Liver Cancer Overview
The liver has many important functions in the body. For example, it cleans toxins from the blood, makes bile that helps digest fat, makes substances that help blood clot, and makes, stores, and releases sugar for energy.
Primary liver cancer is cancer that starts in the liver. The most common type of primary liver cancer is hepatocellular carcinoma, which occurs in the tissue of the liver. When cancer starts in other parts of the body and spreads to the liver, it is called liver metastasis.
Liver cancer is rare in children and teenagers, but there are two types of liver cancer that can form in children. Hepatoblastoma occurs in younger children, and hepatocellular carcinoma occurs in older children and teenagers.
The bile ducts are tubes that carry bile between the liver and gallbladder and the intestine. Bile duct cancer is also called cholangiocarcinoma. When it begins in the bile ducts inside the liver, it is called intrahepatic cholangiocarcinoma. When it begins in the bile ducts outside the liver, it is called extrahepatic cholangiocarcinoma. Extrahepatic cholangiocarcinoma is much more common than intrahepatic cholangiocarcinoma.
Source: NCI
Adult Primary Liver Cancer Treatment (PDQ®)-Patient Version
Key Points
- Adult primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver.
- There are two types of adult primary liver cancer.
- Having hepatitis or cirrhosis can affect the risk of adult primary liver cancer.
- Signs and symptoms of adult primary liver cancer include a lump or pain on the right side.
- Tests that examine the liver and the blood are used to detect (find) and diagnose adult primary liver cancer.
- Certain factors affect prognosis (chance of recovery) and treatment options.
lt 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. Three of the many important functions of the liver are:
- To filter harmful substances from the blood so they can be passed from the body in stools and urine.
- To make bile to help digest fat that comes from food.
- To store 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.
There are two types of adult primary liver cancer.
The two types of adult primary liver cancer are:
- Hepatocellular carcinoma.
- Cholangiocarcinoma (bile duct cancer).
The most common type of adult primary liver cancer is hepatocellular carcinoma. This type of liver cancer is the third leading cause of cancer-related deaths worldwide.
This summary is about the treatment of primary liver cancer (cancer that begins in the liver). Treatment of cancer that begins in other parts of the body and spreads to the liver is not covered in this summary.
Primary liver cancer can occur in both adults and children. However, treatment for children is different than treatment for adults.
Having hepatitis or cirrhosis can affect the risk of 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. Talk with your doctor if you think you may be at risk.
The following are risk factors for adult primary liver cancer:
- Having hepatitis B or hepatitis C. Having both hepatitis B and hepatitis C increases the risk even more.
- Having cirrhosis, which can be caused by:
- hepatitis (especially hepatitis C); or
- drinking large amounts of alcohol for many years or being an alcoholic.
- Having metabolic syndrome, a set of conditions that occur together, including extra fat around the abdomen, high blood sugar, high blood pressure, high levels of triglycerides and low levels of high-density lipoproteins in the blood.
- Having liver injury that is long-lasting, especially if it leads to cirrhosis.
- Having hemochromatosis, a condition in which the body takes up and stores more iron than it needs. The extra iron is stored in the liver, heart, and pancreas
- 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).
Signs and symptoms of adult primary liver cancer include a lump or pain on the right side.
These and other signs and symptoms may be caused by adult primary liver cancer or by other conditions. Check with your doctor if you have any of the following:
- A hard lump on the right side just below the rib cage.
- Discomfort in the upper abdomen on the right side.
- A swollen abdomen.
- Pain near the right shoulder blade or in the back.
- Jaundice (yellowing of the skin and whites of the eyes).
- Easy bruising or bleeding.
- Unusual tiredness or weakness.
- Nausea and vomiting.
- Loss of appetite or feelings of fullness after eating a small meal.
- Weight loss for no known reason.
- Pale, chalky bowel movements and dark urine.
- Fever.
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. Sometimes the AFP level is normal even when there is liver cancer.
- Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver cancer.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen, 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. Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver. This is called triple-phase CT. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
- 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, such as the liver. This procedure is also called nuclear magnetic resonance imaging (NMRI). To create detailed pictures of blood vessels in and near the liver, dye is injected into a vein. This procedure is called MRA (magnetic resonance angiography). Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver. This is called triple-phase MRI.
- 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.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the sample of cells or tissues include the following:
- Fine-needle aspiration biopsy: The removal of cells, tissue or fluid using a thin needle.
