Liver Cancer - Types, Symptoms, Causes Risks, Diagnosis, Treatment and Prevention

Liver Cancer: Overview

Liver cancer refers to the abnormal growth and spread of unhealthy cells in the liver. It can either originate in the liver itself or spread from other parts of the body.

• Primary liver cancer begins in the liver. The most common type is hepatocellular carcinoma (HCC), which starts in the main liver cells called hepatocytes.
• Secondary or metastatic liver cancer occurs when cancer spreads to the liver from other organs such as the colon, stomach, pancreas, lungs, or breasts.

Liver cancer is one of the leading causes of cancer-related deaths globally. It is often diagnosed at a later stage, which can make treatment more complex. Early detection and timely medical intervention are key to improving outcomes and managing symptoms effectively.

Is a Liver Tumor the Same as Liver Cancer?

Not necessarily. A liver tumor refers to any abnormal mass in the liver. These tumors can be:

• Benign (non-cancerous) – such as hepatic hemangiomas or focal nodular hyperplasia, which typically do not spread or become life-threatening.
• Malignant (cancerous) – such as Hepatocellular Carcinoma (HCC), which can grow aggressively and spread to other organs.

So, while all liver cancers are liver tumors, not all liver tumors are cancer. A proper medical evaluation is required to determine the nature of the tumor.

Types of Cancer That Affect the Liver

Liver cancer can be classified into two main types based on where it originates:

1. Primary Liver Cancer

This type of cancer starts in the liver itself. The most common form is:

• Hepatocellular Carcinoma (HCC): Originates in the main type of liver cells called hepatocytes. It is the most frequently diagnosed type of primary liver cancer.

Other less common types include:

• Intrahepatic Cholangiocarcinoma (bile duct cancer): Begins in the bile ducts inside the liver.
• Hepatoblastoma: A rare liver cancer that mostly affects young children.

2. Secondary (Metastatic) Liver Cancer

Also known as liver metastasis, this type of cancer starts in another organ—such as the colon, breast, stomach, pancreas, or lungs—and spreads to the liver.

Since the liver filters blood from various parts of the body, it is a common site for cancer cells to spread to from other locations.

Causes of Liver Cancer

Focus: Direct causes or triggers—what biologically or environmentally leads to liver cancer.

This section should answer “What triggers liver cancer to form?”

Content may include:

• Hepatitis B and  Hepatitis C infections
• Cirrhosis (from alcohol, hepatitis, Fatty Liver disease)
• Aflatoxins (from mold-contaminated grains/nuts)
• Exposure to toxins (arsenic, vinyl chloride, thorotrast, etc.)
• Long-term alcohol abuse
• Smoking
• Metabolic disorders (e.g., Wilson’s disease, hemochromatosis)

Who is at Higher Risk for Liver Cancer?

Liver cancer doesn’t affect everyone equally. Certain individuals are more likely to develop the disease due to specific risk factors. These aren’t direct causes but increase the chances of getting liver cancer over time.

Key Risk Factors Include:

1. Chronic Hepatitis B or C Infection

People with long-term hepatitis B or C infections are at significantly higher risk, as these viruses cause liver inflammation and damage that may lead to cancer.

2. Cirrhosis

A major risk factor, cirrhosis involves scarring of the liver due to chronic liver damage. It may be caused by viral infections, alcohol abuse, or fatty liver disease.

3. Age Group

Liver cancer is more common in adults aged 40 to 60 years.

4. Male Gender

Men are more likely to develop liver cancer than women, possibly due to lifestyle-related factors and hormone influences.

5. Diabetes and Obesity

These conditions are linked to non-alcoholic fatty liver disease (NAFLD), which may progress to cirrhosis and increase the risk of liver cancer.

6. Family History

Having close relatives with liver cancer or chronic liver disease can increase your risk due to shared genetics or environment.

7. Smoking

Tobacco use is associated with a higher likelihood of developing several cancers, including liver cancer.

