Liver cancer is a malignant growth of liver cells.
The most common type of liver cancer, hepatocellular carcinoma (HCC), originates from the main liver cell, the hepatocyte. This is different from metastatic liver cancer, which occurs in a different part of the body and spreads (metastasizes) to the liver. In the United States, the biggest risk factors for HCC are hepatitis C infection, chronic heavy alcohol consumption, and nonalcoholic fatty liver disease related to diabetes and obesity. These factors produce scarring of the liver (cirrhosis), which increases the risk of HCC. Often, HCC does not produce symptoms; hence, patients with cirrhosis are recommended to be screened for HCC with an ultrasound of the liver every 6 months.
Multiple options are available for treating HCC. Optimal treatment depends on how far the cancer has spread when it is found (stage), the underlying function of the liver, and the overall health of the patient. The care of a patient with HCC may include a surgeon, cancer specialist (oncologist), liver specialist (hepatologist), interventional radiologist, and palliative care specialist.
Patients with small HCC tumors localized to one or a few area(s) of the liver and who have preserved liver function and are in good overall health may be offered treatments intended to cure the cancer. With curative treatment, most patients in this category live beyond 5 years. Treatment options include
Partial liver resection: A surgical procedure in which the part of the liver that has the tumor is removed. When appropriate, this may be performed with minimally invasive techniques, such as laparoscopic or robotic techniques. In a cirrhotic liver, up to 60% of the liver may be removed, and some of the remnant liver grows back.
Liver transplantation: When there is no major blood vessel involvement, no spread of cancer beyond the liver, and 3 or fewer tumors within the liver generally smaller than 5 cm, liver transplantation may be done. Allocation of donor livers is determined by the Model of End-Stage Liver Disease (MELD) score. Patients with HCC tumors are given extra MELD points, and these points are added every 3 months. The wait time for a donor liver varies in different parts of the United States; therefore, treatments such as ablation or embolization may be used in the interim to slow progression of the cancer.
Ablation: A procedure in which special probes are introduced into the cancer, commonly through the skin, to destroy the cancer by producing very high or low temperatures.
Survival following partial liver resection, liver transplantation, and ablation is similar, with 5-year survival rates approaching 70% in most centers. However, the recurrence rates following liver transplantation are typically lower than those of liver resection and ablation.
When HCC involves multiple parts of the liver, invades the blood vessels, or spreads outside the liver, it becomes incurable. Treatment in such cases is aimed at prolonging life and includes
Embolization: A procedure in which a catheter is placed into the blood supply of the liver through a blood vessel in the groin, and beads tagged with cancer-killing drugs or radiation particles are injected into the cancer.
Chemotherapy: This is when drugs that kill cancer cells are given. Sorafenib is currently the only chemotherapy drug that has proven effectiveness for HCC. It is a pill taken by mouth once or twice daily. Many clinical trials are ongoing to evaluate new potential chemotherapy agents that might be effective for patients with advanced-stage HCC. Information about ongoing clinical trials can be found on the American Cancer Society’s website.
Use of curative and palliative treatments is dependent on liver function being suitable for these procedures. If the liver function is too deteriorated, palliative care is the only option.
Palliative care is an important part of care for many patients with HCC. Palliative care focuses on alleviating pain and other cancer-related symptoms, improving quality of life during treatment, and providing support to cope with feelings related to a cancer diagnosis.
National Library of Medicinewww.nlm.nih.gov/medlineplus/livercancer.html
National Cancer Institutewww.cancer.gov/types/liver
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 liver cancer was published in the December 22/29, 2015, issue of JAMA and one on liver transplantation in the January 18, 2012, issue.
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
Riaz R, Miller FH, Kulik LM, et al. Imaging response in the primary index lesion and clinical outcomes following transarterial locoregional therapy for hepatocellular carcinoma. JAMA. 2010;303(11):1062-1069.
Zhu AW, Kudo M, Assenat E, et al. Effect of everolimus on survival in advanced hepatocellular carcinoma after failure of sorafenib. JAMA. 2014;312(1):57-67.
Mokdad AA, Singal AG, Yopp AC. Treatment of Liver Cancer. JAMA. 2016;315(1):100. doi:10.1001/jama.2015.15431