- Core needle biopsy: The removal of cells or tissue using a slightly wider needle.
- 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. Another instrument is inserted through the same or another incision to remove the tissue samples.
A biopsy is not always needed to diagnose adult primary liver cancer.
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.
Key Points
- 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.
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the body.
- The Barcelona Clinic Liver Cancer Staging System may be used to stage adult primary liver cancer.
- The following groups are used to plan treatment.
- BCLC stages 0, A, and B
- BCLC stages C and D
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:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, 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).
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if primary liver cancer spreads to the lung, the cancer cells in the lung are actually liver cancer cells. The disease is metastatic liver cancer, not lung cancer.
The Barcelona Clinic Liver Cancer Staging System may be used to stage adult primary liver cancer.
There are several staging systems for liver cancer. The Barcelona Clinic Liver Cancer (BCLC) Staging System is widely used and is described below. This system is used to predict the patient’s chance of recovery and to plan treatment, based on the following:
- Whether the cancer has spread within the liver or to other parts of the body.
- How well the liver is working.
- The general health and wellness of the patient.
- The symptoms caused by the cancer.
The BCLC staging system has five stages:
- Stage 0: Very early
- Stage A: Early
- Stage B: Intermediate
- Stage C: Advanced
- Stage D: End-stage
The following groups are used to plan treatment.
- BCLC stages 0, A, and B
Treatment to cure the cancer is given for BCLC stages 0, A, and B.
- BCLC stages C and D
Treatment to relieve the symptoms caused by liver cancer and improve the patient’s quality of life is given for BCLC stages C and D. Treatments are not likely to cure the 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.
Key Points
- There are different types of treatment for patients with adult primary liver cancer.
- Patients with liver cancer are treated by a team of specialists who are experts in treating liver cancer.
- Seven types of standard treatment are used:
- Surveillance
- Surgery
- Liver transplant
- Ablation therapy
- Embolization therapy
- Targeted therapy
- Radiation therapy
- Patients can enter clinical trials before, during, or after starting their cancer treatment.
- Follow-up tests may be needed.
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.
Patients with liver cancer are treated by a team of specialists who are experts in treating liver cancer.
The patient’s treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. The medical oncologist may refer the patient to other health professionals who have special training in treating patients with liver cancer. These may include the following specialists:
- Hepatologist (specialist in liver disease).
- Surgical oncologist.
- Transplant surgeon.
- Radiation oncologist.
- Interventional radiologist (a specialist who diagnoses and treats diseases using imaging and the smallest incisions possible).
- Pathologist.
Seven types of standard treatment are used:
- Surveillance
Surveillance for lesions smaller than 1 centimeter found during screening. Follow-up every three months is common.
- Surgery
A partial hepatectomy (surgery to remove the part of the liver where cancer is found) may be done. A wedge of tissue, an entire lobe, or a larger part of the liver, along with some of the healthy tissue around it is removed. The remaining liver tissue takes over the functions of the liver and may regrow.
- Liver transplant
In a liver transplant, the entire liver is removed and replaced 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.
- Ablation therapy
Ablation therapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer:
- Radiofrequency ablation: The use of special needles that are inserted directly through the skin or through an incision in the abdomen to reach the tumor. High-energy radio waves heat the needles and tumor which kills cancer cells.
- Microwave therapy: A type of treatment in which the tumor is exposed to high temperatures created by microwaves. This can damage and kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs.
- Percutaneous ethanol injection: A cancer treatment in which a small needle is used to inject ethanol (pure alcohol) directly into a tumor to kill cancer cells. Several treatments may be needed. Usually local anesthesia is used, but if the patient has many tumors in the liver, general anesthesia may be used.
- Cryoablation: A treatment that uses an instrument to freeze and destroy cancer cells. This type of treatment is also called cryotherapy and cryosurgery. The doctor may use ultrasound to guide the instrument.
- Electroporation therapy: A treatment that sends electrical pulses through an electrode placed in a tumor to kill cancer cells. Electroporation therapy is being studied in clinical trials.
Embolization therapy is the use of substances to block or decrease the flow of blood through the hepatic artery to the tumor. When the tumor does not get the oxygen and nutrients it needs, it will not continue to grow. Embolization therapy is used for patients who cannot have surgery to remove the tumor or ablation therapy and whose tumor has not spread outside the liver.
