Liver cancer or hepatocellular carcinoma is a cancer that starts only in the liver. When you have another cancer that has spread into the liver that is called metastatic disease. Liver cancer is caused by chronic inflammation in the liver usually as a result of infections like hepatitis B or hepatitis C. Other causes of Liver cancer are cirrhosis from chronic alcoholism or fatty liver disease, which results in non-alcoholic steatohepatitis (NASH) which comes from obesity. In places where hepatitis B is prevalent, like Asia or Africa, the cause is more from the infection but in the United States the most common cause is from alcoholism along with hepatitis B or hepatitis C.
Liver cancer can go undetected because the patient is already suffering from the cirrhosis and the cancer is hiding within the cirrhotic liver. Eventually it becomes clear that there is a problem because patient has a lot of yellowing of the skin, or jaundice. They can have excessive bleeding from the stomach, bruising on the skin, or fluid buildup within the abdomen, called ascites. Some patients will start to lose weight, have pain on their right side or feel a growth under the skin near their liver.
Patients with chronic cirrhosis or hepatitis are often routinely checked with ultrasounds to make sure that there is no growth of any tumors. Once a growth is detected a biopsy might be required and a blood test called alpha-feto protein (AFP) is used to confirm the diagnosis. Then a CAT scan or MRI is needed to make sure it has not spread.
If the cancer hasn’t spread then if is small enough it can be removed surgically but if it is too big or the patient’s liver has too much damage so they can’t have surgery, then the cancer can be attacked in a few different ways: One is through the arteries of the leg where a catheter is inserted and threaded into the liver from the inside and then the cancer is choked off (hepatic arterial embolization or trans-arterial chemoembolization). Another way is by inserting a probe into the liver and destroying the cancer by heating it up (radiofrequency ablation) or freezing it (cryoablation). The approach taken depends on the precise location in the liver as well as its size.
Finally if the cancer has spread too far (metastasized) and cannot be attacked directly in the liver anymore then there are pills as well as intravenous (IV) chemotherapy that can slow the cancer’s growth. Unfortunately we have not found a way to cure metastatic liver cancer. A lot of new therapies have become available recently and are being researched – one example is an IV treatment that can harness the immune system and train it to attack the liver cancer or simply make the immune system more aware that the cancer is there so it can find it and kill it.