8. Exposure to Toxins

Substances such as:

• Aflatoxins (found in moldy grains and nuts)
• Arsenic (in contaminated drinking water)
• Vinyl chloride (industrial chemical)
• Anabolic steroids (used over long periods)

Symptoms of Liver Cancer

Early-stage liver cancer often presents no noticeable symptoms. Many cases are discovered incidentally during routine health check-ups or imaging tests. However, as the tumor grows or the disease progresses, the following signs and symptoms may appear:

Common Symptoms of Liver Cancer

• Unexplained weight loss
• Loss of appetite or early satiety (feeling full quickly)
• Fatigue and general weakness
• Upper abdominal pain or discomfort
• A lump or mass in the right upper abdomen
• Abdominal swelling due to fluid accumulation (ascites)
• Yellowing of the skin and eyes (Jaundice)
• Nausea or vomiting
• Swelling in the legs (edema)
• Fever (in some cases)

Symptoms in Patients with Chronic Liver Disease (Cirrhosis)

• Sudden worsening of liver function
• Abdominal distension
• Altered mental status or confusion (hepatic encephalopathy)
• Dark-colored stools or blood in vomit (GI bleeding)

Symptoms of Metastatic Liver Cancer

• Similar symptoms as primary liver cancer, including fatigue, weight loss, and jaundice
• Symptoms related to the original cancer site (e.g., breast, colon, or lung)

Rare Complications: Paraneoplastic Syndromes

In rare cases, liver cancer may lead to paraneoplastic syndromes, which are group of symptoms caused by the immune system’s reaction to cancer, not the tumor itself. These may affect:

• Muscles and joints
• Hormone levels (endocrine system)
• Blood cell counts (hematologic system)
• Heart, kidneys, or gastrointestinal tract

How is Liver Cancer Diagnosed?

Liver cancer is often first detected through a routine ultrasound scan of the abdomen, especially in individuals undergoing health check-ups or those with chronic liver disease.

Once a suspicious mass or tumor is identified on ultrasound, your doctor may recommend a contrast-enhanced CT scan or MRI of the abdomen, known as a triphasic scan. This specialized imaging helps in accurately characterizing the liver tumor.

If the imaging shows distinctive features of hepatocellular carcinoma (HCC)—the most common type of primary liver cancer—a biopsy may not be necessary. In such cases, treatment decisions, including surgery, can be made based on the imaging results alone.

However, if the scan results are inconclusive or if the tumor appears unusual, a liver biopsy may be advised to confirm the diagnosis.

Treatment for Liver Cancer

Liver cancer treatment depends on the cancer type, stage, size and number of tumors, overall liver function, and the patient's health. The Barcelona Clinic Liver Cancer (BCLC) staging system is often used to guide treatment.

1. Surgical Options

• Liver Resection (Hepatectomy): When the tumor is limited and the rest of the liver is healthy, surgery to remove the affected part can be curative.
• Liver Transplant: In cases of liver cancer with underlying liver disease (like cirrhosis), a liver transplant may be the best option—if the patient meets specific criteria regarding tumor size and number.

2. Non-Surgical and Minimally Invasive Treatments

• Ablation Therapies:
  Techniques like Radiofrequency Ablation (RFA) or Microwave Ablation (MWA) use heat to destroy cancer cells and are effective for small tumors.
• TACE (Transarterial Chemoembolization):
  A catheter-based procedure that delivers chemotherapy directly to the liver tumor and blocks its blood supply to limit its growth.
• TARE (Transarterial Radioembolization):
  Similar to TACE, but uses radioactive particles to target tumors with internal radiation.

3. Advanced Therapies

• Targeted Therapy:
  Oral medications like sorafenib or regorafenib block cancer cell growth and are typically used in advanced stages.
• Immunotherapy:
  Helps boost the body's immune response against cancer cells and may be used when other treatments are less effective.
• Proton Beam Therapy:
  Proton Therapy is an advanced form of radiation that delivers highly precise, high-dose radiation directly to the tumor while sparing surrounding healthy tissue.
  Apollo Hospitals is among the few centers in Asia offering this cutting-edge technology, particularly beneficial for liver tumors located near sensitive structures.

Can Part of Your Liver Be Removed If You Have Liver Cancer?

Yes, in many cases, part of the liver can be surgically removed to treat liver cancer. This procedure is called liver resection or hepatectomy, and it is a potentially curative option — especially when the cancer is detected early and confined to one part of the liver.

When Is Liver Resection an Option?

Liver resection is considered based on:

• The type and extent of the tumor
• The overall health and liver function of the patient
• Whether the cancer has spread beyond the liver

This treatment is most commonly used for primary liver cancers, such as:

• Hepatocellular carcinoma (HCC)
• Intrahepatic cholangiocarcinoma

In patients with healthy liver function, up to 70–75% of the liver can be removed safely, thanks to the liver’s remarkable ability to regenerate. For patients with underlying liver conditions like cirrhosis, a larger portion of healthy liver (at least 40%) needs to remain intact to support recovery.

What About Liver Cancer That Has Spread From Other Organs?