The liver receives blood from the hepatic portal vein and the hepatic artery. Blood that comes into the liver from the hepatic portal vein usually goes to the healthy liver tissue. Blood that comes from the hepatic artery usually goes to the tumor. When the hepatic artery is blocked during embolization therapy, the healthy liver tissue continues to receive blood from the hepatic portal vein.
There are two main types of embolization therapy:
- Transarterial embolization (TAE): A small incision (cut) is made in the inner thigh and a catheter (thin, flexible tube) is inserted and threaded up into the hepatic artery. Once the catheter is in place, a substance that blocks the hepatic artery and stops blood flow to the tumor is injected.
- Transarterial chemoembolization (TACE): This procedure is like TAE except an anticancer drug is also given. The procedure can be done by attaching the anticancer drug to small beads that are injected into the hepatic artery or by injecting the anticancer drug through the catheter into the hepatic artery and then injecting the substance to block the hepatic artery. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. This type of treatment is also called chemoembolization.
Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Adult liver cancer may be treated with a targeted therapy drug that stops cells from dividing and prevents the growth of new blood vessels that tumors need to grow.
- 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. There are two types of radiation therapy:
- External radiation therapy uses a machine outside the body to send radiation toward the cancer. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of external radiation therapy include the following:
- Conformal radiation therapy: Conformal radiation therapy is a type of external radiation therapy that uses a computer to make a 3-dimensional (3-D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue.
- Stereotactic body radiation therapy: Stereotactic body radiation therapy is a type of external radiation therapy. Special equipment is used to place the patient in the same position for each radiation treatment. Once a day for several days, a radiation machine aims a larger than usual dose of radiation directly at the tumor. By having the patient in the same position for each treatment, there is less damage to nearby healthy tissue. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.
- Proton beam radiation therapy: Proton-beam therapy is a type of high-energy, external radiation therapy. A radiation therapy machine aims streams of protons (tiny, invisible, positively-charged particles) at the cancer cells to kill them. This type of treatment causes less damage to nearby healthy tissue.
- Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat adult primary liver cancer.
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 listing of clinical trials.
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.
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.
- Stages 0, A, and B Adult Primary Liver Cancer
Treatment of stages 0, A, and B adult primary liver cancer may include the following:
- Surveillance for lesions smaller than 1 centimeter.
- Partial hepatectomy.
- Total hepatectomy and liver transplant.
- Ablation of the tumor using one of the following methods:
- Radiofrequency ablation.
- Microwave therapy.
- Percutaneous ethanol injection.
- Cryoablation.
- A clinical trial of electroporation therapy.
Stages C and D Adult Primary Liver Cancer
Treatment of stages C and D adult primary liver cancer may include the following:
- Embolization therapy using one of the following methods:
- Transarterial embolization (TAE).
- Transarterial chemoembolization (TACE).
- Targeted therapy.
- Radiation therapy.
- A clinical trial of targeted therapy after chemoembolization or combined with chemotherapy.
- A clinical trial of new targeted therapy drugs.
- A clinical trial of targeted therapy with or without stereotactic body radiation therapy.
- A clinical trial of stereotactic body radiation therapy or proton-beam radiation therapy.
Treatment options for recurrent adult primary liver cancer may include the following:
- Total hepatectomy and liver transplant.
- Partial hepatectomy.
- Ablation
- Transarterial chemoembolization and targeted therapy with sorafenib, as palliative therapy to relieve symptoms and improve quality of life.
- A clinical trial of a new treatment.
Childhood Liver Cancer Treatment (PDQ®)-Patient Version
Key Points
- Childhood liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver.
- There are different types of childhood liver cancer.
- Certain diseases and disorders can increase the risk of childhood liver cancer.
- Signs and symptoms of childhood liver cancer include a lump or pain in the abdomen.
- Tests that examine the liver and the blood are used to detect (find) and diagnose childhood liver cancer and find out whether the cancer has spread.
- Certain factors affect prognosis (chance of recovery) and treatment options.
Childhood 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. Three of the many important functions of the liver are:
- To filter harmful substances from the blood so they can be passed from the body in stools and urine.
- To make bile to help digest fats from food.
- To store glycogen (sugar), which the body uses for energy.
Liver cancer is rare in children and adolescents.
There are different types of childhood liver cancer.
There are two main types of childhood liver cancer:
- Hepatoblastoma: Hepatoblastoma is the most common type of childhood liver cancer. It usually affects children younger than 3 years of age.
