"Recent advances in liver cancer treatment have significantly expanded options for patients. At Lahey, our multidisciplinary teams provide patients with the most innovative liver cancer therapies developed at the nation's leading research centers, as well as the opportunity to participate in groundbreaking clinical studies." -Keith E. Stuart, MD, Lahey liver cancer specialist and chair of Hematology/Oncology The liver is one of the body's largest, most important organs. This hard-working organ not only filters toxic materials out of the blood, but also produces chemicals essential for digestion and blood clotting. The term "liver cancer" actually refers to two different types of tumors. The more common are secondary, or metastatic tumors-malignant cells that have spread to the liver from cancers in other parts of the body such as the colon, lung or breast. Primary liver cancer consists of tumors that originate in the cells of the liver (hepatocellular carcinoma or hepatoma) or bile duct (cholangiocarcinoma). In the United States, primary liver cancer is relatively rare, although that may be changing. Recent statistics suggest it has actually doubled over the past 10 years, possibly associated with the rise in chronic hepatitis C infections during the 1970s. Bile duct cancer is uncommon, accounting for only 10 percent of primary liver cancer cases. Lahey physicians have significant experience employing traditional and newer treatments for liver cancer, including chemoembolization and transplantation. Since 1999, the Liver Transplant Team has performed nearly 400 transplants-more than any other liver transplant center in New England. Lahey radiologists are specialized in applying state-of-the-art noninvasive imaging techniques, including computed tomographic angiography (CTA), to produce 3-D models of liver arteries prior to surgery. This technology delivers exceptional images of the liver and its vasculature, allowing radiologists and surgeons to customize scans that increase the effectiveness of pre-surgery planning. Given the link between hepatitis and liver cancer, both diseases are highly active areas of research at Lahey Clinic. Our clinicians work on the front lines of medical research with the goal of improving outcomes for liver cancer patients. See our clinical trials, and learn how to participate in them.
Approximately 25 percent of liver tumors have no known cause. In the remaining 75 percent of cases, the following risk factors increase the likelihood of developing primary liver cancer:
What many of the above risk factors have in common is that they all can lead to cirrhosis-severe, irreversible scarring of the liver caused by a continuous cycle of repeated cell injury, death, and regeneration. The cirrhotic process itself may eventually trigger the formation of cancer cells. Cholangiocarcinoma, or cancer of the bile duct, has various causes, ranging from ulcerative colitis to bile duct damage. Few cases are due to cirrhosis, and many people with this type of cancer have no obvious risk factors.
To lower the risk of developing liver cancer:
Liver cancer is hard to detect because symptoms often don't appear until the disease is in its later stages. Further complicating diagnosis, the signs and symptoms of liver cancer can be vague and associated with many other digestive disorders. When symptoms do occur, they include:
If a physician suspects liver cancer, he or she will order high-resolution studies. These include CT (computerized tomography) and PET/CT (position-emission-tomography) scans, ultrasound and MRI (magnetic resonance imaging). Sometimes additional tests are needed, such as specialized angiograms or laparoscopy-procedures that allow more precise visualization of the liver and its major arteries and blood vessels. Once there is definite evidence of liver cancer, your physician may want to order further tests such as the following to help clarify certain aspects of the diagnosis:
Although some cancers are treated mainly on the basis of tumor size, liver cancer is usually more complex, requiring more individualized therapy. This is particularly important when cancer occurs in people who already have diseased or damaged livers, as is often the case. Whatever form of treatment doctors prescribe for liver cancer, it is important for patients to remember that all treatments have limitations, as well as potential benefits. Because every therapy involves side effects, any decision about treatment will depend on a careful evaluation of the patient's liver function, blood vessels, degree of disease and overall health. The reality is many patients find themselves ineligible for surgery or transplantation. For these patients, physicians often find the best treatment results from using multiple techniques or drugs, trying one, seeing what helps, and moving along to the next therapy as needed. Lahey oncologists will work closely with other specialists on the cancer care team to determine the best treatment approach for each patient. When developing a treatment plan, physicians consider:
The best treatment for primary liver cancer is also the only truly curative one-cutting and removing the malignant tissues and possibly surrounding lymph nodes. The formal medical term for this is liver resection, but unfortunately, it is not often possible for a number of reasons. First, if a patient's liver is cirrhotic or poorly functioning, it might not be safe to perform the operation. Second, the tumors may be so small or widespread that surgery will not be effective in preventing the cancer from returning.
Transplantation involves replacing the diseased organ with healthy liver tissue from a donor. It is interesting to note that
Chemotherapy is the term for specialized anticancer drugs given by mouth or intravenously. Chemotherapy medications work against tumors anywhere in the body, not just in the liver. Although highly effective for many types of tumors, chemotherapy does not always work well against primary liver cancer. This is because the liver's primary job is to filter out all toxic chemicals from the body-including the chemotherapy.
Radiation, which applies high-dose energy such as X-rays directly on small areas of the body, is used to destroy many forms of cancer cells. In liver cancer, radiation is particularly challenging because it may be more damaging to healthy liver tissue than to cancerous cells. For this reason, standard radiation is seldom used in treating patients with liver cancer unless it involves one of the newer techniques such as radiofrequency ablation and stereotactic radiation, described below.
The following treatments target only the liver tumor, not the entire organ:
Researchers are constantly exploring new approaches to improve treatment of liver cancer. On the horizon for patients with liver cancer are several emerging therapies:
Learn more about the patient-centered, high-quality approach to cancer care provided to patients diagnosed and treated at Lahey Clinic's Sophia Gordon Cancer Center.