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More About Liver Cancer

What Is Liver Cancer?

Hepatoma (also called hepatocellular carcinoma) is the most common cancer of the liver. It’s a primary tumor, meaning the tumor started growing in the liver and did not spread from someplace else in the body.

In the United States, about 6000 new cases occur each year. Hepatomas are more common in men than women, usually occurring in people 50 to 70 years old. Unfortunately, many hepatomas are found late. Early diagnosis gives the best hope for cure.

What Causes Liver Cancer?

Hepatoma occurs most often in people with cirrhosis (liver scarring), chronic hepatitis B, or chronic hepatitis C or after severe liver damage from chronic alcohol abuse. Hepatomas aren’t contagious or passed from parents to children.

What Are the Symptoms of Liver Cancer?

One third of people do not have any symptoms. Symptoms may include pain in the abdomen (belly), an abdominal mass, abdominal fluid (ascites), and jaundice (yellow skin color). Later, weakness, loss of appetite, weight loss, and fatigue can occur.

How Is Liver Cancer Diagnosed?

Diagnosis is difficult because hepatomas often don’t have many early symptoms. To help diagnosis, the health care provider may initially do blood tests called alpha-fetoprotein and liver function tests for people with cirrhosis or hepatitis B or C. However, these tests are not diagnostic because not everyone with a hepatoma has abnormal blood tests, so the health care provider may want imaging studies called ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). If these imaging studies show a probable tumor, a liver biopsy will be done. In a biopsy, liver tissue is taken with a needle and looked at with a microscope.

How Is Liver Cancer Treated?

Untreated people have a rapid downhill course. Surgery offers the best chance for cure, but most people cannot have surgery because of cirrhosis or tumor spread. Smaller tumors (less than 5 cm, or about 2 inches) that haven’t spread and with remaining liver working well are less likely to recur after surgery.

People who cannot have surgery may have other treatments, including injecting chemotherapy drugs into the artery that feeds the tumor or injecting ethanol (alcohol) directly into the tumor to destroy it.

People with very large tumors or with too much liver damage may be candidates for liver transplantation. A team of doctors and other health care workers must work together to manage care.

DOs and DON’Ts in Managing Liver Cancer:
  • DO call your health care provider if you have abdominal pain or vomit blood.
  • DO tell your health care provider if you have a drinking problem.
  • DO tell your health care provider if you feel a mass or large lump in the right upper part of your abdomen (belly).
  • DON’T drink alcohol. Alcohol abuse can lead to cirrhosis and increase the risk of hepatoma.
  • DON’T miss follow-up health care provider appointments.

Contact the following sources:

  • American Liver Foundation
    Tel: (800) 223-0179
  • American Cancer Society
    Tel: (800) 227-2345
  • National Cancer Institute Cancer Information Service
    Tel: (800) 422-6237

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

Ferri’s Netter Patient Advisor

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.

What are the stages of liver cancer?

Several systems can be used to divide liver cancer into stages. Doctors in different parts of the world might use different systems.

AJCC TNM system

The American Joint Committee on Cancer (AJCC) TNM staging system is often used to describe how much a cancer has grown.

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.

Once your doctor knows your T, N, and M status, he or she uses this information to assign the cancer an overall stage. Your doctor uses Roman numerals from I (the earliest stage) to IV (the most advanced stage).

  • Stage I. There is a single tumor in the liver that has not grown into any blood vessels.

  • Stage II. There is a single tumor in the liver that has grown into blood vessels. Or there are several tumors in the liver, but none is wider than 5 centimeters (about 2 inches).

  • Stage IIIA. There are many tumors in the liver and at least one is larger than 5 centimeters (about 2 inches). The cancer has not spread to nearby lymph nodes or to areas outside of the liver. 

  • Stage IIIB. The cancer is growing into a branch of one of the main blood vessels in the liver (the portal or hepatic veins). It has not reached the lymph nodes or other organs. 

  • Stage IIIC. The cancer has spread to nearby organs other than the gallbladder, which lies directly under the liver. Or the cancer has extended into the outer layer of tissue that covers the liver. The cancer has not spread to the lymph nodes or distant organs. 

  • Stage IVA. Tumors can be of any size, but the cancer has spread into lymph nodes near the liver. The cancer has not yet reached distant organs.

  • Stage IVB. The cancer has spread to distant organs, such as the lungs, bones, or brain. It may not be clear that the cancer has invaded nearby blood vessels and lymph nodes. 

Other staging systems

How far the cancer has grown or spread is important in figuring out treatment. But 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 there would be enough healthy liver remaining after surgery. Some other staging systems look at liver function. These systems include the Okuda system and Barcelona Clinical Liver Cancer (BCLC) system. Talk with your doctor if you have questions about which system your doctor uses.

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. Make sure to ask any questions or talk about your concerns.