In hepatoblastoma, the histology (how the cancer cells look under a microscope) affects the way the cancer is treated. The histology for hepatoblastoma may be one of the following:
- Pure fetal histology.
- Small cell undifferentiated histology.
- Non-pure fetal histology, non-small cell undifferentiated histology.
- Hepatocellular carcinoma: Hepatocellular carcinoma usually affects older children and adolescents. It is more common in areas of Asia that have high rates of hepatitis infection than in the U.S.
Three less common types of childhood liver cancer include the following
- Undifferentiated embryonal sarcoma of the liver is a type of liver cancer that usually occurs in children between 5 and 10 years of age. It often spreads all through the liver and/or to the lungs.
- Infantile choriocarcinoma of the liver is a very rare tumor that starts in the placenta and spreads to the fetus. The tumor is usually found during the first few months of life. Also, the mother of the child may be diagnosed with choriocarcinoma. Choriocarcinoma is a type of gestational trophoblastic disease.
- Vascular liver tumors are tumors that form in the liver from cells that make blood vessels or lymph vessels. Vascular liver tumors may be benign (not cancer) or malignant (cancer).
This summary is about 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. However, treatment for children is different than treatment for adults.
Certain diseases and disorders can increase the risk of childhood 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. Talk with your child’s doctor if you think your child may be at risk.
Risk factors for hepatoblastoma include the following syndromes or conditions:
- Aicardi syndrome.
- Beckwith-Wiedemann syndrome.
- Familial adenomatous polyposis (FAP).
- Glycogen storage disease.
- A very low weight at birth.
- Simpson-Golabi-Behmel syndrome.
- Certain genetic changes, such as Trisomy 18.
Risk factors for hepatocellular carcinoma include the following syndromes or conditions:
- Alagille syndrome.
- Glycogen storage disease.
- Hepatitis B virus infection that was passed from mother to child at birth.
- Progressive familial intrahepatic disease.
- Tyrosinemia.
Some patients with tyrosinemia or progressive familial intrahepatic disease will have a liver transplant before there are signs or symptoms of cancer.
Signs and symptoms of childhood liver cancer include a lump or pain in the abdomen.
Signs and symptoms are more common after the tumor gets big. Other conditions can cause the same signs and symptoms. Check with your child’s doctor if your child has any of the following:
- A lump in the abdomen that may be painful.
- Swelling in the abdomen.
- Weight loss for no known reason.
- Loss of appetite.
- Nausea and vomiting.
Tests that examine the liver and the blood are used to detect (find) and diagnose childhood liver cancer and find out whether the cancer has spread.
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 blood sample is checked 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. The blood of children who have liver cancer may have increased amounts of a hormone called beta-human chorionic gonadotropin (β-hCG) or a protein called alpha-fetoprotein (AFP). Other cancers and certain noncancer conditions, including cirrhosis and hepatitis, can also increase AFP levels.
- Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the blood sample made up of red blood cells.
- Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver damage or cancer.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin or lactate dehydrogenase (LDH), released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
- Epstein-Barr virus (EBV) test: A blood test to check for antibodies to the EBV and DNA markers of the EBV. These are found in the blood of patients who have been infected with EBV.
- Hepatitis assay: A procedure in which a blood sample is checked for pieces of the hepatitis virus.
- MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the liver. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. 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. In childhood liver cancer, an ultrasound exam of the abdomen to check the large blood vessels is usually done.
- 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. In childhood liver cancer, a CT scan of the chest and abdomen is usually done.
- Abdominal x-ray: An x-ray of the organs in the abdomen. An x-ray is a type of energy beam that can go through the body onto film, making a picture of areas inside the body.
- Biopsy: The removal of a sample of cells or tissues so it can be viewed under a microscope to check for signs of cancer. The sample may be taken during surgery to remove or view the tumor. A pathologist looks at the sample under a microscope to find out the type of liver cancer.
The following test may be done on the sample of tissue that is removed:
- Immunohistochemistry: A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test is used to check for a certain gene mutation and to tell the difference between different types of cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options for hepatoblastoma depend on the following:
- The PRETEXT or POSTTEXT group.
- Whether the cancer has spread to other places in the body, such as the lungs or certain large blood vessels.
- Whether the cancer can be removed completely by surgery.
- How the cancer responds to chemotherapy.
- How the cancer cells look under a microscope.
- Whether the AFP blood levels go down after treatment.
- Whether the cancer has just been diagnosed or has recurred.
