General Information

What is adult primary liver cancer?

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

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

A doctor should be seen if the following symptoms appear: a hard lump just below the rib cage on the right side where the liver has swollen, discomfort in the upper abdomen on the right side, pain around the right shoulder blade, or yellowing of the skin (jaundice).

If there are symptoms, a doctor may order special x-rays, such as a computed tomographic scan or a liver scan. If a lump is seen on an x-ray, a doctor may use a needle inserted into the abdomen to remove a small amount of tissue from the liver. This procedure is called a needle biopsy, and a doctor usually will use an x-ray for guidance. The doctor will have the tissue looked at under a microscope to see if there are any cancer cells. Before the test, a patient will be given a local anesthetic (a drug that causes loss of feeling for a short 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 a laparoscope, 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 can be inserted. The doctor may also take a small piece of tissue (biopsy specimen) during the laparoscopy and look at it under the microscope to see if there 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 this examination, a tube (catheter) is inserted into the main blood vessel that takes blood to the liver. Dye is then injected through the tube so that the blood vessels in the liver can be seen on an x-ray. Angiography can help a doctor tell whether the cancer is primary liver cancer or cancer that has spread from another part of the body. This test is usually done in the hospital.

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

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

Stage Information

Stages of adult primary liver cancer:

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

Localized resectable
Cancer is found in one place in the liver and can be totally removed in an operation.

Localized unresectable
Cancer is found only in one part of the liver, but the cancer cannot be totally removed.

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

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

Treatment Option Overview

How adult primary liver cancer is treated:

There are treatments for all patients with adult primary liver cancer. Three kinds 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.

Resection of the liver takes out the part of the liver where the cancer is found.
A liver transplant is the removal of the entire liver and replacement with a healthy liver donated from someone else. Very few patients with liver cancer are eligible for this procedure.

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 cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from putting materials that contain radiation through thin plastic tubes (internal radiation therapy) in the area where the cancer cells are found. Drugs may be given with the radiation therapy 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; each antibody fights specific cells.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for liver cancer is usually put into the body by inserting a needle into a vein or artery. This type of chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the liver. In another type of chemotherapy called regional chemotherapy, a small pump containing drugs is placed in the body. The pump puts 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 injecting chemotherapy drugs between the blockage and the liver, using the liver's arteries to deliver the chemotherapy throughout the liver.

If a doctor removes all the cancer that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any remaining cells. Chemotherapy that is given after surgery to remove the cancer is 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 clinical trials.

Hyperthermia therapy is the use of a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the tumor shrinks.

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

Treatment By Stage

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. Standard treatment may be considered, based on its effectiveness in patients in past studies, or participation into a clinical trial. Many patients are not cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of adult liver cancer. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Localized Resectable Adult Primary Liver Cancer

Treatment is usually surgery (resection). Liver transplantation may be done in certain patients. Clinical trials are testing adjuvant systemic or regional chemotherapy following surgery.

Localized Unresectable Adult Primary Liver Cancer
Treatment may be one of the following:

1. Blocking the hepatic artery and then injecting chemotherapy drugs into
the artery and liver (chemoembolization), surgery to freeze and kill the
tumor (cryosurgery), injection of ethanol into the tumor, or use of highly
focused radio waves designed to destroy the tumor.
2. Liver transplantation.
3. Regional chemotherapy, including injecting the chemotherapy directly into
the tumor.
4. Systemic chemotherapy.
5. Surgery with or without chemotherapy possibly followed by radiation
therapy.
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
There is no standard treatment for patients with advanced adult primary liver cancer. Patients may wish to consider taking part in a clinical trial. Some clinical trials may also help reduce or relive symptoms.

Recurrent Adult Primary Liver Cancer
Treatment of recurrent adult primary liver cancer depends on what treatment a patient has already received, the part of the body where the cancer has come back, whether the liver has cirrhosis, and other factors. Patients may wish to consider taking part in a clinical trial.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

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