The two basic types of liver cancer are primary (originating in the liver) and metastatic (originating elsewhere and spreading to the liver).
Primary Liver Cancer
About 75 percent of adult primary liver cancers are of a type called hepatocellular carcinoma (HCC), which begins in the hepatocytes, the cells that make up the main tissue of the liver. HCC sometimes starts as a single tumor that spreads to other parts of the liver, or it may develop as nodules at several different places in the liver.
Between 10 and 20 percent of primary liver cancers are intrahepatic cholangiocarcinomas (bile duct cancers), which begin in the bile ducts that connect the liver to the gallbladder.
Angiosarcoma and hemangiosarcoma are rare forms of primary liver cancer that originate in the organ’s blood vessels.
Metastatic Liver Cancer
Cancers originating in the pancreas, colon, stomach, breast, lung, or other areas can spread (metastasize) to the liver. These cancers are generally identified and treated according to the site of origin. For example, if cancer originates in the pancreas and spreads to the liver, the disease is identified and treated as pancreatic cancer.
The most common risk factor for liver cancer is chronic (long-term) hepatitis B or hepatitis C. Other risk factors may include:
Heavy alcohol use
Cirrhosis, or scarring of the liver
Inherited metabolic diseases such as tyrosinemia, alpha1-antitrypsin deficiency, and Wilson’s disease
Obesity, which can lead to fatty liver disease
Liver cancer rarely causes symptoms in its early stages; as the disease progresses, patients may notice the following symptoms:
Pain and swelling in the upper-right abdomen
Unexplained weight loss
Loss of appetite
Fatigue or weakness
Nausea and vomiting
Jaundice (yellowing of the skin and/or whites of the eyes)
Pale stools and dark urine
It’s very important to realize that liver cancer often causes no symptoms at all. Because this is a “silent” cancer, it’s very important to be screened regularly if you have any of the following risk factors:
- Liver cirrhosis
- Chronic hepatitis B or C
- Exposure to certain toxins and chemicals such as aflatoxin and polyvinyl chloride
- Family history of liver cancer
- Inherited liver diseases such as hemochromatosis, autoimmune hepatitis, and Wilson's disease
- Nonalcoholic fatty liver disease (NAFLD)
Screening for liver cancer usually involves one or more of the following tests:
Blood tests: High levels of alpha-fetoprotein (AFP) in the blood could be a sign of liver cancer, and other blood tests can reflect how well the liver is working.
Imaging tests: A CT scan, an MRI, or an ultrasound can allow your physician to see tumors in the liver or elsewhere in the abdomen.
In rare cases, a liver biopsy may be needed, in which the physician removes a sample of liver tissue and a pathologist examines it to look for cancer cells. In most cases a liver biopsy is not needed to make the diagnosis of liver cancer; in fact, often a biopsy is avoided due to the risk of spreading the cancer with the needle used to biopsy it.
If liver cancer is diagnosed, the next step is for your physician to determine the stage of the disease. Staging allows your doctor to determine the best course of treatment and find out if the cancer has spread (metastasized).
When liver cancer spreads, it may spread to the lungs as well as to the lymph nodes or the bones located near the liver. Your physician may order a CT scan of your chest, a bone scan, or occasionally a PET scan to see if the disease has metastasized.
For information about treatment options, visit our Treating Liver Cancer page.
To find out more about the Methodist Center for Liver Disease and Transplantation, call us at 713-441-8839 or 866-94-LIVER (866-945-4837) or send us an email.