- Age of the child.
The prognosis (chance of recovery) and treatment options for hepatocellular carcinoma depend on the following:
- The PRETEXT or POSTTEXT group.
- Whether the cancer has spread to other places in the body, such as the lungs.
- Whether the cancer can be removed completely by surgery.
- How the cancer responds to chemotherapy.
- How the cancer cells look under a microscope.
- Whether the child has hepatitis B infection.
- Whether the cancer has just been diagnosed or has recurred.
For childhood liver cancer that recurs (comes back) after initial treatment, the prognosis and treatment options depend on:
- Where in the body the tumor recurred.
- The type of treatment used to treat the initial cancer.
Childhood liver cancer may be cured if the tumor is small and can be completely removed by surgery. Complete removal is possible more often for hepatoblastoma than for hepatocellular carcinoma.
Key Points
- After childhood 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.
- There are two grouping systems for childhood liver cancer.
- There are four PRETEXT and POSTTEXT groups:
- PRETEXT and POSTTEXT Group I
- PRETEXT and POSTTEXT Group II
- PRETEXT and POSTTEXT Group III
- PRETEXT and POSTTEXT Group IV
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the body.
After childhood 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, to nearby tissues or organs, or to other parts of the body is called staging. In childhood liver cancer, the PRETEXT and POSTTEXT groups are used instead of stage to plan treatment. The results of the tests and procedures done to detect, diagnose, and find out whether the cancer has spread are used to determine the PRETEXT and POSTTEXT groups.
There are two grouping systems for childhood liver cancer.
Two grouping systems are used for childhood liver cancer:
- The PRETEXT group describes the tumor before the patient has treatment.
- The POSTTEXT group describes the tumor after the patient has treatment.
There are four PRETEXT and POSTTEXT groups:
The liver is divided into 4 sections. The PRETEXT and POSTTEXT groups depend on which sections of the liver have cancer.
PRETEXT and POSTTEXT Group I
In group I, the cancer is found in one section of the liver. Three sections of the liver that are next to each other do not have cancer in them.
PRETEXT and POSTTEXT Group II
In group II, cancer is found in one or two sections of the liver. Two sections of the liver that are next to each other do not have cancer in them.
PRETEXT and POSTTEXT Group III
In group III, one of the following is true:
- Cancer is found in three sections of the liver and one section does not have cancer.
- Cancer is found in two sections of the liver and two sections that are not next to each other do not have cancer in them.
PRETEXT and POSTTEXT Group IV
In group IV, cancer is found in all four sections of the liver.
There are three ways that cancer spreads in the body.
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if childhood liver cancer spreads to the lung, the cancer cells in the lung are actually liver cancer cells. The disease is metastatic liver cancer, not lung cancer.
Recurrent childhood 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. Cancer that is growing or worsening during treatment is progressive disease.
Updated: September 29, 2017
Key Points
- There are different types of treatment for patients with childhood liver cancer.
- Children with liver cancer should have their treatment planned by a team of healthcare providers who are experts in treating this rare childhood cancer.
- Some cancer treatments cause side effects months or years after treatment has ended.
- Six types of standard treatment are used:
- Surgery
- Watchful waiting
- Chemotherapy
- Radiation therapy
- Ablation therapy
- Antiviral treatment
- Targeted therapy
- Patients can enter clinical trials before, during, or after starting their cancer treatment.
- Follow-up tests may be needed.
There are different types of treatment for patients with childhood liver cancer.
Different types of treatments are available for children with 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.
Taking part in a clinical trial should be considered for all children with liver cancer. Some clinical trials are open only to patients who have not started treatment.
Children with liver cancer should have their treatment planned by a team of healthcare providers who are experts in treating this rare childhood cancer.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other healthcare providers who are experts in treating children with liver cancer and who specialize in certain areas of medicine. It is especially important to have a pediatric surgeon with experience in liver surgery who can send patients to a liver transplant program if needed. Other specialists may include the following:
- Pediatrician.
- Radiation oncologist.
- Pediatric nurse specialist.
- Rehabilitation specialist.
- Psychologist.
- Social worker.
Some cancer treatments cause side effects months or years after treatment has ended.
Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:
- Physical problems.
- Changes in mood, feelings, thinking, learning, or memory.
- Second cancers (new types of cancer).
Some late effects may be treated or controlled. It is important to talk with your child’s doctors about the effects cancer treatment can have on your child.
