Adult Primary Liver Cancer Treatment (PDQ®)
NCI PDQ® Summaries for Patients
General Information About Adult Primary Liver Cancer
Stages of Adult Primary Liver Cancer
Recurrent Adult Primary Liver Cancer
Treatment Option Overview
Treatment Options for Adult Primary Liver Cancer
To Learn More About Adult Primary Liver Cancer
Get More Information From NCI
Changes to This Summary (01/20/2010)
About PDQ
Adult Primary Liver Cancer Treatment
General Information About Adult Primary Liver Cancer
Adult primary liver cancer is a disease in which malignant (cancer) cells form in
the tissues of the liver.
The liver
is one of the largest organs
in the body. It has four lobes
and fills the upper right side of the abdomen
inside the rib cage. The liver has many important functions, including:
- Filtering harmful substances from the blood
so they can be passed from the body in stools
and urine
.
- Making bile
to help digest fats from food.
- Storing glycogen (sugar), which the body uses for energy.
Anatomy of the liver. The liver is in the upper abdomen near the stomach, intestines, gallbladder, and pancreas. The liver has four lobes. Two lobes are on the front and two small lobes (not shown) are on the back of the liver.
This summary refers to the treatment of primary
liver cancer
(cancer
that begins in the liver). Treatment of metastatic
liver cancer, which is cancer that begins in other parts of the body and spreads to the liver, is not discussed in this summary. Primary liver cancer can occur in both adults and children. Treatment for children, however, is different than treatment for adults. (Refer to the PDQ summary on Childhood Liver Cancer Treatment for more information.)
Having hepatitis or cirrhosis can affect the risk of developing adult primary liver cancer.
Anything that increases your chance of getting a disease is called a risk factor
. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. The following are possible risk factors for adult primary liver cancer:
- Having hepatitis B
and/or hepatitis C
.
- Having a close relative with both hepatitis and liver cancer.
-
Having cirrhosis
.
- Eating foods tainted with aflatoxin
(poison from a fungus
that can grow on foods, such as grains and nuts, that have not been stored properly).
Possible signs of adult primary liver cancer include a lump or pain on the right side.
These symptoms
may be caused by swelling of the liver. These and other symptoms may be caused by adult primary liver cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
- A hard lump on the right side just below the rib cage.
-
Discomfort in the upper abdomen on the right side.
-
Pain around the right shoulder blade.
- Unexplained weight loss.
- Jaundice
(yellowing of the skin and whites of the eyes).
- Unusual tiredness.
- Nausea.
- Loss of appetite.
Tests that examine the liver and the blood are used to detect (find) and diagnose adult primary liver cancer.
The following tests and procedures may be used:
- Physical exam
and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Serum tumor marker test
: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues
, or tumor
cells
in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers
. An increased level of alpha-fetoprotein
(AFP) in the blood may be a sign of liver cancer. Other cancers and certain noncancerous conditions, including cirrhosis and hepatitis, may also increase AFP levels.
- Complete blood count
(CBC): A procedure in which a sample of blood is drawn and checked for the following:
- Laparoscopy
: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions
(cuts) are made in the wall of the abdomen and a laparoscope
(a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy
.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The sample may be taken using a thin needle inserted into the liver during an x-ray
or ultrasound
. This is called a fine-needle aspiration (FNA) biopsy
. The biopsy may be done during a laparoscopy
.
- CT scan
(CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye
may be injected
into a vein
or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- MRI
(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Ultrasound
exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram
. The picture can be printed to be looked at later.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis
(chance of recovery) and treatment options depend on the following:
- The stage
of the cancer (the size of the tumor
, whether it affects part or all of the liver, or has spread to other places in the body).
- How well the liver is working.
- The patient’s general health, including whether there is cirrhosis of the liver.
Prognosis is also affected by alpha-fetoprotein (AFP) levels.
Stages of Adult Primary Liver Cancer
After adult primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body.
The process used to find out if cancer
has spread within the liver
or to other parts of the body is called staging
. The information gathered from the staging process determines the stage
of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging
process:
- Chest x-ray
: An x-ray
of the organs
and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- CT scan
(CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye
may be injected
into a vein
or swallowed to help the organs or tissues
show up more clearly. This procedure is also called computed tomography,
computerized tomography, or computerized axial tomography.
- MRI
(magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Bone scan
: A procedure to check if there are rapidly dividing cells
, such as cancer cells, in the bone. A very small amount of radioactive
material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
- Doppler ultrasound
: A type of ultrasound that uses differences in the ultrasound echoes to measure the speed and direction of blood
flow.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue
. Cancer invades
the surrounding normal tissue.
- Through the lymph system
. Cancer invades the lymph system and travels through the lymph vessels
to other places in the body.
- Through the blood
. Cancer invades the veins
and capillaries
and travels through the blood to other places in the body.
When cancer cells
break away from the primary
(original) tumor
and travel through the lymph
or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis
. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer
spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer
.
The following stages are used for adult primary liver cancer:
Stage I
In stage I
, there is one tumor
and it has not spread to nearby blood vessels
.
Pea, peanut, walnut, and lime show tumor sizes.
Stage II
In stage II
, one of the following is found:
Stage III
Stage III is divided into Stage IIIA, IIIB, and IIIC.
Stage IV
In stage IV
, cancer
has spread beyond the liver
to other places in the body, such as the bones or lungs
. The tumors
may be of any size and may also have spread to nearby blood vessels
and/or lymph nodes
.
