• General Information About Adult Primary Liver Cancer
• Stages of Adult Primary Liver Cancer
• Recurrent Adult Primary Liver Cancer
• Treatment Option Overview
• Treatment Options for Adult Primary Liver Cancer
• To Learn More About Adult Primary Liver Cancer
• Get More Information From NCI
• Changes to This Summary (10/31/2011)
• About PDQ

General Information About Adult Primary Liver Cancer

Adult primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver.

The liver is one of the largest organs in the body. It has four lobes and fills the upper right side of the abdomen inside the rib cage. The liver has many important functions, including:

• Filtering harmful substances from the blood so they can be passed from the body in stools and urine.
• Making bile to help digest fats from food.
• Storing glycogen (sugar), which the body uses for energy.

Anatomy of the liver. The liver is in the upper abdomen near the stomach, intestines, gallbladder, and pancreas. The liver has four lobes. Two lobes are on the front and two small lobes (not shown) are on the back of the liver.

This summary refers to the treatment of primaryliver cancer (cancer that begins in the liver). Treatment of metastatic liver cancer, which is cancer that begins in other parts of the body and spreads to the liver, is not discussed in this summary. Primary liver cancer can occur in both adults and children. Treatment for children, however, is different than treatment for adults. (See the PDQ summary on Childhood Liver Cancer Treatment for more information.)

Having hepatitis or cirrhosis can affect the risk of developing adult primary liver cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. The following are possible risk factors for adult primary liver cancer:

• Having hepatitis B and/or hepatitis C.
• Having a close relative with both hepatitis B and liver cancer.
• Having cirrhosis.
• Eating foods tainted with aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts, that have not been stored properly).
• Obesity.

Possible signs of adult primary liver cancer include a lump or pain on the right side.

These symptoms may be caused by swelling of the liver. These and other symptoms may be caused by adult primary liver cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

• A hard lump on the right side just below the rib cage.
• Discomfort in the upper abdomen on the right side.
• Pain around the right shoulder blade.
• Unexplained weight loss.
• Jaundice (yellowing of the skin and whites of the eyes).
• Unusual tiredness.
• Nausea.
• Loss of appetite.

Tests that examine the liver and the blood are used to detect (find) and diagnose adult primary liver cancer.

The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
• Serum tumor marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumorcells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. An increased level of alpha-fetoprotein (AFP) in the blood may be a sign of liver cancer. Other cancers and certain noncancerous conditions, including cirrhosis and hepatitis, may also increase AFP levels.
• Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver cancer.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). To create detailed pictures of blood vessels in and near the liver, dye is injected into a vein. This procedure is called MRA (magnetic resonance angiography).
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
• Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The sample may be taken using a thin needle inserted into the liver during an x-ray or ultrasound. This is called a fine-needle aspiration (FNA) biopsy. The biopsy may be done during a laparoscopy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body).
• How well the liver is working.
• The patient's general health, including whether there is cirrhosis of the liver.

Prognosis is also affected by alpha-fetoprotein (AFP) levels.