There are several types of liver cancer, each with a different cause, treatment and outlook. Generally speaking, liver cancer has a poor survival rate. However, survival can be increased by avoiding certain risky behaviors.
About 75 percent of liver cancers in adults are hepatocellular carcinomas (HCC), or hepatomas. A hepatoma can begin as a single tumor that spreads to other parts of the liver; or it can start as many small cancer nodules throughout the liver. The latter is the most common form seen in the United States and often affects people with cirrhosis (chronic liver damage). Other, less common, liver cancers arise in different areas and have a range of outcomes.
In the United States and Europe, metastatic liver cancer (cancer that has spread to the liver from another location) is more common than primary liver cancer. However, in many areas of Asia and Africa, the opposite is true. Liver cancer is more common in men than in women, with the average age at diagnosis is 63 years old. Asian-Americans and Pacific Islanders have the highest rates of liver cancer in the U.S.
Worldwide, the most common risk factor for liver cancer is chronic infection with Hepatitis B (more common in Asia and developing countries) or Hepatitis C (more common in the U.S.). Both diseases will eventually lead to cirrhosis of the liver. 80 percent of Americans with liver cancer also have cirrhosis. Alcohol abuse also commonly causes cirrhosis. Hemochromatosis (excess iron absorption) and other rare inherited metabolic diseases can lead to cirrhosis as well.
Other risk factors include obesity, diabetes, exposure to aflatoxins in food, exposure to the chemicals vinyl chloride and thorium dioxide, exposure to arsenic in drinking water, and the use of anabolic steroids.
Liver cancer symptoms often do not appear until later stages or mimic symptoms of other conditions. Still, certain symptoms warrant examination without delay. These symptoms include: unanticipated weight loss, loss of appetite, feeling very full after a small meal, nausea or vomiting, fever, an enlarged liver or spleen, pain or swelling in the abdomen or pain near the right shoulder blade, itching, jaundice, enlarged veins and worsening hepatitis or cirrhosis.
Additional symptoms, caused by hormones produced by some liver tumors, include confusion, weakness, fatigue, breast enlargement and/or shrinking of the testicles in men; high red blood cell counts and high cholesterol levels.
There are no commonly recommended screening tests for liver cancer but reducing exposure to known risk factors can help prevent this disease. A vaccine is available for Hepatitis B, although not for Hepatitis C. People thought to have Hepatitis B or C should be tested and treated with appropriate drugs. Those diagnosed with either disease should avoid contaminated needles and unprotected sex. Those at risk of inheriting certain high-risk diseases should be screened and treated early.
Limiting alcohol and tobacco use and exposure to dangerous chemicals can also help. Many tropical countries are changing the way certain grains are stored to prevent their contamination with aflatoxins. Most developed countries also have regulations to protect consumers and workers from chemical exposure.
Currently, the best cure for liver cancer is surgery – either through removal of the tumor or a liver transplant. In partial hepatectomy surgery, the part of the liver containing the tumor is removed; but enough healthy liver must remain to enable a person to function. Unfortunately, most liver cancers cannot be completely removed, especially among those people with cirrhosis. Liver transplant patients generally have a reasonably high survival rate. Chemotherapy is largely ineffective at treating liver cancer. Please see our Liver Transplantation page for more information.