Six types of standard treatment are used:
Surgery
When possible, the cancer is removed by surgery.
- 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 part of the liver, along with a small amount of normal tissue around it.
- Total hepatectomy and liver transplant: Removal of the entire liver followed by a transplant of a healthy liver from a donor. A liver transplant may be possible when cancer has not spread beyond the liver and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.
- Resection of metastases: Surgery to remove cancer that has spread outside of the liver, such as to nearby tissues, the lungs, or the brain.
Factors that affect the type of surgery used include the following:
- The PRETEXT group and POSTTEXT group.
- The size of the primary tumor.
- Whether there is more than one tumor in the liver.
- Whether the cancer has spread to nearby large blood vessels.
- The level of alpha-fetoprotein (AFP) in the blood.
- Whether the tumor can be shrunk by chemotherapy so that it can be removed by surgery.
- Whether a liver transplant is needed.
Chemotherapy is sometimes given before surgery, to shrink the tumor and make it easier to remove. This is called neoadjuvant therapy.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Watchful waiting
Watchful waiting is closely monitoring a patient’s condition without giving any treatment until signs or symptoms appear or change. In hepatoblastoma, this treatment is only used for small tumors that have been completely removed by surgery.
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 cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Treatment using more than one anticancer drug is called combination chemotherapy.
Chemoembolization of the hepatic artery (the main artery that supplies blood to the liver) is a type of regional chemotherapy used to treat childhood liver cancer. 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. This procedure is also called transarterial chemoembolization or TACE.
The way the chemotherapy is given depends on the type of the cancer being treated and the PRETEXT or POSTTEXT group.
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. There are two types of radiation therapy:
- 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.
The way the radiation therapy is given depends on the type of the cancer being treated and the PRETEXT or POSTTEXT group. Radioembolization of the hepatic artery (the main artery that supplies blood to the liver) is a type of internal radiation therapy used to treat hepatocellular carcinoma. A very small amount of a radioactive substance is attached to tiny beads that are injected into the hepatic artery through a catheter (thin tube). The beads are mixed with a substance that blocks the artery, cutting off blood flow to the tumor. Most of the radiation is trapped near the tumor to kill the cancer cells. This is done to relieve symptoms and improve quality of life for children with hepatocellular carcinoma. External radiation therapy is used to treat hepatoblastoma that cannot be removed by surgery or has spread to other parts of the body.
Ablation therapy
Ablation therapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer:
- Radiofrequency ablation: The use of special needles that are inserted directly through the skin or through an incision in the abdomen to reach the tumor. High-energy radio waves heat the needles and tumor which kills cancer cells. Radiofrequency ablation is being used to treat recurrent hepatoblastoma.
- Percutaneous ethanol injection: A small needle is used to inject ethanol (pure alcohol) directly into a tumor to kill cancer cells. Several treatments may be needed. Percutaneous ethanol injection is being used to treat recurrent hepatoblastoma.
Hepatocellular carcinoma that is linked to the hepatitis B virus may be treated with antiviral drugs.
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.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Targeted therapy is being studied for the treatment of all types of childhood liver cancer that have come back.
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 listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the treatment group 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.
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.
- Hepatoblastoma
- Hepatocellular Carcinoma
- Undifferentiated Embryonal Sarcoma of the Liver
- Infantile Choriocarcinoma of the Liver
- Recurrent Childhood Liver Cancer
Hepatoblastoma
Treatment options for hepatoblastoma that can be removed by surgery at the time of diagnosis may include the following:
- Surgery to remove the tumor, followed by watchful waiting or chemotherapy, for hepatoblastoma with pure fetal histology.
- Surgery to remove the tumor, with combination chemotherapy given either before surgery, after surgery, or both, for hepatoblastoma that is not pure fetal histology. For hepatoblastoma with small cell undifferentiated histology, aggressive chemotherapy is given.
Treatment options for hepatoblastoma that cannot be removed by surgery or is not removed at the time of diagnosis may include the following:
- Combination chemotherapy to shrink the tumor, followed by surgery to remove the tumor.
- Combination chemotherapy followed by a liver transplant.
- Chemoembolization of the hepatic artery to shrink the tumor, followed by surgery to remove the tumor.
For hepatoblastoma that has spread to other parts of the body at the time of diagnosis, combination chemotherapy is given to shrink the cancer in the liver and cancer that has spread to other parts of the body. After chemotherapy, imaging tests are done to check whether the cancer can be removed by surgery.
