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JAMA Patient Page
December 22/29, 2015

Liver Cancer

JAMA. 2015;314(24):2701. doi:10.1001/jama.2015.15425

Liver cancer is an abnormal and malignant growth of liver cells.

The most common type of liver cancer originates from the main liver cells, called hepatocytes, and is called hepatocellular carcinoma (HCC). The most common cause of cancer in the liver is metastatic cancer, which is different because it begins in a different part of the body and spreads (metastasizes) to the liver. Hepatocellular carcinoma is the third most common cause of cancer deaths worldwide and ranks eighth in the United States. The number of new patients with HCC in the United States has been increasing most quickly among all solid cancers. Hepatocellular carcinoma is more common in men and usually develops after age 60 years.

Common Risk Factors

Certain conditions increase the risk of HCC by causing scarring of the liver, a condition called cirrhosis. These conditions include chronic hepatitis B or C infections, which pose the highest risk of developing HCC; heavy and prolonged alcohol consumption; nonalcoholic fatty liver disease, related mainly to diabetes and obesity; and some inherited liver diseases. Because the risk of HCC is high in patients with hepatitis B infection and in those with cirrhosis, it is recommended these patients undergo ultrasound screening of the liver every 6 months.

Signs, Symptoms, and Diagnosis

Hepatocellular carcinoma may not produce any specific signs or symptoms. Pain in the right upper abdomen, abdominal swelling, eating very little, bloating, constant tiredness, weight loss, or jaundice (yellow discoloration of the eyes and skin) may be caused by HCC but also may be caused by many other diseases. Patients with similar symptoms related to their underlying chronic liver disease or cirrhosis may notice worsening of these symptoms. Hepatocellular carcinoma is usually diagnosed by computed tomography or magnetic resonance imaging. A liver biopsy may be needed to confirm the diagnosis. Blood tests are done to evaluate the degree of liver dysfunction.

Treatment

Treatment of HCC depends on the patient’s overall health, liver function, and how far the cancer has spread when it is found (stage). Patients with early-stage tumors may be offered curative treatments such as surgery to remove the portion of the liver with cancer, liver transplantation, or ablation, in which special probes are inserted into the cancer to destroy it. Patients with more extensive tumors may be offered noncurative treatments such as embolization or chemotherapy. With curative treatment, most patients live longer than 5 years. When HCC spreads to multiple parts of the liver or outside of the liver, it becomes incurable, and noncurative treatments may prolong life up to 2 years.

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For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab. A Patient Page on hepatitis C infection was published in the August 13, 2014, issue of JAMA and one on cirrhosis in the February 22/29, 2012, issue.

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Article Information
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Singal reports personal fees from Bayer. No other disclosures were reported.

Sources: National Library of Medicine, National Cancer Institute

Hepatocellular carcinoma—United States, 2001-2006. JAMA. 2010;303(23)2349-2350.

Topic: Cancer

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