Cancer Care

Liver Cancer

MaineHealth provides services for screening, diagnosis, and treatment of primary (arising from the liver) and secondary (spread from other sites) liver tumors. Medical research has demonstrated that secondary liver (or metastatic) cancer is more common than primary liver cancer. 

What is liver cancer?

  • Primary liver cancers arise from cells within the liver when these cells begin to grow uncontrollably. In adults, there are several primary liver cancers. However, the most two common are hepatocellular cancer and cholangiocarcinoma. Hepatocellular cancer is the most common primary liver cancer, and it arises from cells of the liver called hepatocytes. The second most common primary liver cancer is cholangiocarcinoma. This cancer arises from cells within the bile ducts.
  • Secondary liver cancers arise from other sites, such as the colon, and metastasize (spread) through the bloodstream to the liver. The most common primary cancers (the site where cancer started) are colorectal, lung, breast, pancreatic, stomach, melanoma, and the neuroendocrine system.

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Alcohol, Obesity are Liver Cancer Risk Factors

Hepatocellular cancer, the most common type of liver cancer, is most often associated with a viral infection from hepatitis B or hepatitis C.

Other risk factors include cirrhosis from alcohol, obesity, or other causes. Most patients with cholangiocarcinoma have no risk factors. However, known risk factors include inflammatory bowel disease (ulcerative colitis), and less often a parasitic liver disease that is uncommon in the United States.

The risk for secondary or metastatic liver cancer is a previous diagnosis of high-risk cancer most commonly from colorectal, lung, breast, pancreatic, stomach, skin, or neuroendocrine system.

Yellowing Skin and Eyes are Signs of Liver Cancer

People with liver cancer may not experience symptoms in the early stage. Common symptoms in later stages include:

  • Unexplained weight loss
  • Yellowing skin and eyes
  • Stomach pain
  • Bloating
  • Nausea and vomiting

Variety of Tests for Diagnosing Liver Cancer

People with symptoms of liver cancer may undergo a variety of tests that include:

  • Lab tests
  • Biopsy to sample tissue
  • Ultrasound
  • CT scan
  • Magnetic Resonance Imaging (MRI)
  • Angiogram
  • Bone scan
  • X-rays

For patients with long-standing viral hepatitis (hepatitis B or hepatitis C) or high-risk conditions such as sclerosing cholangitis, screening can identify early disease and improve survival. Gastroenterologists often monitor patients with the ultrasound or other imaging techniques.

Patients with cancers that have high-risk for metastasizing to the liver may be monitored by their oncologist or surgeon for the disease. Possible imaging techniques include CT, MRI, or PET scan.

The treatment of liver cancers is difficult and requires a multidisciplinary team such as the hepatopancreatic biliary team at Maine Medical Center that includes surgical oncologists, gastroenterologists, interventional oncologists, interventional radiologists, medical oncologists, radiation oncologists and pathologists. Treatment can include:

  • Surgery
  • Chemotherapy
  • Liver transplant
  • Tumor ablation (kills tumors without removing them)
  • Tumor embolization (reduces blood flow to cancer cells)
  • Radiation
  • Targeted therapy

For patients with primary liver cancer, treatment is often complicated by the presence of cirrhosis.

Potential treatment options include surgery, ablation (destroying tumors with heat energy), precision radiation therapy, delivery of chemotherapy or radiation directly into tumors (embolization), and occasionally liver transplantation.

Treatment of cholangiocarcinoma most often involves curative surgery, chemotherapy, and radiation therapy.

Treatment of secondary or metastatic liver cancer is equally complex.

Treatment modalities such as surgery, ablation, radiation, chemotherapy, and targeted therapy are often employed, many times in combination. Although secondary liver cancer is Stage IV,  treatment can be curative or life-extending.Primary sites of liver metastasis that respond best to curative therapies include colorectal, neuroendocrine, genitourinary and breast.