times these times these symptoms don’t show up until the cancer is pretty far along.
Liver cancer symptoms are:
- Jaundice: yellowing of your skin and the whites of your eyes
- Intensely itchy skin
- White or clay-like stool (acholia)
- Dark urine (choluria)
- Fatigue
- Abdominal pain on the right side, just below the ribs
- Losing weight without trying
- Fever
- Night sweats
What are the different stages of liver cancer?
Stage 0 (Very Early)
- A single tumor 2 cm or smaller that hasn’t grown into blood vessels
- No spread outside of the liver
Stage I (Early)
- A single tumor larger than 2 cm but still within the liver
- No spread outside of the liver
Stage II (Intermediate)
- Either a single tumor larger than 2 cm that has grown into blood vessels
- Or more than one tumor, but none larger than 5 cm (about 2 inches) across (
- No spread outside of the liver
Stage III (Advanced)
- Multiple tumors larger than 5 cm across
- Or tumor(s) that have grown into nearby structures
- May involve nearby lymph nodes but no distant spread
Stage IV (End-Stage)
Cancer has spread to distant lymph nodes or distant organs like bones or lungs
The higher the stage number, the more advanced the cancer
What’s the difference between bile duct cancer and liver cancer?
“Primary liver cancer and bile duct cancer are two separate entities but they both affect the same organ.” explains Dr. Elliot Newman, chief of surgical oncology at the Northwell Health Cancer Institute at Lenox Hill Hospital in Manhattan, explains to SurvivorNet. “They are somewhat related in that they both have a relationship to the liver but they are often treated differently and the risk factors and etiologies can be different.”
Liver cancer and bile duct cancer are both cancers that affect the upper digestive system, but they originate in different locations and have some key distinctions:
- Liver cancer: This cancer starts in the liver itself, the large organ responsible for filtering blood, producing bile, and other vital functions. HCC is the most common type, arising from the main type of liver cell, the hepatocyte.
- Bile duct cancer: This cancer originates in the bile ducts, a network of tubes that carry bile, a digestive fluid produced by the liver that helps break down fats in the intestines
There are two main type of bile duct cancer:
- Intrahepatic bile duct cancer: This type starts within the smaller bile ducts located inside the liver.
- Extrahepatic bile duct cancer: This type develops in the larger bile ducts outside the liver, closer to the small intestine.
What are my treatment options?
“We kind of individualized treatment based on a few factors. Stage is definitely an important consideration in deciding the best treatment. So an earlier stage cancer may be appropriate for something like surgical resection. However, there’s other factors also such as the patient’s condition, their medical comorbidities and what their goals are in care,” explains Dr. Kinkhabwala.
Dr. Kinkhabwala goes on to say that some patients may prefer or be offered non-surgical techniques that are less likely to affect their function and allow them to live their lives normally.
Doctors may also recommend combining treatments. This could include surgery, systemic therapy (like chemotherapy), embolization (which is another treatment that radiologists perform where an angiogram is performed with a little catheter inserted into the liver and particles can be directed into the tumor to try and kill the cancer cells).
Many times physicians combine these treatments with surgery or transplantation, which gives patients a much better chance of getting success.
Immunotherapy for liver cancer
One of the most exciting advancements in cancer treatment is immunotherapy, says Dr. Kinkhabwala. This approach harnesses the power of your own immune system to fight cancer cells.
For liver cancer specifically, the latest standard of care combines immunotherapy with another powerful drug, for a two-pronged attack.
- Tecentriq (Atezolizumab): This medication acts like a brake pedal on your immune system. Normally, this “brake” is helpful to prevent the immune system from attacking healthy cells. However, cancer cells can exploit this mechanism to avoid being destroyed. Tecentriq blocks this “brake,” allowing your immune system to recognize and attack the cancer cells.
- Avastin (Bevacizumab): This drug takes a different approach by starving the tumor. Cancer cells grow by creating new blood vessels to feed themselves. Avastin blocks a protein called VEGF, which is crucial for blood vessel formation. By cutting off the tumor’s blood supply, Avastin helps to stop it from growing.
In essence, this combination therapy works in two ways: Tecentriq empowers your immune system to fight the cancer, while Avastin cuts off the fuel supply that helps the tumor grow.
Questions for your doctor?
- What type of liver cancer do I have?
- What stage is my cancer?
- What are my treatment options?
- What results can I expect from treatment?
- What side effects can I expect from treatment?
- What part of my care will be covered by insurance and how much can I expect to pay out of pocket?
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