Adult Primary Liver Cancer Treatment
General Information(Symptoms and Diagnosis)
Stages
Treatment
General Information About Adult Primary Liver Cancer
Key Points
- Adult primary liver cancer is a disease in which malignant
(cancer) cells form in the tissues of the liver.
- There are two types of adult primary liver cancer.
- Having hepatitis or cirrhosis can affect the risk of adult
primary liver cancer.
- Signs and symptoms of adult primary liver cancer include a
lump or pain on the right side.
- Tests that examine the liver and the blood are used to
detect (find) and diagnose adult primary liver cancer.
- Certain factors affect prognosis (chance of recovery) and
treatment options.
Adult
primary liver cancer is a disease in which malignant (cancer) cells
form in the tissues of the liver.
The liver
is one of the largest organs
in the body. It has four lobes
and fills the upper right side of the abdomen
inside the rib cage. Three of the many important functions of the liver
are:
- To filter harmful substances from the blood
so they can be passed from the body in stools
and urine.
- To make bile
to help digest
fat that comes from food.
- To store glycogen (sugar), which the body uses for energy.
Anatomy of the liver. The
liver is in the upper abdomen near the stomach, intestines,
gallbladder, and pancreas. The liver has four lobes. Two lobes are on
the front and two small lobes (not shown) are on the back of the liver.
There
are two types of adult primary liver cancer.
The two types of adult
primary liver
cancer are:
- Hepatocellular
carcinoma.
- Cholangiocarcinoma
(bile duct cancer). (See the PDQ
summary on Bile
Duct Cancer Treatment for more information.)
The most common type of
adult primary liver cancer is hepatocellular carcinoma. This type of
liver cancer is the third leading cause of cancer-related deaths
worldwide.
This summary is about
the treatment of primary
liver cancer (cancer
that begins in the liver). Treatment of cancer that begins in other
parts of the body and spreads to the liver is not covered in this
summary.
Primary liver cancer can
occur in both adults and children. However, treatment for children is
different than treatment for adults. (See the PDQ summary on Childhood
Liver Cancer Treatment for more information.)
Having
hepatitis or cirrhosis can affect the risk of adult primary liver
cancer.
Anything that increases
your chance of getting a disease is called a risk
factor. Having a risk factor does not mean that you will
get
cancer; not having risk factors doesn't mean that you will not get
cancer. Talk with your doctor if you think you may be at risk.
The following are risk
factors for adult primary liver cancer:
- Having hepatitis
B or hepatitis
C. Having both hepatitis B and hepatitis C increases the
risk
even more.
- Having cirrhosis,
which can be caused by:
- hepatitis
(especially hepatitis C); or
- drinking large amounts of alcohol
for many years or being an alcoholic.
- Having metabolic
syndrome, a set of conditions
that occur together, including extra fat around the abdomen, high blood
sugar, high blood
pressure, high levels of triglycerides and low levels of
high-density lipoproteins in the blood.
- Having liver injury that is long-lasting, especially if it
leads to cirrhosis.
- Having hemochromatosis,
a condition in which the body takes up and stores more iron
than it needs. The extra iron is stored in the liver, heart, and pancreas
- Eating foods tainted with aflatoxin
(poison from a fungus
that can grow on foods, such as grains and nuts, that have not been
stored properly).
Signs
and symptoms of adult primary liver cancer include a lump or pain on
the right side.
These and other signs
and symptoms
may be caused by adult primary liver cancer or by other conditions.
Check with your doctor if you have any of the following:
- A hard lump on the right side just below the rib cage.
- Discomfort in the upper abdomen on the right side.
- A swollen abdomen.
- Pain near the right shoulder
blade or in the back.
- Jaundice
(yellowing of the skin and whites of the eyes).
- Easy bruising or bleeding.
- Unusual tiredness or weakness.
- Nausea
and vomiting.
- Loss of appetite
or feelings of fullness after eating a small meal.
- Weight loss for no known reason.
- Pale, chalky bowel
movements and dark urine.
- Fever.
Tests
that examine the liver and the blood are used to detect (find) and
diagnose adult primary liver cancer.
The following tests and
procedures may be used:
Certain
factors affect prognosis (chance of recovery) and treatment options.
The prognosis
(chance of recovery)
and treatment options depend on the following:
- The 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, including whether there is
cirrhosis of the liver.
Stages of Adult Primary Liver Cancer
Key Points
- After adult primary liver cancer has been diagnosed, tests
are done to find out if cancer cells have spread within the liver or to
other parts of the body.
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the
body.
- The Barcelona Clinic Liver Cancer Staging System may be
used to stage adult primary liver cancer.
