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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 - Treatment
• Patient Comments: Liver Cancer - Describe Your Experience
• Patient Comments: Liver Cancer - Diagnosis
• Find a local Oncologist in your town
• Liver Cancer Index

The natural history of liver cancer depends on the stage of the tumor and the severity of associated liver disease (for example, cirrhosis) at the time of diagnosis. For example, a patient with a 1 cm tumor with no cirrhosis has a greater than 50% chance of surviving three years, even without treatment. In contrast, a patient with multiple tumors involving both lobes of the liver (multicentric tumors) with decompensated cirrhosis (signs of liver failure) is unlikely to survive more than six months, even with treatment.

What are the predictors of a poor outcome? Our knowledge of the prognosis is based on studying many patients with liver cancer, separating out their clinical characteristics, and relating them to the outcome. Grouped in various categories, the unfavorable clinical findings include the following:

• Population characteristics (demographics): male gender, older age, or alcohol consumption
  
  
• Symptoms: weight loss or decreased appetite



• Signs of impaired liver function: jaundice, ascites, or encephalopathy (altered mental state)
  
  
• Blood tests: elevated liver tests (bilirubin or transaminase), reduced albumin, elevated AFP, elevated blood urea nitrogen (BUN), or low serum sodium



• Staging of tumor (based on imaging or surgical findings): more than one tumor, tumor over 3 cm (almost 1¼ inches), tumor invasion of local blood vessels (portal and/or hepatic vein), tumor spread outside of the liver (to lymph nodes or other organs)

There are various systems for staging liver cancer. Some systems look at clinical findings while others rely solely on pathological (tumor) characteristics. It makes the most sense to use a system that incorporates a combination of clinical and pathological elements. In any event, it is important to stage the cancer because staging can provide guidelines not only for predicting outcome (prognosis) but also for decisions regarding treatment.

The doubling time for a cancer is the time it takes for the tumor to double in size. For liver cancer, the doubling time is quite variable, ranging from one month to 18 months. This kind of variability tells us that every patient with liver cancer is unique. Therefore, an assessment of the natural history and the evaluation of different treatments are very difficult. Nevertheless, in patients with a solitary liver cancer that is less than 3 cm, with no treatment, we can expect that 90% of the patients will survive (live) for one year, 50% for three years, and 20% for five years. In patients with more advanced disease, we can expect that 30% will survive for one year, 8% for three years, and none for five years.