Your liver is essential. You cannot survive without it. It is a vital organ that performs more than 500 functions in your body, including cleaning your blood by filtering out toxins and waste, secreting bile to the intestines to aid with digestion and making clotting factors to help stop bleeding. Because cancer can impair the liver’s many functions, it is crucial to learn as much as you can about your diagnosis so you can make informed decisions.
Liver cancer is a disease of the hepatobiliary (heh-PAH-toh-BIH-lee-ayr-ee) system. “Hepato” means liver, and “biliary” refers to the gallbladder and bile ducts. There are two main types of primary liver cancer: hepatocellular carcinoma (HCC) and cholangiocarcinoma. When other types of cancer metastasize, they can spread to the liver; however, that is considered secondary liver cancer.
This information focuses on HCC and is designed to help you learn more about an HCC diagnosis.
About the Liver
The liver has two lobes and is located on the upper right side of the abdomen above the stomach, protected by the ribs (see Figure 1). It is the largest organ in the body and the only one with the ability to regenerate, or grow back, when part of it is removed, as long as the remaining part of the liver is healthy. A liver afflicted with a chronic disease such as cirrhosis cannot regrow.
How HCC Develops
Healthy cells typically divide in an orderly fashion. When worn out or damaged, they die and are replaced by new cells. But cancer develops when genes begin to change, or mutate, within otherwise normal cells. Cancer cells behave abnormally, dividing rapidly, growing out of control and pushing out healthy cells. Unchecked, these cancer cells eventually form a tumor.
HCC begins in the hepatocellular cells of the liver tissue, generally in the presence of underlying chronic liver disease. Two conditions must be addressed: the cancer and the underlying liver disease. That is why liver cancer is sometimes referred to as a disease within a disease and why it is challenging to diagnose and treat.
Cirrhosis, which is scarring of the liver, is the most common underlying condition of HCC. This long-lasting, progressive disease causes inflammation and irreversible damage over time as scar tissue slowly replaces healthy liver cells and the organ gradually loses function. Another condition is nonalcoholic fatty liver disease (NAFLD) and its most severe form, nonalcoholic steatohepatitis (NASH). Both have been linked to obesity. Viral hepatitis B and C (HBV and HCV), which are carried and spread through contact with blood and other bodily fluids, are other potential underlying conditions. Though most patients with HCC have an underlying liver disease, some patients will have a normal liver.
Although it is common not to feel any symptoms, many may occur, including the following:
- Mild to moderate pain or tenderness in the upper right part of the abdomen or right shoulder
- Decreased appetite
- Feeling full despite eating less than normal
- Unintended weight loss
- Deep fatigue
Advanced cancer may result in swelling in the legs or abdomen (ascites); unexplained fevers and jaundice, which can cause yellow skin and yellowing in the whites of the eyes; dark urine and light-colored stools.
Multiple tumors may develop simultaneously. When cancer becomes advanced and spreads beyond the liver, the most common sites are the lung, abdominal lymph nodes and bone.
Your treatment plan will have many moving parts. Your team will look at any underlying liver disease, other serious health conditions and the malignant tumors caused by HCC. Ideally, you would have a multidisciplinary team of specialists from a cancer center or hospital with significant experience treating liver cancer. Experts are required to accurately diagnose and stage the cancer, plan effective treatment and coordinate supportive care to help manage side effects.
Depending on your diagnosis, you may consider participating in a clinical trial. As you and your doctors discuss treatment options, ask about clinical trials taking place in the U.S. and in other parts of the world. In some situations, a clinical trial may offer the best chance for a positive outcome. Every trial has certain eligibility requirements and some may be closed. Check back often for new trials.
Seeking a second opinion is encouraged, especially if your physician does not have extensive experience treating liver cancer. Consulting with another physician does not mean you mistrust your doctor. Rather, it means you are taking control of your health. Another opinion will confirm your current treatment plan or add new recommendations to consider. Never feel guilty for gathering as much information as you can. You deserve to know all your options so you can make more confident decisions.
Pushing Past the Stigma
No one deserves cancer, regardless of lifestyle choices. Yet many medical conditions, including HCC, are often accompanied by “disease stigma.” Disease stigma occurs when people make negative assumptions about or assign blame to individuals with certain diagnoses.
Because HCC is often related to underlying conditions that are directly related to lifestyle choices, some people diagnosed with it feel embarrassed and ashamed. These intense feelings can cause them to withdraw. They may avoid friends and family, which can affect their emotional well-being. They may even avoid medical appointments, which, in turn, can affect their outcome. Loved ones and caregivers can also feel this burden.
So, how do you get past feeling guilt or embarrassment that you or your loved one is responsible for this diagnosis? Surround yourself with support, and remember that you do not have to face HCC alone. A variety of resources at most cancer centers and hospitals and through advocacy groups are available to offer support. Talking with others whose lives are affected by HCC will be invaluable. Supportive care specialists address the emotional, practical and spiritual issues that may affect you, your caregiver and/or your loved ones. Access these services as soon as possible.
In the U.S., HCC is more commonly associated with the following risk factors. Although many are out of your control, you can make lifestyle choices that may reduce your chance of an underlying condition giving rise to liver cancer. In some cases, no risk factors are found, and it is not known what causes the liver to become compromised and vulnerable to HCC.
Age: Older than 60
Ethnicity (U.S.): Higher incidence rates are found in Asians and Pacific Islanders, African Americans, Hispanics and American Indians/Alaska Natives
Lifestyle: Cirrhosis, NASH, obesity and certain environmental factors
Positive for hepatitis B or hepatitis C: Ask your doctor about hepatitis B vaccinations and blood tests for the presence of hepatitis C
- Your body cannot survive without your liver, a vital organ that performs more than 500 important functions.
- If you have NASH, changing some lifestyle habits may help you manage your condition.