Liver Cancer

The various types of liver cancer break down into two main categories: primary and secondary.

Primary liver cancer

Many types of cancer often spread to the liver. However, only cancer that starts in the liver is called primary liver cancer. Often, liver cancer patients have underlying liver disease, such as cirrhosis and hepatitis. The various types of primary liver cancer include: 

• Hepatocellular carcinoma (HCC)
• Cholangiocarcinoma
• Angiosarcoma
• Hemangiosarcoma

Secondary liver cancer

Patients may also be diagnosed with secondary liver cancer, also called liver metastases. This is cancer that has spread to the liver from other cancerous organs. Because your liver filters all the blood that circulates through your body, cells from many types of cancer that begin in other parts of your body — such as the colon, breast or lungs — can spread to the liver.

Hepatocellular carcinoma (HCC)

Hepatocellular carcinoma (HCC) is the most common type of liver cancer. It begins either as a single tumor that spreads through the liver or as many small cancer nodules throughout the liver. 

Cholangiocarcinoma

Cholangiocarcinoma is a rare form of cancer that starts in the bile ducts of the liver — either inside (intrahepatic cholangiocarcinoma) or outside (extrahepatic cholangiocarcinoma) the organ. For more, refer to bile duct cancer.

Angiosarcoma and hemangiosarcoma

Rare but fast-growing tumors, angiosarcoma and hemangiosarcoma start in the cell lining of the liver’s blood vessels and are typically treated like other sarcomas. For more, refer to soft tissue sarcoma. 

What causes liver cancer is not fully known — especially when it comes to understanding how certain risk factors spur the transition from normal cells to cancer cells. Doctors do know that several risk factors may increase a person’s chances of developing primary liver cancer. 

The most common risk factors include:

Cirrhosis

Many people who develop liver cancer already had cirrhosis. This disease occurs when damaged liver cells are replaced by scar tissue. It’s most often caused by alcohol abuse or chronic viral hepatitis. 

Chronic viral hepatitis

The most common liver cancer risk factor is long-term infection with hepatitis B or hepatitis C.

Non-alcoholic fatty liver disease

Common in obese people, this condition can cause cirrhosis even in people who drink little or no alcohol.

Gender

Hepatocellular carcinoma is much more common in men than in women.

Ethnicity

In the United States, liver cancer is most common among Asian-Americans and Pacific Islanders. 

It’s unusual, but in some cases a family history of liver cancer or some inherited metabolic diseases may raise the risk. Talk to your doctor about your risk and whether you should consider genetic counseling.

Early detection of liver cancer can increase the likelihood of successful treatment. There’s currently no routine screening exam for liver cancer, but more than 80% of people diagnosed with this cancer also have cirrhosis of the liver, according to the American Cancer Society. Many doctors recommend liver cancer screening using ultrasound imaging and an alpha fetoprotein (AFP) blood test for patients who may have a higher risk of liver cancer. If you’re concerned, talk with your doctor about your risk.

Minimizing your lifestyle risk factors may help with liver cancer prevention. You may be able to lower your risk of developing liver cancer by:

• Preventing or treating chronic viral infections, including hepatitis B and hepatitis C
• Limiting alcoholic beverages
• Maintaining a healthy weight

Liver cancer symptoms are rare in the early stages of the disease. Liver tumors are usually too small for a doctor to feel during a physical exam, so tumors are rarely found until they become much larger.

As the disease develops, symptoms of liver cancer may include:

• Unintended weight loss 
• Loss of appetite
• Feeling of fullness even after a small meal
• Nausea or vomiting
• Feeling a growth or mass under the ribs 
• Pain in the abdomen or near the right shoulder blade
• Swelling or fluid in the abdomen
• Yellowing of the skin and eyes (jaundice)

Some types of liver cancer produce hormones that may cause other signs and symptoms, such as:

• High blood calcium levels that may lead to constipation, nausea or confusion
• Low blood sugar levels that may cause fatigue or lightheadedness
• Increased red blood cell count
• Enlarged breasts or shrinking of testicles in men

Having any of these symptoms doesn’t mean you have liver cancer. But you should let your doctor know, so you can find the cause of the symptoms and any potential health problems.

In addition to a physical exam and family medical history, Scripps physicians use the most advanced liver cancer diagnostic tests.

Ultrasound

Ultrasound uses sound waves to show any growths on the liver, which may be tumors.

Computed tomography (CT) scan

A CT scan uses X-rays to provide detail about the size, shape and location of any growths in the liver and surrounding areas. 

Magnetic resonance imaging (MRI)

An MRI uses radio waves to provide detailed images of the liver and any abnormal growths.

Angiography

Angiography injects a dye into the blood vessels that supply blood to a liver tumor. This makes them visible on an imaging exam, which can help the doctor decide how best to treat the cancer.

A patient’s liver cancer stage is determined by the severity of the disease and if the cancer has spread beyond the liver. Treatment depends the stage, as well as whether a patient has other liver disease (such as cirrhosis) and their general health.

Stage I

Stage I liver cancer is when there’s a single tumor in the liver; the rest of the liver is healthy, and nearby blood vessels are not affected. 

