When we say liver cancer, really what we mean is cancer that has started in the liver.
Sometimes people get a little bit confused and say liver cancer but really are talking about cancer that has spread from somewhere else, like colon cancer that spread to the liver.
Liver cancer really does mean primary liver cancer, meaning the cancer actually started there. When it has spread from somewhere else, it is secondary liver cancer, and we usually use call it metastatic cancer in that case.
Other cancers spread to the liver because cancer likes to get into blood vessels and spread via the blood. The liver has some of the biggest blood flow in our entire bodies. It has liters of blood going every minute through it. Every amount of blood that comes out of our intestines goes straight into the liver. There is also blood flow from the artery as well. The liver has really a lot of blood flow and that is why cancer ends up there.
Unfortunately, liver cancer is on the rise because liver disease is on the rise.
The number one cause of liver cancer in the United States is underlying liver disease, mostly cirrhosis. When someone has something attacking the liver, such as hepatitis C or alcohol, the liver can develop cirrhosis, which results in this lumpy, bumpy, shrunken liver that does not work very well.
Unfortunately, all the damage that contributed to developing cirrhosis can lead to cancer in the liver. That chronic damage over the years can cause cancer, just like sun damage causes skin cancer, or lung damage from smoking causes lung cancer.
We have lots of studies that have looked at various risk factors that can affect liver cancer. We know that:
- Patients who drink alcohol in excess are at risk. For women, this is more than one drink a day. For men, this is more than two drinks a day. Having more alcohol than that doubles your risk of liver cancer.
- If you have obesity, if your body mass index is more than 30, your risk of liver cancer increases by 60%.
- If you have diabetes, your risk of liver cancer doubles.
There are things that we can do to keep our liver healthy, including changes in lifestyle and habits.
Unfortunately, liver cancer often doesn’t have symptoms until it’s very advanced. We want to find the cancer when it’s the size of a golf ball. One of the most important things for people who are at risk for getting liver cancer is to be screened so that we can find that cancer when it’s small and treatable.
Once someone develops more advanced cancer — maybe they didn’t know they had underlying liver disease, or they fell out of touch with their doctors — the main symptom for that cancer is the same as for liver failure. People can turn yellow. People can develop water in their abdomen called ascites. People can develop blood clotting problems where they bleed too frequently, or it also can cause pain.
When the liver gets full of cancer, it stretches and that hurts. But often times when there are symptoms developing, that means it’s too late for curative treatments.
We know patients with underlying liver disease are at risk. Every six months, I have these patients come in. We get a picture of their liver, either through an ultrasound or a CAT scan or an MRI. We also do blood tests. We have to do both because neither one alone is very good at picking up liver cancer. But when you combine them, they’re much better at finding early liver cancer.
Again, these exams have to be done every six months. We pick six months because that’s about the time that it takes for a cancer in the liver to double in size. It’s every six months. If we do it every six months, we’re going to find it when it’s small enough to treat, but yet big enough to actually see on the images.
We often try to do curative treatments. That might include resection, which is cutting out the part of the liver that has the cancer in it. Unfortunately, many patients aren’t candidates for resection because the underlying cirrhosis makes it too risky to do surgery on that liver.
The other thing that we’ll often do is liver transplant. We perform transplant on a lot of patients with liver cancer here at Scripps. We have very good outcomes and very high rates of curing people with liver cancer when we transplant them here.
There are also multiple treatments that we can do, such as ablation or burning it. We can radiation and chemotherapy.
Also there are a lot of different systemic treatments for people who have very advanced disease, including multiple clinical trials.
We have a wonderful team here that helps me with my transplant patients. We have multiple hepatologists. Our surgeons are absolutely phenomenal, and we really have one of the highest success rates for liver transplant for liver cancer in the country. We really do a very good job.
Yes. Liver cancer is curable if you can find it early enough. That’s really the key, finding it early so that we can absolutely cure it, no problem. If we find it late, it becomes very, very difficult.
If we find it early, the cure rate is around 75 to 90%, depending on what treatments are possible, depending on how many tumors, what size of tumors. But 75 to 90% is about the rate, so it’s very, very good.
I hope everyone thinks about their liver and keeping it healthy. The liver is the unsung hero of the human body. It really doesn’t cause any symptoms and people don’t think about it until it takes a lot of beating and starts causing trouble. So just keep your liver healthy. Follow up with your doctor to make sure that your liver tests are checked. Stay away from alcohol as much as possible. Keep your weight under control. And by the way, coffee is good for your liver. So, drink a cup of coffee for me.
Lightly edited for clarity
Watch the San Diego Health video with host Susan Taylor and Dr. Frenette discussing why liver cancer is on the rise.