National Cancer Institute


Posted Date: Aug 12, 2002

TABLE OF CONTENTS


Description

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What is adult primary liver cancer?

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Adult primary liver cancer is a disease in which cancer (malignant) cells startto grow in the tissues of the liver. The liver is one of the largest organs inthe body, filling the upper right side of the abdomen and protected by the ribcage. The liver has many functions. It has an important role in making foodinto energy and also filters and stores blood.

People who have hepatitis B or C (viral infections of the liver) or a diseaseof the liver called cirrhosis are more likely than other people to get adultprimary liver cancer. Primary liver cancer is different from cancer that hasspread from another place in the body to the liver. (Refer to the PDQ summaryon Childhood Liver Cancer Treatment for more information.)

A doctor should be seen if the following symptoms appear:

  • A hard lump justbelow the rib cage on the right side where the liver has swollen.
  • Discomfort inthe upper abdomen on the right side.
  • Pain around the right shoulder blade.
  • Yellowing of the skin (jaundice).

If there are symptoms, a doctor may order special x-rays, such as a computedtomographic scan or a liver scan. If a lump is seen on an x-ray, a doctor mayuse a needle inserted into the abdomen to remove a small amount of tissue fromthe liver. This procedure is called a needle biopsy, and a doctor usually willuse an x-ray for guidance. The doctor will have the tissue looked at under amicroscope to see if there are any cancer cells. Before the test, a patientwill be given a local anesthetic (a drug that causes loss of feeling for ashort period of time) in the area so that no pain is felt.

A doctor may also want to look at the liver with an instrument called alaparoscope, which is a small tube-shaped instrument with a light on the end. For this test, a small cut is made in the abdomen so that the laparoscope canbe inserted. The doctor may also take a small piece of tissue (biopsyspecimen) during the laparoscopy and look at it under the microscope to see ifthere are any cancer cells. An anesthetic will be given so no pain is felt.

A doctor may also order an examination called an angiography. During thisexamination, a tube (catheter) is inserted into the main blood vessel thattakes blood to the liver. Dye is then injected through the tube so that theblood vessels in the liver can be seen on an x-ray. Angiography can help adoctor tell whether the cancer is primary liver cancer or cancer that hasspread from another part of the body. This test is usually done in thehospital.

Certain blood tests (such as alpha-fetoprotein, or AFP) may also help a doctordiagnose primary liver cancer.

The chance of recovery (prognosis) and choice of treatment depend on the stageof the cancer (whether it is just in the liver or has spread to other places)and the patient's general state of health.


Stage Explanation

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Stages of adult primary liver cancer

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Once adult primary liver cancer is found, more tests will be done to find outif the cancer cells have spread to other parts of the body (staging). Thefollowing stages are used for adult primary liver cancer:


Localized resectable

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Cancer is found in one place in the liver and can be totally removed in anoperation.


Localized unresectable

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Cancer is found only in one part of the liver, but the cancer cannot be totallyremoved.


Advanced

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Cancer has spread through much of the liver or to other parts of the body.


Recurrent

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Recurrent disease means that the cancer has come back (recurred) after it hasbeen treated. It may come back in the liver or in another part of the body.


Treatment Option Overview

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How adult primary liver cancer is treated

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There are treatments for all patients with adult primary liver cancer. Threekinds of treatment are used:

  • Surgery (taking out the cancer in an operation).
  • Radiation therapy (using high-dose x-rays to kill cancer cells).
  • Chemotherapy (using drugs to kill cancer cells).

Surgery may be used to take out the cancer or to replace the liver.

  1. Resection of the liver takes out the part of the liver where the cancer isfound.
  2. A liver transplant is the removal of the entire liver and replacement with ahealthy liver donated from someone else. Very few patients with liver cancerare eligible for this procedure.
  3. Cryosurgery is a type of surgery that kills cancer by freezing it.

Radiation therapy is the use of x-rays or other high-energy rays to kill cancercells and shrink tumors. Radiation may come from a machine outside the body(external-beam radiation therapy) or from putting materials that containradiation through thin plastic tubes (internal radiation therapy) in the areawhere the cancer cells are found. Drugs may be given with the radiationtherapy to make the cancer cells more sensitive to radiation(radiosensitization).