- The following groups are used to plan treatment.
- BCLC stages 0, A, and B
- BCLC stages C and D
After
adult primary liver cancer has been diagnosed, tests are done to find
out if cancer cells have spread within the liver or to other parts of
the body.
The process used to find
out if cancer
has spread within the liver
or to other parts of the body is called staging.
The information gathered from the staging process determines the stage
of the disease. It is important to know the stage in order to plan
treatment. The following tests and procedures may be used in the
staging process:
- CT
scan (CAT scan): A procedure that makes a
series of detailed pictures of areas inside the body, such as the
chest, abdomen,
and pelvis,
taken from different angles. The pictures are made by a computer linked
to an x-ray
machine. A dye
may be injected
into a vein
or swallowed to help the organs
or tissues
show up more clearly. This procedure is also called computed
tomography, computerized tomography, or computerized axial tomography.
- MRI
(magnetic resonance imaging): A procedure that uses a
magnet, radio
waves, and a computer to make a series of detailed
pictures
of areas inside the body. This procedure is also called nuclear
magnetic resonance imaging (NMRI).
- PET
scan (positron emission tomography scan): A
procedure to find malignant
tumor
cells
in the body. A small amount of radioactive
glucose
(sugar) is injected into a vein. The PET scanner
rotates around the body and makes a picture of where glucose is being
used in the body. Malignant tumor cells show up brighter in the picture
because they are more active and take up more glucose than normal cells
do.
There
are three ways that cancer spreads in the body.
Cancer can spread
through tissue,
the lymph
system, and the blood:
- Tissue. The cancer spreads from where it began by growing
into nearby areas.
- Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through the lymph
vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood
vessels to other parts of the body.
Cancer
may spread from where it began to other parts of the body.
When cancer spreads
to another part of the body, it is called metastasis.
Cancer cells
break away from where they began (the primary
tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system,
travels through the lymph vessels, and forms a tumor
(metastatic
tumor) in another part of the body.
- Blood. The cancer gets into the blood, travels through the
blood vessels, and forms a tumor (metastatic tumor) in another part of
the body.
The metastatic tumor is
the same type of cancer as the primary tumor. For example, if primary liver
cancer spreads to the lung,
the cancer cells in the lung are actually liver cancer cells. The
disease is metastatic liver cancer, not lung cancer.
The
Barcelona Clinic Liver Cancer Staging System may be used to stage adult
primary liver cancer.
There are several staging
systems for liver cancer. The Barcelona Clinic Liver
Cancer
(BCLC) Staging System is widely used and is described below. This
system is used to predict the patient's chance of recovery
and to plan treatment, based on the following:
- Whether the cancer has spread within the liver or to other
parts of the body.
- How well the liver is working.
- The general health and wellness of the patient.
- The symptoms
caused by the cancer.
The BCLC staging system
has five stages:
- Stage 0: Very early
- Stage A: Early
- Stage B: Intermediate
- Stage C: Advanced
- Stage D: End-stage
The
following groups are used to plan treatment.
BCLC
stages 0, A, and B
Treatment to cure
the cancer is given for BCLC stages 0, A, and B.
BCLC
stages C and D
Treatment to relieve the
symptoms caused by liver cancer and improve the patient's quality
of life is given for BCLC stages C and D. Treatments are
not
likely to cure the cancer.
Recurrent Adult Primary Liver Cancer
Recurrent
adult primary
liver
cancer is cancer
that has recurred (come back) after it has been treated. The cancer may
come back in the liver
or in other parts of the body.
Treatment Option Overview
Key Points
- There are different types of treatment for patients with
adult primary liver cancer.
- Patients with liver cancer are treated by a team of
specialists who are experts in treating liver cancer.
- Seven types of standard treatment are used:
- Surveillance
- Surgery
- Liver transplant
- Ablation therapy
- Embolization therapy
- Targeted therapy
- Radiation therapy
- New types of treatment are being tested in clinical trials.
- Patients may want to think about taking part in a clinical
trial.
- Patients can enter clinical trials before, during, or after
starting their cancer treatment.
- Follow-up tests may be needed.
There
are different types of treatment for patients with adult primary liver
cancer.
Different types of
treatments are available for patients with adult primary
liver
cancer. Some treatments are standard
(the currently used treatment), and some are being tested in clinical
trials. A treatment clinical trial is a research
study meant to help improve current treatments or obtain
information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the
standard treatment, the new treatment may become the standard
treatment. Patients may want to think about taking part in a clinical
trial. Some clinical trials are open only to patients who have not
started treatment.