For adult primary liver cancer, stages are also grouped according to how the cancer may be treated. There are 3 treatment groups:
Localized resectable
The cancer
is found in the liver
only, has not spread, and can be completely removed by surgery
.
Localized and locally advanced unresectable
The cancer
is found in the liver
only and has not spread, but cannot be completely removed by surgery
.
Advanced
Cancer
has spread throughout the liver
or has spread to other parts of the body, such as the lungs
and bone.
Recurrent Adult Primary Liver Cancer
Recurrent
adult primary
liver cancer
is cancer
that has recurred (come back) after it has been treated. The cancer may come back in the liver
or in other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with adult primary liver cancer.
Different types of treatments are available for patients with adult primary
liver cancer
. Some treatments are standard
(the currently used treatment), and some are being tested in clinical trials
. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer
. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
Surgery
The following types of surgery
may be used to treat liver cancer:
- Cryosurgery
: A treatment that uses an instrument to freeze and destroy abnormal
tissue
, such as carcinoma in situ
. This type of treatment is also called cryotherapy. The doctor may use ultrasound
to guide the instrument.
- Partial hepatectomy
: Removal of the part of the liver
where cancer is found. The part removed may be a wedge
of tissue, an entire lobe
, or a larger portion of the liver, along with some of the healthy tissue around it. The remaining liver tissue takes over the functions of the liver.
- Total hepatectomy and liver transplant
: Removal of the entire liver and replacement with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.
- Radiofrequency ablation
: The use of a special probe with tiny electrodes that kill cancer cells
. Sometimes the probe is inserted directly through the skin and only local anesthesia
is needed. In other cases, the probe is inserted through an incision
in the abdomen
. This is done in the hospital with general anesthesia
.
Radiation therapy
Radiation therapy
is a cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. Radiation therapy is given in different ways:
- External radiation
therapy uses a machine outside the body to send radiation toward the cancer.
- Internal radiation
therapy uses a radioactive
substance sealed in needles, seeds
, wires, or catheters
that are placed directly into or near the cancer.
- Drugs
called radiosensitizers
may be given with the radiation therapy to make the cancer cells more sensitive to radiation therapy.
- Radiation may be delivered to the tumor
using radiolabeled
antibodies
. Radioactive substances are attached to antibodies made in the laboratory. These antibodies, which target tumor cells, are injected
into the body and the tumor cells are killed by the radioactive substance.
The way the radiation therapy is given depends on the type and stage
of the cancer being treated.
Chemotherapy
Chemotherapy
is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein
or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy
). When chemotherapy is placed directly into the spinal column
, an organ
, or a body cavity
such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy
).
Regional chemotherapy is usually used to treat liver cancer. A small pump containing anticancer drugs may be placed in the body. The pump puts the drugs directly into the blood vessels
that go to the tumor.
Another type of regional chemotherapy is chemoembolization
of the hepatic artery
. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance that blocks the artery, cutting off blood
flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumor is prevented from getting the oxygen and nutrients
it needs to grow. The liver continues to receive blood from the hepatic portal vein
, which carries blood from the stomach
and intestine
.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Percutaneous ethanol injection
Percutaneous ethanol injection
is a cancer treatment in which a small needle is used to inject ethanol (alcohol) directly into a tumor to kill cancer cells. The procedure may be done once or twice a week. Usually local anesthesia
is used, but if the patient has many tumors in the liver, general anesthesia may be needed.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials
. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Hyperthermia therapy
Hyperthermia therapy
is a type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. Because some cancer cells are more sensitive to heat than normal cells are, the cancer cells die and the tumor shrinks.
Biologic therapy
Biologic therapy
is a treatment that uses the patient’s immune system
to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial
may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring
(coming back) or reduce the side effects
of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's
clinical trials database.
Follow-up tests may be needed.
Some of the tests that were done to diagnose
the cancer or to find out the stage
of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred
(come back). These tests are sometimes called follow-up
tests or check-ups.
Treatment Options for Adult Primary Liver Cancer
A link to a list of current clinical trials
is included for each treatment section. For some types or stages
of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Localized Resectable Adult Primary Liver Cancer
Treatment of localized
resectable
adult primary
liver cancer
may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized resectable adult primary liver cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Localized and Locally Advanced Unresectable Adult Primary Liver Cancer
Treatment of localized
and locally advanced
unresectable
adult primary
liver cancer
may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized unresectable adult primary liver cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Advanced Adult Primary Liver Cancer
There is no standard treatment
for advanced adult primary
liver cancer
. Patients may consider taking part in a clinical trial
. Treatment may be a clinical trial of biologic therapy
, chemotherapy
, and/or radiation therapy
with or without radiosensitizers
. These treatments may be given as palliative therapy
to help relieve symptoms
and improve the quality of life
.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with advanced adult primary liver cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Recurrent Adult Primary Liver Cancer
Treatment of recurrent
adult primary
liver cancer
may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent adult primary liver cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
To Learn More About Adult Primary Liver Cancer
For more information from the National Cancer Institute
about adult primary liver cancer, see the following:
For general cancer
information and other resources from the National Cancer Institute, see the following:
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Changes to This Summary (01/20/2010)
The PDQ
cancer
information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Images were added to this summary.
About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
Date last modified: 2010-01-20