Overview

What is liver cancer? An expert explains

Learn more from liver surgeon Sean Cleary, M.D.

Hello. I'm Dr. Sean Cleary, a liver surgeon at Mayo Clinic. In this video, we'll cover the basics of liver cancer: What is it? Who gets it? What are the symptoms, diagnosis and treatment? Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. First, before we get into liver cancer, let's talk about what your liver actually does. Your liver is a football-sized organ that sits under the right portion of your abdomen, beneath your diaphragm and beside your stomach. The liver has over 500 known functions. But the most common way the liver works is by: Balancing the chemicals in your blood. Making bile, which is a crucial part of the digestive process. Clearing toxins from the blood and regulating blood clotting. Each year, about 24,500 men and 10,000 women are diagnosed with liver cancer in the United States. Most people who have cancer in the liver have cancer that spreads, or metastasizes, to the liver from another site, such as the colon, breast, stomach or other organs. It is important to differentiate this type of cancer from liver cancer that begins in the liver cells. The treatment of cancer that spreads to the liver, rather than starting in the liver, is determined by the original organ in the body where the cancer started. So for example, if the cancer started in your colon and then spread to the liver, it would be called metastatic colon cancer. Today we'll be focusing on liver cancer that starts in the liver. As with all cancers, liver cancer start when changes or mutations accumulate in the DNA of those liver cells. The cells DNA is the material that provides instructions for every chemical and structural process in your body. DNA mutations cause changes in these instructions. And when enough of these mutations accumulate and affect important genes the cells can begin to grow out of control and eventually form a tumor or a mass of cancerous cells.

Most liver cancers occur in people with an underlying liver disease. But sometimes liver cancer happens in people with no underlying liver disease and it's not exactly clear why. Liver disease can cause longstanding inflammation in the liver and accumulate mutations that can lead to cancer. One of the big problems is that many people can have liver disease and not be aware of it until their liver is quite damaged or a cancer forms. Here are some things that we know increase your risk of developing liver cancer: If you have chronic infections of hepatitis B or C, cirrhosis, certain inherited liver diseases such as hemochromatosis and Wilson's disease, diabetes, non-alcoholic fatty liver disease, or an exposure to aflatoxins, you have a greater chance of developing liver cancer. Excessive alcohol consumption over many years can also lead to irreversible liver damage and lead to liver cancer.

Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include unintentional weight loss, loss of appetite, upper abdominal pain, nausea and vomiting, general weakness and fatigue, abdominal swelling, jaundice where your eyes and skin turn yellow, and white, chalky stools. Other symptoms can include fever, enlarged veins on the abdomen that can be seen through the skin, and abnormal bruising or bleeding. Screening programs using ultrasound are very effective at finding liver cancer before symptoms develop. And we encourage everyone with known liver problems to talk to their doctor about whether screening is right for you.

Tests and procedures used to diagnose liver cancer include blood tests. These may reveal liver function abnormalities. Imaging tests such as an ultrasound, CT, and MRI. And if you are diagnosed, the next step is determining the extent of liver cancer, or stage. Your doctor will then ask for staging tests to help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CT scans, MRI, and bone scans. There are different methods of staging liver cancer. For example, one method uses Roman numerals one through four, and another uses letters A through D. Your doctor evaluates your cancer stage to determine your treatment options and your prognosis.

There are a number of ways your doctor can help you develop a strategy to combat liver cancer. Surgery may be scheduled to remove the tumor or remove the entire liver to perform a liver transplant. Your treatment may include radiation therapy, which uses high-powered energy from sources such as X-rays and protons, to destroy cancer cells and shrink tumors. Doctors carefully direct the energy to liver while sparing the healthy surrounding tissue. Chemotherapy is a common treatment and is the use of powerful chemicals to combat and hopefully kill the cancer. Targeted drug therapy focuses on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

Liver cancer is a frightening diagnosis, but finding a team of experts to work together can help you sort out your best options for treatment using the latest technology, most advanced research and specialized care techniques. With new therapies worked on every day. We have lots of hope for positive outcomes. If you'd like to learn even more about liver cancer, here are related videos, or visit mayoclinic.org. We wish you well.

Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.

Several types of cancer can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.

Cancer that spreads to the liver is more common than cancer that begins in the liver cells. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer. This type of cancer is named after the organ in which it began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver.

Types

Symptoms

Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

  • Losing weight without trying
  • Loss of appetite
  • Upper abdominal pain
  • Nausea and vomiting
  • General weakness and fatigue
  • Abdominal swelling
  • Yellow discoloration of your skin and the whites of your eyes (jaundice)
  • White, chalky stools

When to see a doctor

Make an appointment with your doctor if you experience any signs or symptoms that worry you.

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Causes

Liver cancer happens when liver cells develop changes (mutations) in their DNA. A cell's DNA is the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.

Sometimes the cause of liver cancer is known, such as with chronic hepatitis infections. But sometimes liver cancer happens in people with no underlying diseases and it's not clear what causes it.

Risk factors

Factors that increase the risk of primary liver cancer include:

  • Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
  • Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.
  • Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson's disease.
  • Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than those who don't have diabetes.
  • Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.
  • Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops, such as grains and nuts, can become contaminated with aflatoxins, which can end up in foods made of these products.
  • Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase your risk of liver cancer.

Prevention

Reduce your risk of cirrhosis

Cirrhosis is scarring of the liver, and it increases the risk of liver cancer. You can reduce your risk of cirrhosis if you:

  • Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For women, this means no more than one drink a day. For men, this means no more than two drinks a day.
  • Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising most days of the week. If you need to lose weight, reduce the number of calories you eat each day and increase the amount of exercise you do. Aim to lose weight slowly — 1 or 2 pounds (0.5 to 1 kilograms) each week.

Get vaccinated against hepatitis B

You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine. The vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.

Take measures to prevent hepatitis C

No vaccine for hepatitis C exists, but you can reduce your risk of infection.

  • Know the health status of any sexual partner. Don't engage in unprotected sex unless you're certain your partner isn't infected with HBV, HCV or any other sexually transmitted infection. If you don't know the health status of your partner, use a condom every time you have sexual intercourse.
  • Don't use intravenous (IV) drugs, but if you do, use a clean needle. Reduce your risk of HCV by not injecting illegal drugs. But if that isn't an option for you, make sure any needle you use is sterile, and don't share it. Contaminated drug paraphernalia is a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
  • Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff members about their safety practices. If employees at a shop refuse to answer your questions or don't take your questions seriously, take that as a sign that the facility isn't right for you.

Seek treatment for hepatitis B or C infection

Treatments are available for hepatitis B and hepatitis C infections. Research shows that treatment can reduce the risk of liver cancer.

Ask your doctor about liver cancer screening

For the general population, screening for liver cancer hasn't been proved to reduce the risk of dying of liver cancer, and it isn't generally recommended. People with conditions that increase the risk of liver cancer might consider screening, such as people who have:

  • Hepatitis B infection
  • Hepatitis C infection
  • Liver cirrhosis

Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves a blood test and an abdominal ultrasound exam every six months.

Liver cancer care at Mayo Clinic

May 18, 2021

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