When liver cancer originates elsewhere in the body (such as the colon or breast) and spreads to the liver, known as metastatic liver cancer, surgery may still be an option in some cases. The choice depends on:

• The origin of the primary cancer
• The number and size of liver lesions
• Overall health and liver reserve

In such cases, doctors may also consider other treatments like radiofrequency ablation, TACE/TARE, chemotherapy, or targeted therapies.

In Summary:

• Yes, part of your liver can be safely removed in many liver cancer cases.
• The decision depends on careful assessment by a multidisciplinary medical team.
• Thanks to the liver’s ability to regenerate, liver resection remains one of the most effective treatment options when possible.

Management of Liver Cancer in the Last Stage

When liver cancer reaches an advanced or metastatic stage, it means the cancer has spread to nearby lymph nodes or distant organs. At this stage, surgical options are no longer viable, and the focus shifts to controlling the disease, relieving symptoms, and improving quality of life.

Treatment Options for Advanced Liver Cancer

1. Targeted Therapy & Immunotherapy

For patients with relatively well-functioning liver (Child-Pugh Class A or B), doctors may recommend:

• Atezolizumab (Tecentriq) + Bevacizumab (Avastin) – A combination of immunotherapy and targeted therapy.
• Sorafenib (Nexavar) or Lenvatinib (Lenvima) – These targeted drugs help slow cancer growth and may improve survival.

2. Radiation Therapy

While not a cure, radiation may be used to:

• Shrink tumors
• Relieve pain
• Ease symptoms like bleeding or blockages

3. Clinical Trials

Advanced liver cancer patients may benefit from participating in clinical trials that test:

• New immunotherapy combinations
• Novel targeted drugs
• Advanced radiation techniques
• Innovative chemotherapy delivery methods

Clinical trials may offer hope when standard treatments are no longer effective.

Palliative Care: Comfort and Support

If curative treatments are not possible, palliative care becomes essential. It focuses on:

• Relieving symptoms such as pain, fatigue, nausea, and fluid buildup
• Supporting emotional and psychological wellbeing
• Improving quality of life for both the patient and their family

Palliative care can be provided alongside medical treatment or as the main focus in end-stage disease.

How to Prevent or Reduce the Risk of Liver Cancer

While not all liver cancers can be prevented, you can significantly reduce your risk by making informed lifestyle choices and managing underlying conditions. Key prevention tips include:

1. Get Vaccinated Against Hepatitis B

Hepatitis B infection is a major risk factor for liver cancer. Vaccination is safe, effective, and widely recommended—especially for infants, healthcare workers, and high-risk individuals.

2. Prevent and Treat Hepatitis C

There’s no vaccine for hepatitis C, but it can be prevented by:

• Practicing safe sex
• Avoiding sharing needles or other drug paraphernalia
• Using sterilized equipment for tattoos and piercings

If already infected, early detection and antiviral treatment can reduce the risk of liver damage and cancer.

3. Avoid or Limit Alcohol Consumption

Chronic alcohol use can lead to liver cirrhosis, which significantly raises liver cancer risk. Reducing or quitting alcohol can lower this risk.

4. Adopt a Healthy Lifestyle

• Maintain a healthy weight through regular exercise and a balanced diet.
• Avoid high-sugar, high-fat, and processed foods to prevent non-alcoholic fatty liver disease (NAFLD).
• Quit smoking, as it increases cancer risk in general, including liver cancer.

5. Manage Medical Conditions

• Diabetes and obesity are linked to liver disease and cancer. Control these conditions through lifestyle changes and medication if needed.
• Undergo regular check-ups if you have chronic liver disease or cirrhosis. Surveillance programs can help detect liver cancer early when treatment is most effective.

6. Avoid Exposure to Liver-damaging Substances

• Limit exposure to aflatoxins (toxins from moldy grains and nuts) by storing food properly.
• Avoid industrial chemicals like vinyl chloride and arsenic-contaminated water wherever possible.

Conclusion

Liver cancer is a serious condition, but understanding its causes, risk factors, and symptoms can help in early detection and better outcomes. While anyone can develop liver cancer, certain factors such as chronic hepatitis infections, cirrhosis, obesity, diabetes, and a family history of liver disease increase the risk.

The good news is that liver cancer is often preventable. Vaccination against hepatitis B, managing existing liver conditions, maintaining a healthy lifestyle, and avoiding harmful substances like alcohol and tobacco can significantly reduce the risk.

If you're at higher risk, regular check-ups and liver screenings are essential. Early diagnosis greatly improves the chances of successful treatment. Whether through surgery, transplant, targeted therapy, or supportive care, a timely approach makes a big difference in managing liver cancer.

Always consult your doctor if you notice any symptoms or have concerns about your liver health.