Patients
with liver cancer are treated by a team of specialists who are experts
in treating liver cancer.
The patient's treatment
will be overseen by a medical
oncologist, a doctor who specializes in treating people
with
cancer. The medical oncologist may refer the patient to other health
professionals who have special training in treating patients with liver
cancer. These may include the following specialists:
- Hepatologist (specialist in liver disease).
- Surgical
oncologist.
- Transplant
surgeon.
- Radiation
oncologist.
- Interventional radiologist (a specialist who diagnoses
and treats diseases using imaging
and the smallest incisions
possible).
- Pathologist.
Seven
types of standard treatment are used:
Surveillance
Surveillance
for lesions smaller than 1 centimeter
found during screening.
Follow-up
every three months is common.
Surgery
A partial hepatectomy
(surgery
to remove the part of the liver
where cancer is found) may be done. A wedge
of tissue,
an entire lobe,
or a larger part of the liver, along with some of the healthy tissue
around it is removed. The remaining liver tissue takes over the
functions of the liver and may regrow.
Liver
transplant
In a liver transplant,
the entire liver is removed and replaced with a healthy donated
liver. A liver transplant may be done when the disease is in the liver
only and a donated liver can be found. If the patient has to wait for a
donated liver, other treatment is given as needed.
Ablation
therapy
Ablation
therapy
removes or destroys tissue. Different types of ablation therapy are
used for liver cancer:
- Radiofrequency
ablation: The use of special needles that are inserted
directly through the skin or through an incision in the abdomen
to reach the tumor.
High-energy radio
waves heat the needles and tumor which kills cancer cells.
- Microwave
therapy: A type of treatment in which the tumor is exposed
to
high temperatures created by microwaves. This can damage and kill
cancer cells or make them more sensitive to the effects of radiation
and certain anticancer drugs.
- Percutaneous
ethanol injection: A cancer treatment in which a small
needle
is used to inject
ethanol
(pure alcohol) directly into a tumor
to kill cancer cells.
Several treatments may be needed. Usually local
anesthesia is used, but if the patient has many tumors in
the
liver, general
anesthesia may be used.
- Cryoablation:
A treatment that uses an instrument to freeze and destroy cancer cells.
This type of treatment is also called cryotherapy and cryosurgery. The
doctor may use ultrasound
to guide the instrument.
- Electroporation
therapy: A treatment that sends electrical pulses through
an electrode
placed in a tumor to kill cancer cells. Electroporation therapy is
being studied in clinical trials.
Embolization
therapy
Embolization
therapy is the use of substances to block or decrease the flow of blood
through the hepatic
artery to the tumor. When the tumor does not get the oxygen
and nutrients
it needs, it will not continue to grow. Embolization therapy is used
for patients who cannot have surgery to remove the tumor or ablation
therapy and whose tumor has not spread outside the liver.
The liver receives blood
from the hepatic
portal vein and the hepatic artery. Blood that comes into
the
liver from the hepatic portal vein usually goes to the healthy liver
tissue. Blood that comes from the hepatic artery usually goes to the
tumor. When the hepatic artery is blocked during embolization therapy,
the healthy liver tissue continues to receive blood from the hepatic
portal vein.
There are two main types
of embolization therapy:
- Transarterial
embolization (TAE): A small incision (cut) is made in the
inner thigh and a catheter
(thin, flexible tube) is inserted and threaded up into the hepatic
artery. Once the catheter is in place, a substance that blocks the
hepatic artery and stops blood flow to the tumor is injected.
- Transarterial
chemoembolization (TACE): This procedure is like TAE
except
an anticancer drug
is also given. The procedure can be done by attaching the anticancer
drug to small beads that are injected into the hepatic artery or by
injecting the anticancer drug through the catheter into the hepatic
artery and then injecting the substance to block the hepatic artery.
Most of the anticancer drug is trapped near the tumor and only a small
amount of the drug reaches other parts of the body. This type of
treatment is also called chemoembolization.
Targeted
therapy
Targeted
therapy is a treatment that uses drugs or other substances
to
identify and attack specific cancer cells without harming normal cells.
Adult liver cancer may be treated with a targeted therapy drug that
stops cells from dividing and prevents the growth of new blood
vessels that tumors need to grow.
See Drugs
Approved for Liver Cancer for more information.