Radiation may also be given by attaching radioactive substances to antibodies(radiolabeled antibodies) that search out certain cells in the liver. Antibodies are made by the body to fight germs and other harmful things; eachantibody fights specific cells.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for livercancer is usually put into the body by inserting a needle into a vein orartery. This type of chemotherapy is called a systemic treatment because thedrug enters the bloodstream, travels through the body, and can kill cancercells outside the liver. In another type of chemotherapy called regionalchemotherapy, a small pump containing drugs is placed in the body. The pumpputs drugs directly into the blood vessels that go to the tumor.

Chemoembolization of the hepatic artery involves blocking the hepatic artery(the major artery that supplies blood to the liver) and then injectingchemotherapy drugs between the blockage and the liver, using the liver'sarteries to deliver the chemotherapy throughout the liver.

If a doctor removes all the cancer that can be seen at the time of theoperation, the patient may be given chemotherapy after surgery to kill anyremaining cells. Chemotherapy that is given after surgery to remove the canceris called adjuvant chemotherapy.

Hyperthermia (warming the body to kill cancer cells) and biological therapy(using the body's immune system to fight cancer) are being tested in clinicaltrials.

Hyperthermia therapy is the use of a special machine to heat the body for acertain period of time to kill cancer cells. Because cancer cells are oftenmore sensitive to heat than normal cells, the cancer cells die and the tumorshrinks.

Biological therapy uses the body's immune system to fight cancer. Materialsmade by the body or made in a laboratory are used to boost, direct, or restorethe body's natural defenses against disease. Biological therapy is sometimescalled biological response modifier therapy or immunotherapy.


Treatment by stage

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Treatments for adult primary liver cancer depend on the stage of the disease,the condition of the liver, and the patient's age and general health. Standardtreatment may be considered, based on its effectiveness in patients in paststudies, or participation into a clinical trial. Many patients are not curedwith standard therapy, and some standard treatments may have more side effectsthan are desired. For these reasons, clinical trials are designed to findbetter ways to treat cancer patients and are based on the most up-to-dateinformation. Clinical trials are ongoing in most parts of the country for moststages of adult liver cancer. For more information, call the CancerInformation Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


Localized Resectable Adult Primary Liver Cancer

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Treatment is usually surgery (resection). Liver transplantation may be done incertain patients. Clinical trials are testing adjuvant systemic or regionalchemotherapy following surgery.


Localized Unresectable Adult Primary Liver Cancer

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Treatment may be one of the following:

  1. Blocking the hepatic artery and then injecting chemotherapy drugs intothe artery and liver (chemoembolization), surgery to freeze and kill thetumor (cryosurgery), injection of ethanol into the tumor, or use of highlyfocused radio waves designed to destroy the tumor.
  2. Liver transplantation.
  3. Regional chemotherapy, including injecting the chemotherapy directly intothe tumor.
  4. Systemic chemotherapy.
  5. Surgery with or without chemotherapy possibly followed by radiationtherapy.
  6. Injection of alcohol directly into the tumor.
  7. Radiation therapy plus special drugs that make the tumor more susceptible to the radiation.
  8. Highly focused radio waves designed to destroy the tumor.


Advanced Adult Primary Liver Cancer

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There is no standard treatment for patients with advanced adult primary livercancer. Patients may wish to consider taking part in a clinical trial. Someclinical trials may also help reduce or relieve symptoms.


Recurrent Adult Primary Liver Cancer

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Treatment of recurrent adult primary liver cancer depends on what treatment apatient has already received, the part of the body where the cancer has comeback, whether the liver has cirrhosis, and other factors. Patients may wish toconsider taking part in a clinical trial.


To Learn More

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Call

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write

For more information from the NCI, please write to this address:

  • NCI Public Inquiries Office
  • Suite 3036A
  • 6116 Executive Boulevard, MSC8322
  • Bethesda, MD 20892-8322


About PDQ

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PDQ is a comprehensive cancer database available on Cancer.gov.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the 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.

Before starting treatment, patients may want to think about taking part in a clinical trial. 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 new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov. 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); TTY at 1-800-332-8615.


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