Treatment options may include the following:
- If the cancer in the liver and other parts of the body can be removed, surgery will be done to remove the tumors followed by chemotherapy to kill any cancer cells that may remain.
- If the cancer in the liver cannot be removed by surgery but there are no signs of cancer in other parts of the body, the treatment may be a liver transplant.
If the cancer in other parts of the body cannot be removed or a liver transplant is not possible, chemotherapy, chemoembolization of the hepatic artery, or radiation therapy may be given.
Treatment options in clinical trials for newly diagnosed hepatoblastoma include:
- A clinical trial of new treatment regimens based on how far and where the cancer has spread at diagnosis.
Hepatocellular Carcinoma
Treatment options for hepatocellular carcinoma that can be removed by surgery at the time of diagnosis may include the following:
- Surgery alone to remove the tumor.
- Surgery to remove the tumor, followed by chemotherapy.
- Combination chemotherapy followed by surgery to remove the tumor.
Treatment options for hepatocellular carcinoma that cannot be removed by surgery at the time of diagnosis may include the following:
- Chemotherapy to shrink the tumor, followed by surgery to completely remove the tumor.
- Chemotherapy to shrink the tumor. If surgery to completely remove the tumor is not possible, further treatment may include the following:
- Liver transplant.
- Chemoembolization of the hepatic artery to shrink the tumor, followed by surgery to remove as much of the tumor as possible or liver transplant.
- Chemoembolization of the hepatic artery alone.
- Radioembolization of the hepatic artery as palliative therapy to relieve symptoms and improve the quality of life.
Treatment for hepatocellular carcinoma that has spread to other parts of the body at the time of diagnosis may include:
- Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible from the liver and other places where cancer has spread. Studies have not shown that this treatment works well but some patients may have some benefit.
Treatment options for hepatocellular carcinoma related to hepatitis B virus (HBV) infection include:
- Surgery to remove the tumor.
- Antiviral drugs that treat infection caused by the hepatitis B virus.
Undifferentiated Embryonal Sarcoma of the Liver
Treatment options for undifferentiated embryonal sarcoma of the liver (UESL) may include the following:
- Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible. Chemotherapy may also be given after surgery to remove the tumor.
- Surgery to remove the tumor followed by chemotherapy. A second surgery may be done to remove tumor that remains, followed by more chemotherapy.
- Liver transplant if surgery to remove the tumor is not possible.
- A clinical trial of a combination of targeted therapy, chemotherapy and/or radiation therapy before surgery.
Infantile Choriocarcinoma of the Liver
Treatment options for choriocarcinoma of the liver in infants may include the following:
- Combination chemotherapy to shrink the tumor, followed by surgery to remove the tumor.
- Surgery to remove the tumor.
Recurrent Childhood Liver Cancer
Treatment of progressive or recurrent hepatoblastoma may include the following:
- Surgery to remove isolated (single and separate) metastatic tumors with or without chemotherapy.
- Combination chemotherapy.
- Liver transplant.
- Ablation therapy (radiofrequency ablation or percutaneous ethanol injection).
- A clinical trial of a new treatment.
- A clinical trial that checks a sample of the patient’s tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.
Treatment of progressive or recurrent hepatocellular carcinoma may include the following:
- Chemoembolization of the hepatic artery to shrink the tumor before liver transplant.
- Liver transplant.
- A clinical trial of a new treatment.
- A clinical trial that checks a sample of the patient’s tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.
Treatment of recurrent undifferentiated embryonal sarcoma of the liver (UESL) may include the following:
- A clinical trial that checks a sample of the patient’s tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.
Treatment of recurrent choriocarcinoma of the liver in infants may include the following:
- A clinical trial that checks a sample of the patient’s tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.
Liver (Hepatocellular) Cancer Prevention (PDQ®)-Patient Version
Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.
To prevent new cancers from starting, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.
Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk, but it does not mean that you will not get cancer.
Different ways to prevent cancer are being studied, including:
- Changing lifestyle or eating habits.
- Avoiding things known to cause cancer.
- Taking medicines to treat a precancerous condition or to keep cancer from starting.
Key Points
- Liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver.
- Liver cancer is not common in the United States.
- Being infected with certain types of the hepatitis virus can cause hepatitis and increase the risk of liver cancer.
