December 02, 2020
In 2020, the American Cancer Society projects that 42,810 new cases of liver cancer will be diagnosed and approximately 30,160 people will die from the disease. Liver cancer affects more men than women each year.
Since 1980, the incidence of liver cancer has tripled, and the death rate has doubled. With such alarming statistics, physicians, researchers and scientists are working to find ways to prevent liver cancer. This article offers education and guidance regarding liver cancer causes and prevention, at-risk populations, different liver disease diagnoses and liver cancer treatment options.
What does the liver do?
The liver is the largest internal organ and it is protected by the right side of your ribs. The hepatocyte is a primary cell in liver tissue, accounting for more than half of the organ’s mass. The liver contains blood vessels and bile ducts that carry bile from the liver to the gallbladder or gastrointestinal tract.
The liver breaks down, metabolizes and stores vital nutrients, like fats, from your intestine. It also makes clotting factors to control bleeding and breaks down toxic waste in the blood (like drugs or alcohol), which pass into the urine and stool.
What is liver cancer?
Liver cancer, also known as hepatic cancer, occurs when cells in the liver grow at an abnormal rate and form a tumor that can be malignant (cancerous) or benign (noncancerous). When these cancerous cells start in the liver, it is known as primary liver cancer.
Hepatocellular carcinoma is a liver cancer with undifferentiated hepatocytes. Most people with HCC do not have signs until the disease is advanced. The most common symptoms include:
- Pain in the upper abdomen
- Abdominal swelling
- Abdominal mass
- Fluid in the abdomen
- Unexpected weight loss
- Nausea and vomiting
- Light-colored stool
There are several subtypes of HCC; however, the type does not usually affect treatment or outcomes. One rare subtype, fibrolamellar liver cancer, makes up less than 1% of HCCs and most often occurs in women under age 35. This subtype of liver cancer has the best prognosis overall.
What are the leading causes of liver cancer?
The most common risk factors for developing liver cancer are chronic hepatitis B or hepatitis C virus. According to the ACS, preventing hepatitis could significantly decrease liver cancer risk, potentially reducing incidence by half. Protecting patients from hepatitis will prevent the disease that leads to cirrhosis of the liver and increases the risk of liver cancer.
What is the hepatitis B virus?
Hepatitis B is a virus that causes an infection and inflammation of your liver. Some people develop an acute illness, which is a mild-infection that lasts for less than 6 months and may not warrant treatment. Others get chronic HBV, which is long-lasting and can cause inflammation and scarring, liver failure, liver cancer and even death.
One-third of people infected with HBV don’t have symptoms. In others, symptoms may not show up until 1 to 6 months following infection. Symptoms include:
- Jaundice (yellowing skin or whites of the eyes)
- Light-colored stool
- Brown or orange urine
- Constant fatigue
- Loss of appetite
- Abdominal pain
- Joint pain
How is hepatitis B transmitted?
HBV is spread through blood and body fluids. It can be spread through sex or by sharing needles. Healthcare providers are also at risk of needle sticks. Mothers can transmit HBV to their unborn children, but there are vaccinations and treatments that both mother and baby can receive to minimize transmission risk. Hepatitis B is not spread through kissing, coughing, sneezing, touching or sharing food, drink or eating utensils.
At what stage is hepatitis B contagious?
People infected with HBV that resolves on its own can test negative for the antigen (cells that fight the virus) about 15 weeks after their symptoms start. However, you can spread HBV even if you don’t feel ill. Most adults recover from HBV, and after several months they can no longer transmit the disease.
However, about 2% of adults and 90% of infants develop a chronic infection from HBV and remain contagious. The HBV vaccine is recommended for all individuals exposed to the virus.
What is the hepatitis C virus?
HCV causes liver inflammation and damage. Nearly 4 million people in the United States have HCV, and most don’t know it. HCV is often chronic and asymptomatic for decades. Symptoms include fatigue, loss of appetite, abdominal discomfort, nausea, vomiting and fever. Jaundice occurs in 1 of 4 people with HCV.
By the time symptoms appear, permanent damage may have occurred. Of those with hepatitis C, 2 in 5 fully recover. However, 60% experience chronic infection. About 1/3 of those with chronic HCV develop cirrhosis, and 20% of those develop liver cancer.
How is hepatitis C transmitted?
Hepatitis C is primarily transmitted by exposure to blood that contains the virus. Anyone born between 1945 and 1965 is 5 times more likely to be infected than any other generation. Experts believe this is because medical equipment wasn’t sterilized then as well as it is today. In fact, donated blood and organs were not screened for HCV until 1992. Testing for all seniors is recommended because baby boomers comprise nearly 75% of all cases.
Are hepatitis B and hepatitis C curable?
When treating hepatitis B and C, the goal is not to cure.
Treatment doesn’t cure hepatitis B, but it can turn an aggressive infection into a mild one and reduce long-term effects.
With hepatitis C, the goal is to achieve a sustained virologic response, which means the virus is undetectable in blood 12-24 weeks after ending treatment. Achieving SVR is the same as a cure for HCV because the disease does not return unless reinfection occurs. Minimizing the long-term effects of both types of hepatitis can eliminate cirrhosis, a significant risk factor for liver cancer.
The gift of time
Who is at risk of liver cancer?
