Liver Cancer


Liver cancer is a disease of the hepatobiliary (heh-PAH-toh-BIH-lee-ayr-ee) system. “Hepato” means liver, and “biliary” refers to the gallbladder and bile ducts. You will likely see and hear many new words that contain these elements. There are two main types of primary liver cancer: one is called hepatocellular carcinoma or HCC, which begins in liver tissue, and the other is called cholangiocarcinoma, which begins in cells that line the bile ducts. Although other types of cancer can metastasize (spread) to the liver, a condition known as secondary liver cancer, this guide focuses on adult primary liver cancer.

HCC generally develops in the presence of underlying chronic liver disease. For this reason, it is often called a disease within a disease. The underlying cause and the cancer must be addressed, which makes HCC challenging both to diagnose and treat.

Understanding the Liver

Just as you cannot survive without your heart, you cannot survive without your liver. It plays a vital role in more than 500 functions in your body. These include cleaning your blood by filtering out toxins and waste, secreting bile to the intestines to aid with digestion and making clotting factors to help stop bleeding.

The liver has two lobes and is located on the upper right side of your abdomen above your stomach, protected by your ribs (see Figure 1). It is the largest organ inside your body and the only one with the ability to regenerate, or grow back, when part of it is removed. This is possible only if the remaining part of the liver is healthy; a liver afflicted with a chronic disease such as cirrhosis cannot regrow.

How Liver Cancer Develops

In general, cancer develops when genes begin to change, or mutate, within otherwise normal cells. Healthy cells typically divide in an orderly fashion. When worn out or damaged, they die and are replaced by new cells. But cancer cells behave abnormally as a result of gene mutations, dividing rapidly, growing out of control and pushing out healthy cells. Unchecked, these cancer cells eventually form a tumor.

HCC begins in the hepatocellular cells, which are the main type of cells in the liver. Multiple tumors may develop simultaneously. When cancer becomes advanced and spreads beyond the liver, the most common sites are the lung, abdominal lymph nodes and the bone.

Most patients do not have any symptoms. However, symptoms may include mild to moderate pain or tenderness in the upper right part of the abdomen or right shoulder, decreased appetite, feeling full despite eating less than normal, unintended weight loss, bloating, vomiting or deep fatigue. Advanced cancer may result in swelling in the legs or abdomen (ascites), unexplained fevers and jaundice, which can cause yellow skin and yellowing in the whites of the eyes, dark urine and light-colored stools.

The most common underlying disorder is cirrhosis, which is scarring of the liver. This long-lasting, progressive disease causes inflammation and irreversible damage over time, as scar tissue slowly replaces healthy liver cells as the organ gradually loses function.

Most risk factors for HCC can also cause cirrhosis:

  • Viral hepatitis B and C (HBV and HCV), which are carried and spread through contact with blood and other bodily fluids.
  • Heavy use of alcohol.
  • Environmental factors, such as certain chemicals or aflatoxin (a toxin made by a mold).
  • Nonalcoholic fatty liver disease (NAFLD) and its most severe form, nonalcoholic steatohepatitis (NASH), which have been linked with obesity.

In some cases, however, no risk factors are found, and it is not known what causes the liver to become compromised and vulnerable to HCC.

Disease Stigma

Because many of these underlying conditions can be related to lifestyle choices, liver cancer is associated with “disease stigma.” This occurs when people make negative assumptions about or assign blame to individuals with certain diagnoses, such as liver disease, lung cancer, HIV/AIDS, adult diabetes and other conditions. Some people diagnosed with HCC feel such embarrassment and shame that they withdraw, avoiding friends and family. They may even avoid medical appointments, which, in turn, can affect their outcome. Loved ones and caregivers can also feel this burden.

It is extremely important to understand that nothing you have done makes you deserve a cancer diagnosis, and you do not have to face HCC alone. Supportive care, also called palliative care, includes a variety of resources available at most cancer centers and hospitals and through advocacy groups.

In addition to helping you manage the physical aspects of an HCC diagnosis and treatment, supportive care specialists address the emotional, practical and spiritual issues that may affect you, your caregiver and/or your loved ones. Access these services as soon as possible.

Next Steps

Both the cancer and the underlying condition must be addressed during treatment, along with any other serious health conditions, such as heart disease or lung problems. These factors, coupled with the relative rarity of HCC in the U.S., make it crucial to seek treatment at a cancer center or hospital with significant experience treating liver cancer. A multi-disciplinary team of specialists is required to accurately diagnose and stage the cancer, plan effective treatment and coordinate supportive care to help manage side effects.

Ask about clinical trials taking place in the U.S. and in other parts of the world you may qualify for. More people are considering clinical trials earlier in their treatment plan because they become too unhealthy later in the course of their disease to be eligible for a clinical trial. In some situations, it may offer the best chance for a positive outcome, so talk with your doctor about this treatment option (see Clinical Trials).

Do not hesitate to get a second or even third opinion before making any treatment-related decisions (see Treatment). Your oncologists should be both pleased to and capable of helping you arrange for a second opinion. Many patients mistakenly believe that their oncologist will think poorly of them if they ask for a second opinion. But this is part of a physician’s obligation to you, and a request that physicians commonly receive.

Learning everything you can about your diagnosis is empowering. Your patient/nurse navigator, oncology nurse, other members of your health care team and liver cancer survivors may offer valuable insight.

The more you know about liver cancer, the better prepared you will be to make treatment decisions with your doctors. Actively participating in the direction of your care will offer you a much-needed level of control as you plan the way forward.


Key Takeaways

  • Your liver is essential to your body and plays a vital role in more than 500 functions.
  • Seek a specialist to treat HCC.
  • Explore the possibility of a clinical trial before beginning treatment.
  • Access supportive care resources for you and your loved ones as soon as possible.

Additional Resources