What is Primary Liver Cancer?

Your liver helps clean your blood, digest food, and store sugar that your body uses for energy. Typically, its cells chug along doing their job until they wear out or get damaged. Then they die and new ones take their place. It’s all very orderly.

But when you have primary liver cancer, those cells grow at a pace that’s out of control. Cancer cells start to take over and make it hard for your normal cells to do their job.

Primary means the cancer starts in your liver. If it starts somewhere else and spreads to your liver, it’s called secondary liver cancer, and it’s treated differently.

Children and adults can both get primary liver cancer, but it’s more common when you’re older. There are different types and many ways to treat it. Your doctor can help you understand the best choices for you.

Types of Primary Liver Cancer

Hepatocellular cancer (HCC) is by far the most common type of cancer that starts in the liver. Most people who get it also have an ongoing (or “chronic”) liver disease, such as cirrhosis. It’s found more often in men than women.

Other types of primary liver cancer include:

  • Bile duct cancer (cholangiocarcinoma). The liver makes bile, which helps you digest fats. Bile moves out of the liver in tubes called bile ducts. This cancer occurs in those tubes.
  • Fibrolamellar HCC. This is a type of HCC that doesn’t happen very often. Unlike typical HCC, it’s usually found in women under 35 who don’t have liver disease.
  • Hemangiosarcomas and angiosarcomas. Both of these cancers are found in the liver’s blood vessels.
  • Hepatoblastoma. This rare cancer is usually found in children younger than 3. When it’s caught early, treatment can be very successful.

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Causes

It’s often not clear what causes liver cancer, but you may be more likely to get it if you have:

  • Chronic hepatitis B virus (HBV) or chronic hepatitis C virus (HCV) infection, both of which can lead to cirrhosis and liver cancer
  • Cirrhosis, a chronic liver disease caused by hepatitis or years of heavy drinking
  • Nonalcoholic fatty liver disease -- common with obese people, even if they don’t drink
  • Certain liver diseases, such as hemochromatosis (when your body absorbs too much iron) and Wilson’s disease (when your body absorbs too much copper)
  • Type 2 diabetes

If you’re very overweight or drink heavily for many years, you’re more likely to get cirrhosis, which can make you more likely to get liver cancer.

Also, if you’ve eaten foods with aflatoxins, you have a higher chance of getting this cancer. Aflatoxins are poisons made by a fungus that grows on some crops, such as corn and peanuts, when they aren’t stored the right way.

Symptoms

Early on, it’s likely you won’t notice anything at all. When they do show up, you may have very general symptoms such as:

  • Fever
  • Feeling like you might throw up
  • No desire to eat
  • Weakness or feeling more tired than usual

You may also have:

  • A hard lump on the right side of your belly just below your ribcage
  • Pain on the upper right side of your belly or in your right shoulder blade and back
  • Swelling in your belly
  • Weight loss for no reason
  • White, chalky stool or dark urine
  • Yellowish eyes and skin

Diagnosis and Tests

Typically, your doctor starts with a physical exam to check for lumps or anything else that seems unusual. You’ll also talk about your health history.

Your doctor may then do:

  • Blood tests to look for certain substances that could be signs of cancer
  • Imaging, such as CT, MRI, and ultrasound to see how many tumors you have and where they are located
  • A biopsy, where cells or tissues are removed to see if they’re cancerous. This can be done either with a needle placed into the tumor or through surgery to remove part of the tumor.

In some cases, you won’t need a biopsy because imaging is enough to tell that it’s cancer.

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Treatments

These depend on your age, overall health, how advanced the cancer is, and what you prefer. Different treatments can have different side effects, and you may need more than one.

Surgery: If you have just one small tumor and your cancer hasn’t spread, you may have surgery to remove it along with part of your liver.

If you have liver disease though, that’s not an option. You may get a liver transplant instead, but these aren’t too common.

Tumor ablation: A number of treatments kill tumors without removing them from your body. This is called tumor ablation and can be done with:

  • Alcohol. In ethanol ablation, also called percutaneous ethanol injection, your doctor injects pure alcohol into the tumor to kill the cancer cells.
  • Freezing. In cryoablation, also called cryosurgery or cryotherapy, your doctor uses liquid nitrogen to freeze and destroy the tumor.
  • Heat. Your doctor uses probes with either electricity (radiofrequency ablation) or microwaves (microwave thermotherapy) to heat and kill the tumor.

Embolization therapy (reduced blood flow): Your liver gets blood from two blood vessels. Most normal liver cells get it from one blood vessel and cancer cells get it from the other. With embolization therapy, your doctor cuts off the blood flow to the cancer cells to kill the tumor.

Radiation therapy: This treatment uses high-powered radiation from X-rays and other sources to kill cancer cells. You can either get radiation from outside the body or have it placed inside. Beads filled with radiation are sometimes used in radioembolization therapy.

Targeted drug therapy: These medications work differently than chemotherapy medicines. They go after very specific changes in cancer cells to try and destroy them. Since chemotherapy often isn’t helpful for primary liver cancer, doctors have been trying more targeted medications.

Chemotherapy: This uses medications to treat cancer. For liver cancer, it’s usually done with a pump placed in your body so the medicine goes right to your liver, not your whole body. Chemotherapy that you take by mouth or injection isn’t usually helpful for liver cancer.

WebMD Medical Reference Reviewed by Sabrina Felson, MD on October 13, 2019

Sources

SOURCES:
NIH, National Cancer Institute: “Adult Primary Liver Cancer Treatment (PDQ®) -- Patient Version.”

American Cancer Society: “What Is Cancer?” “What Is Liver Cancer?” “Liver Cancer Risk Factors,” “Tests for Liver Cancer,” “Liver Cancer Treatment,” “Tumor Ablation for Liver Cancer,” “Embolization Therapy for Liver Cancer,” “Targeted Therapy for Liver Cancer,” “Chemotherapy for Liver Cancer.”

Cancer Research UK: “Liver Cancer.”

Mayo Clinic: “Liver Cancer,” “Hemochromatosis,” “Wilson’s disease.”

The University of Texas MD Anderson Cancer Center: “Liver Cancer Facts.”

American Liver Foundation: “Liver Cancer.”

Cleveland Clinic: “Liver Cancer -- Cancer Institute Overview.”

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