Radiation
therapy
Radiation
therapy is a cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. There are two types of
radiation therapy:
- External
radiation therapy uses a machine outside the body to send
radiation toward the cancer. Certain ways of giving radiation therapy
can help keep radiation from damaging nearby healthy tissue. These
types of external radiation therapy include the following:
- Conformal
radiation therapy: Conformal radiation therapy is a type
of
external radiation therapy that uses a computer to make a 3-dimensional
(3-D) picture of the tumor and shapes the radiation beams to fit the
tumor. This allows a high dose
of radiation to reach the tumor and causes less damage to nearby
healthy tissue.
- Stereotactic
body radiation therapy: Stereotactic body radiation
therapy
is a type of external radiation therapy. Special equipment is used to
place the patient in the same position for each radiation treatment.
Once a day for several days, a radiation machine aims a larger than
usual dose of radiation directly at the tumor. By having the patient in
the same position for each treatment, there is less damage to nearby
healthy tissue. This procedure is also called stereotactic
external-beam radiation therapy and stereotaxic radiation therapy.
- Proton
beam radiation therapy: Proton-beam therapy is a type of
high-energy, external radiation therapy. A radiation therapy machine
aims streams of protons
(tiny, invisible, positively-charged particles) at the cancer cells to
kill them. This type of treatment causes less damage to nearby healthy
tissue.
- Internal
radiation therapy uses a radioactive
substance sealed in needles, seeds,
wires, or catheters that are placed directly into or near the cancer.
The way the radiation
therapy is given depends on the type and stage
of the cancer being treated. External radiation therapy is used to
treat adult primary liver cancer.
New
types of treatment are being tested in clinical trials.
Information about
clinical trials is available from the NCI
website.
Patients
may want to think about taking part in a clinical trial.
For some patients,
taking part in a clinical
trial may be the best treatment choice. Clinical trials
are
part of the cancer research process. Clinical trials are done to find
out if new cancer treatments are safe and effective or better than the standard
treatment.
Many of today's
standard treatments for cancer are based on earlier clinical trials.
Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take
part in clinical trials also help improve the way cancer will be
treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions and
help move research forward.
Patients
can enter clinical trials before, during, or after starting their
cancer treatment.
Some clinical trials
only include patients who have not yet received treatment. Other trials
test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring
(coming back) or reduce the side
effects of cancer treatment.
Clinical trials are
taking place in many parts of the country. See the Treatment Options
section that follows for links to current treatment clinical trials.
These have been retrieved from NCI's
listing of clinical trials.
Follow-up
tests may be needed.
Some of the tests
that were done to diagnose
the cancer or to find out the stage
of the cancer may be repeated. Some tests will be repeated in order to
see how well the treatment is working. Decisions about whether to
continue, change, or stop treatment may be based on the results of
these tests.
Some of the tests
will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition
has changed or if the cancer has recurred
(come back). These tests are sometimes called follow-up
tests or check-ups.
Treatment Options for Adult Primary Liver Cancer
Stages 0, A, and B Adult Primary Liver
Cancer
Treatment of stages
0, A, and B adult primary
liver
cancer may include the following:
- Surveillance
for lesions
smaller than 1 centimeter.
- Partial hepatectomy.
- Total hepatectomy
and liver
transplant.
- Ablation
of the tumor
using one of the following methods:
- Radiofrequency
ablation.
- Microwave
therapy.
- Percutaneous
ethanol injection.
- Cryoablation.
- A clinical
trial of electroporation
therapy.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage
0 adult primary liver cancer (BCLC), stage
A adult primary liver cancer (BCLC) and stage
B adult primary liver cancer (BCLC). For more specific
results, refine the search by using other search features, such as the
location of the trial, the type of treatment, or the name of the drug.
Talk with your doctor about clinical trials that may be right for you.
General information about clinical trials is available from the NCI
website.
Stages C and D Adult Primary Liver Cancer
Treatment of stages
C and D adult primary
liver
cancer may include the following:
- Embolization
therapy
using one of the following methods:
- Transarterial
embolization (TAE).
- Transarterial
chemoembolization (TACE).
- Targeted
therapy.
- Radiation
therapy.
- A clinical
trial of targeted therapy after chemoembolization
or combined with chemotherapy.
- A clinical trial of new targeted therapy drugs.
- A clinical trial of targeted therapy with or without stereotactic
body radiation therapy.
- A clinical trial of stereotactic
body radiation therapy or proton-beam
radiation therapy.
Treatment of Recurrent Adult Primary Liver Cancer
Treatment options for recurrent
adult primary
liver
cancer may include the following:
- Total hepatectomy
and liver
transplant.
- Partial hepatectomy.
- Ablation
- Transarterial
chemoembolization and targeted
therapy with sorafenib,
as palliative
therapy to relieve symptoms
and improve quality
of life.
- A clinical
trial of a new treatment.
-NIH
