Liver Cancer - A Growing Threat

By Timothy D. Sielaff, M.D., Ph.D.

Unlike many other cancers that seem to be decreasing in incidence, the number of people who develop liver cancer and die from it is increasing. Nearly 17,300 people in the United States will be diagnosed with liver cancer this year, according to the American Cancer Society. Cancer of the liver, our largest internal organ, is more common in men and is about 10 times more common in African and Asian countries. In many of these countries, it is the most common type of cancer. 

The two main types of liver cancer are metastatic liver cancer and primary liver cancer (disease that originates in the liver). More common in the United States and Europe, metastatic liver cancer occurs when cancer has spread or metastasized from another part of the body likethe pancreas, colon, stomach, breast, or lung. 

Although primary liver cancer accounts for a small percentage of all cancers in this country, it is increasing in frequency. The most common primary liver cancer is liver cell cancer (also called hepatocellular carcinoma or hepatoma). Another type is bile duct cancer. This rare type of cancer most commonly occurs in the bile duct just outside the liver, but these tumors may also occur in the liver itself.

The most common risk factor for primary liver cancer is the hepatitis C virus. Other risk factors include cirrhosis, other chronic liver diseases, fungal toxins in food, and exposure to certain chemicals like arsenic.

The hepatitis B virus can also greatly increase a person's risk for developing primary liver cancer. This may explain why the disease is significantly more prevalent in parts of the world like Africa, Southeast Asia, and China, where a high percentage of the population carries the virus.

Symptoms of liver cancer include unexplained weight loss, severe pain on the right side of the abdomen, abdominal swelling, and jaundice (yellowing of the skin and eyes). Unfortunately, these symptoms often do not appear until the cancer is advanced, making it difficult to successfully treat the disease.

In order to discover the disease early, the American Cancer Society recommends that people infected with hepatitis C virus and others at high risk should talk with their doctor about liver cancer screening. Doctors can screen for liver cancer using a blood test and imaging tests with ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI). Finding small tumors early during a screening test can greatly improve the possibility of curing the disease.

Surgically removing the tumor is the only way to cure liver cancer. This treatment is offered in early-stage disease and only to patients who do not have advanced cirrhosis. 

For patients with advanced liver cancer, liver transplantation is the main treatment. Because of the typically significant waiting time for a new liver, however, many physicians treat the disease using chemotherapy drugs or other therapies to reduce the risk of the tumor growing. 

My colleagues at the University of Minnesota and I also use newer treatments, including radiofrequency ablation (heating the tumor), chemoembolization (injecting a mixture of chemotherapy and a substance to block blood flow into the artery supplying the tumor), and a pump that delivers chemotherapy directly into an artery of the liver. We work with a variety of specialists to determine the appropriate care for each patient with metastatic or primary liver cancer.