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Medical Author:

Keith E. Stuart, MD

Keith E. Stuart, MD

Dr. Keith E. Stuart is a medical oncologist specializing in the study and treatment of cancers involving the gastrointestinal tract, with a special interest in tumors involving the liver. He was educated at Harvard University (graduating magna cum laude) and Albert Einstein College of Medicine and did his medical training at the New England Deaconess Hospital.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• Liver cancer facts
• What is liver cancer (hepatocellular carcinoma, HCC)?
• What is the scope of the liver cancer problem?
• What are the population characteristics (epidemiology) of liver cancer?
• What are liver cancer causes and risk factors?
• What are liver cancer symptoms and signs?
• How is liver cancer diagnosed?
• Blood tests
• Imaging studies
• Liver biopsy or aspiration
• What is the natural history of liver cancer?
• What are the treatment options for liver cancer?
• Chemotherapy and biotherapy
• Chemoembolization (trans-arterial chemoembolization or TACE)
• Radioembolization
• Ablation techniques
• Cryoablation
• Stereotactic radiosurgery
• Proton beam therapy
• Surgery
• Is there a role for routine screening for liver cancer?
• What is fibrolamellar carcinoma?
• What's in the future for the prevention and treatment of liver cancer?
• Patient Comments: Liver Cancer - Describe Your Experience
• Patient Comments: Liver Cancer - Treatment
• Patient Comments: Liver Cancer - Diagnosis
• Find a local Oncologist in your town
• Liver Cancer Index

Fibrolamellar carcinoma is a liver cancer variant that is found in non-cirrhotic livers, usually in younger patients between 20 and 40 years of age. In fact, these patients have no associated liver disease and no risk factors have been identified. The alpha-fetoprotein in these patients is usually normal. The appearance of fibrolamellar carcinoma under the microscope is quite characteristic. That is, broad bands of scar tissue are seen running through the cancerous liver cells. The important thing about fibrolamellar carcinoma is that it has a much better prognosis than the common type of liver cancer. Thus, even with a fairly extensive fibrolamellar carcinoma, a patient can have a successful surgical removal.

Prevention

Worldwide, the majority of liver cancer is associated with chronic hepatitis B virus infection. Today, however, all newborns are vaccinated against hepatitis B in China and other Asian countries. Therefore, the frequency of chronic hepatitis B virus in future generations will decrease. Eventually, perhaps in three or four generations, hepatitis B virus will be totally eradicated, thereby eliminating the most common risk factor for liver cancer. Studies have already shown a decrease of up to 75% in the incidence of liver cancer in children and teenagers in Hong Kong and even in the United States since routine vaccination was introduced.

Some retrospective (looking back in time) studies suggest that patients with chronic hepatitis C who were treated with interferon were less likely to develop liver cancer than patients who were not treated. Interestingly, in these studies, interferon treatment seemed to provide this benefit, even to patients who had less than an optimal antiviral response to interferon. Still, it remains to be seen whether the risk of developing cirrhosis and liver cancer is significantly decreased in prospectively (looking ahead) followed patients who responded to interferon.

Theoretically, we know that liver cancer should be an almost totally preventable disease. Most of it is caused by infection with hepatitis; this can be reduced (if not eliminated) by treating infected mothers before they give birth, vaccinating all children regardless of where they live, screening the blood supply to avoid infected transfusion, and always using clean needles for any injections. (Many cases of hepatitis C infection are thought to have been from doctors or schools using the same needles for many patients or classroom vaccinations!) Aflatoxin contamination can be eradicated by proper storing of foodstuffs and, in fact, is not a measurable problem in developed countries. Alcohol abuse is difficult to eliminate, but at an individual level, this is a totally avoidable risk factor for liver cancer. Even more difficult is obesity and diabetes, but as with alcohol, personal lifestyle choices will directly lead to the development of this cancer. Therefore, a combination of societal, financial, and political changes around the world could lead to a very substantial decrease in the incidence of this cancer over the next two to three decades.

Treatment

Treatment options for liver cancer have grown exponentially over the past two decades. Using the way the cancer grows -- generally just within the liver, killing the person as it destroys the liver around it -- has led to many effective methods of attacking the cancer directly, through surgery, transplantation, ablation, and chemoembolization. In fact, the chances of someone with liver cancer being alive after just a year are now three times higher than they were 20 years ago, probably just because of the growth in popularity and effectiveness of these local treatment methods. The approval of sorafenib, the first drug shown to prolong lives in liver cancer, heralds a new understanding of the molecular nature of this cancer and has tremendously increased the interest of researchers and pharmaceutical companies in finding a more effective treatment for liver cancer. There is more research going on than ever before for these patients, and everyone should be encouraged to join a clinical trial if possible, to try to get the most advanced treatment available.

Additional resources from WebMD Boots UK on Liver Cancer

Previous contributing author and editor:

Medical Author: Tse-Ling Fong, MD
Medical Editor: Paul Oneill, MD, Board Certified Oncology

REFERENCES:

Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D. Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies. J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):217-23.

Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005 Nov;42(5):1208-36.

Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, Primrose JN, Parks RW. Guidelines for resection of colorectal cancer liver metastases. Gut. 2006 Aug;55 Suppl 3:iii1-8.

Previous contributing medical editor: Leslie J. Schoenfield, MD, PhD