Any condition that causes abnormal cells in the liver increases the risk of cancer. For instance, HBV and HCV are the most common risk factors for liver cancer. Other risk factors for liver cancer include:
- Cirrhosis, also known as scarring of the liver, causes permanent and worsening damage to the liver
- Genetic liver diseases, like hemochromatosis (overload of iron in organs) and Wilson’s disease (accumulation of copper in organs)
- Type 2 diabetes increases the risk by 2 to 3 times
- Nonalcoholic fatty liver disease for those who drink little to no alcohol, but have too much fat stored in liver cells
- Exposure to aflatoxins, which are carcinogens produced by certain molds in soil, decaying vegetation, hay and grains
- Excessive alcohol consumption, because alcohol is filtered through the liver and excessive drinking can cause scarring and permanent liver damage
- Smoking, because the carcinogens from tobacco cause stress to the liver
- Obesity, because an elevated BMI and large waist circumference increase cancer risk
- Exposure to arsenic, vinyl chloride and herbicides
Can liver cancer be prevented?
You can’t prevent liver cancer, but you can take steps to reduce your risk of developing the disease. The most important step is to adhere to a healthy lifestyle, which includes:
- Exercise regular.
- Maintain a healthy weight; if your current weight is in a healthy range, maintain it. If you need to lose weight, focus on a healthy diet and increase your activity.
- Drink alcohol in moderation, 1 drink daily for women and 2 drinks for men.
- Eat a healthy diet that includes grapefruit, cranberries, blueberries, grapes, cruciferous vegetables, nuts, seeds, fish and olive oil, which can decrease your risk for liver disease. Avoid fatty foods to improve liver health.
Avoid infection with hepatitis B and C viruses by getting vaccinated. The hepatitis B vaccination saves lives. There is no vaccination for hepatitis C at this time. Additional steps you can take include using a condom during sexual intercourse, not using intravenous drugs and using reputable tattoo and piercing shops.
How can you detect liver cancer early?
Blood tests, such as the following, can track abnormalities in liver function:
- At-risk population screening blood tests for those who are at high risk for hepatitis B and C. In pregnancy, most women will be tested for hepatitis. If you are at high risk for hepatitis, you should be screened.
- Liver function blood tests are often done routinely as part of a complete metabolic profile during annual exams.
- See your healthcare provider annually and report any abnormal signs or symptoms.
How is liver cancer diagnosed?
If any blood work is abnormal, further testing will be done to determine a diagnosis. Liver cancer is diagnosed by:
- Computed tomography scan, which is X-ray imaging with a contrast dye that produces a detailed image of soft tissues in the body.
- Positron emission tomography scanning, which uses a camera that visualizes organs in your body from a radioactive tracer (sugar) injected into your veins. Cancer cells use sugar more than normal cells, so the tracer shows up in cancer cells.
- Endoscopic ultrasound, which combines endoscopy and ultrasound and significantly improves the ability to diagnose liver cancer.
- A liver biopsy, which involves inserting a long needle between 2 of the right lower ribs to obtain a liver tissue sample. The tissue sample goes to the lab where a pathologist examines the cells for cancer. The biopsy has risks such as bleeding, infection and death.
After the diagnosis, more information is necessary to describe the location of the cancer, whether the cancer has spread, the stage of the cancer and the cancer treatment plan.
How is liver cancer treated?
There are a number of treatments available for liver cancer, including:
- Systemic therapies like immunotherapy, targeted therapy and chemotherapy, can be used to destroy cancer cells.
- Partial hepatectomy
- Liver transplant at The University of Kansas Health System, which is a regional leader in liver transplant and has performed more than 1,100 procedures since 1990.
- Radiation therapy, which involves high-dose X-rays to shrink tumors and kill cancer cells.
- Interventional radiology
- Embolization cuts off the blood supply to the tumor.
- Radiofrequency ablation destroys tumors with heat.
- Chemoembolization injects anticancer drugs directly into the blood vessel that feeds the tumor’s blood supply.
- Microwave ablation injects microwave energy through a needle to destroy cells.
- Calypso 4D localization tracks movement of the specific tissue to properly deliver energy.
- Radioembolization uses radioactive glass beads to treat cancer and is typically combined with chemotherapy.
The University of Kansas Cancer Center offers new-generation treatments including targeted chemotherapy, minimally invasive surgery, liver transplants, chemoembolization, radiofrequency ablation and TheraSphere therapy.
Can you fully recover from liver cancer?
Yes, it is possible to recover from liver cancer. Those with early-stage liver cancer who have had a liver transplant have a 5-year survival rate of about 80%.
The Surveillance Epidemiology and End Results Program of the National Cancer Institute provides information on cancer survival statistics. For liver cancer, the SEER survival rates are:
- Localized cancer - 33%
- Regional cancer - 11%
- Distant cancer - 2%
- All stages combined - 18%
A liver cancer prognosis relates to the extent of the spread of the cancer. As liver cancer progresses and spreads, survival rates decline.
Why choose The University of Kansas Cancer Center for liver cancer diagnosis and treatment?
The University of Kansas Cancer Center focuses and provides leading-edge treatments for liver cancer. Our collaborative, interdisciplinary team of specialized doctors focus on liver disease and provide you with collaborative care. This team includes hepatologists, hepatobiliary surgeons, medical oncologists, interventional radiologists, nurse practitioners, nurses and clinical providers. We also offer the most current clinical trials – giving you access to brand-new therapies before they are available anywhere else. These research studies provide additional opportunities for preventing, diagnosing and treating liver cancer.
The University of Kansas Health System has a hepatology clinic that cares for people with liver disease, including hepatitis and liver cancer. The health system also offers consultations with other skilled experts for a seamless transition.