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D
- Hepatitis E
- Hepatitis G
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. Three of the many important functions of the liver are:
- To filter harmful substances from the blood so they can be passed from the body in stools and urine.
- To make bile to help digest fats from food.
- To store glycogen (sugar), which the body uses for energy.
Liver cancer is not common in the United States.
Liver cancer is the fourth most common cancer and the third leading cause of cancer death in the world. In the United States, men, especially Asian/Pacific Islander men, have an increased risk of liver cancer. The number of new cases of liver cancer and the number of deaths from liver cancer continue to increase, especially among middle-aged black, Hispanic, and white men. People are usually older than 40 years when they develop this cancer.
Finding and treating liver cancer early may prevent death from liver cancer.
Being infected with certain types of the hepatitis virus can cause hepatitis and increase the risk of liver cancer.
Hepatitis is most commonly caused by the hepatitis virus. Hepatitis is a disease that causes inflammation (swelling) of the liver. Damage to the liver from hepatitis that lasts a long time can increase the risk of liver cancer.
There are six types of the hepatitis virus. Hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV) are the three most common types. These three viruses cause similar symptoms, but the ways they spread and affect the liver are different.
The Hepatitis A vaccine and the hepatitis B vaccine prevent infection with hepatitis A and hepatitis B. There is no vaccine to prevent infection with hepatitis C. If a person has had one type of hepatitis in the past, it is still possible to get the other types.
Hepatitis viruses include:
Hepatitis A
Hepatitis A is caused by eating food or drinking water infected with hepatitis A virus. It does not lead to chronic disease. People with hepatitis A usually get better without treatment.
Hepatitis B
Hepatitis B is caused by contact with the blood, semen, or other body fluid of a person infected with hepatitis B virus. It is a serious infection that may become chronic and cause scarring of the liver (cirrhosis). This may lead to liver cancer. Blood banks test all donated blood for hepatitis B, which greatly lowers the risk of getting the virus from blood transfusions.
Hepatitis C
Hepatitis C is caused by contact with the blood of a person infected with hepatitis C virus. Hepatitis C may range from a mild illness that lasts a few weeks to a serious, lifelong illness. Most people who have hepatitis C develop a chronic infection that may cause scarring of the liver (cirrhosis). This may lead to liver cancer. Blood banks test all donated blood for hepatitis C, which greatly lowers the risk of getting the virus from blood transfusions.
Hepatitis D
Hepatitis D develops in people already infected with hepatitis B. It is caused by hepatitis D virus (HDV) and is spread through contact with infected blood or dirty needles, or by having unprotected sex with a person infected with HDV. Hepatitis D causes acute hepatitis.
Hepatitis E
Hepatitis E is caused by hepatitis E virus (HEV). Hepatitis E can be spread through oral- anal contact or by drinking infected water. Hepatitis E is rare in the United States.
Hepatitis G
Being infected with hepatitis G virus (HGV) has not been shown to cause liver cancer.
Key Points
- Avoiding risk factors and increasing protective factors may help prevent cancer.
- The following risk factors may increase the risk of liver cancer:
- Hepatitis B and C
- Cirrhosis
- Aflatoxin
- Hepatitis B vaccine
Avoiding risk factors and increasing protective factors may help prevent cancer.
Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.
The following risk factors may increase the risk of liver cancer:
Hepatitis B and C
Having chronic hepatitis B or chronic hepatitis C increases the risk of developing liver cancer. The risk is even greater for people with both hepatitis B and C. Also, the longer the hepatitis infection lasts (especially hepatitis C), the greater the risk.
In a study of patients with chronic hepatitis C, those who were treated to lower their iron levels by having blood drawn and eating a low-iron diet were less likely to develop liver cancer than those who did not have this treatment.
Cirrhosis
The risk of developing liver cancer is increased for people who have cirrhosis, a disease in which healthy liver tissue is replaced by scar tissue. The scar tissue blocks the flow of blood through the liver and keeps it from working as it should. Chronic alcoholism and chronic hepatitis C are the most common causes of cirrhosis.
Aflatoxin
The risk of developing liver cancer may be increased by eating foods that contain aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts, that have not been stored properly).
The following protective factor may decrease the risk of liver cancer:
Hepatitis B vaccine
Preventing hepatitis B infection (by being vaccinated for hepatitis B) has been shown to lower the risk of liver cancer in children. It is not yet known if it lowers the risk in adults.
Cancer prevention clinical trials are used to study ways to prevent cancer.
Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.
The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.