Stage II

Stage II liver cancer is when there are several tumors smaller than 2 inches across, or a tumor has grown into the blood vessels.

Stage III

In stage III liver cancer, at least one tumor is larger than 2 inches across, the tumors have grown into a major vein or the outer covering of the liver stage or another organ, but not into the lymph nodes or distant sites.

Stage IV

Stage IV is when tumors have spread into the lymph nodes or distant organs. 

Resectable, transplantable and unresectable liver cancer

While staging provides information about the severity of liver cancer, it doesn’t indicate how the cancer should be treated. Doctors generally need to know whether the tumor can be removed with surgery (resectable), and may describe the liver cancer as potentially resectable or transplantable, unresectable or advanced.

• Resectable liver cancer is when the tumor is found early and the rest of the liver is healthy. Surgery may be a possibility for removing all of the cancer. 
• Transplantable liver cancer is when the cancer is in its early stages but the rest of the liver is not healthy. A liver transplant may be an option. Since it may be a long time until a liver becomes available, doctors may recommend other treatments to control the cancer.
• Unresectable liver cancer is when tumors haven’t spread, but their size or location means they cannot be safely removed with surgery.
• Advanced liver cancer is when the cancer has spread to the lymph nodes or other parts of the body and cannot be treated with surgery.

No one wants to hear that they have liver cancer. You may feel frightened, overwhelmed, anxious or sad. All of these feelings are perfectly normal. The more you learn about your diagnosis and next steps, the sooner you can begin to make informed decisions about your treatment.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your liver cancer diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my cancer treatment plan?
• Will I have to miss work/school?
• What are the side effects of liver cancer treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps cancer care team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones at Scripps.

At Scripps, you’ll have a multidisciplinary team of professionals caring for you, including physicians, surgeons, radiation oncologists and nurses who specialize in cancer care. In most cases, you’ll be partnered with a nurse navigator, who will help coordinate your care and ensure you get the support you need throughout your treatment and recovery. For more on our patient-focused approach to treating cancer, visit our section titled Why Scripps.

The most appropriate liver cancer treatment options depend on several factors, including the type and stage of the cancer and whether the patient has any other liver disease, as well as the patient's age and overall health.

At Scripps, our goal is to completely eliminate your cancer using the most advanced therapies and technologies, including surgery, radiation and drug therapy. Should you need a liver transplant, your physician will recommend short-term treatments designed to address symptoms or manage the disease until you are able to receive a transplant.

Liver resection

Scripps surgeons perform liver resection, or liver cancer surgery, to remove the cancerous portion of the liver, leaving the healthy tissue in place. This procedure can also be performed with robot-assisted surgery though the Scripps Minimally Invasive Robotic Surgery Program.

Liver transplant

Scripps is an international leader in liver transplant procedures. The most common treatment for patients with cirrhosis, liver transplantation removes the diseased liver and replaces it with a healthy liver from a donor. 

Transcatheter chemoembolization (TACE)

Transcatheter chemoembolization is a procedure performed by Scripps interventional radiologists where they implant tiny beads containing chemotherapy directly into tumors, and then use high-energy rays to attack cancer cells.

Stereotactic radiosurgery

This targeted treatment delivers a high dose of radiation to a precise location to kill cancer cells while protecting surrounding healthy tissue and organs from radiation damage. Scripps uses leading-edge technology to deliver stereotactic radiosurgery. 

Radiofrequency ablation (RFA)

Scripps interventional radiologists perform radiofrequency ablation, a minimally invasive procedure that uses an electric current to heat and destroy cancer cells.

3-D conformal radiation therapy

With 3-D conformal radiation therapy, our radiation oncologists can visualize a patient’s anatomy in 3-D, enabling them to match the radiation dose to the shape of the tumor while minimizing radiation exposure to surrounding healthy tissues and organs.

Intensity-modulated radiation therapy (IMRT)

Using intensity-modulated radiation therapy (IMRT) — an advanced form of radiation therapy — our radiation oncologists can specify the dose of radiation for the tumor while restricting the dose to surrounding healthy tissues.

Chemotherapy

Most liver cancers are resistant to chemotherapy. However, sorafenib — a class of medications called kinase inhibitors — can slow or stop the progression of liver cancer in patients who are not candidates for surgery.

Some liver cancer treatment plans involve clinical trials. Talk with your physician about whether a clinical trial is right for you. 

For a list of clinical trials that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your liver cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your liver cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need. 

Your team may include:

• Gastroenterologists
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more information on Scripps Cancer Center's multi-disciplinary approach to treatment.

In support of our patients, survivors, their family members and the community, we host a handful of cancer support groups as well as a range of free workshops and health and wellness events on a number of topics such as:

• Nutrition
• Expressive writing
• Yoga
• Meditation

Check the current list of support offerings or contact your oncology social worker or cancer care coordinator.

For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.

We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps Cancer Center offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:

• Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
• Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life. 
• Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
• Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
• Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
• Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
• Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
• Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
• Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.

For the full spectrum of offerings, please visit our cancer patient support services section.