Part of looking after our health is understanding our risk factors. Knowing what we’re at risk for allows us to make lifestyle changes and get screenings to help us stay healthier for longer. This is especially important when it comes to cancer.
Here, we’ll focus on liver cancer. The most common form of liver cancer, known as hepatocellular carcinoma, is the fifth most common cancer and the second leading cause of cancer deaths worldwide. While it’s most strongly linked to chronic liver disease, liver cancer has a number of risk factors that are important to be aware of.
Keep reading to learn when symptoms of liver cancer typically appear, lifestyle and health factors that can increase your risk, how it’s treated and more.
The first signs and symptoms of liver cancer may not appear until its later stages
The reason screenings are so important for cancer prevention is that many cancers – liver cancer included – generally don’t have symptoms until they’ve reached an advanced stage. In addition, cancer symptoms can overlap with symptoms of other conditions. Liver cancer, for example, shares some symptoms with chronic liver disease.
Symptoms of liver cancer can include:
- Easy bruising or bleeding
- Fatigue or weakness
- Feeling full after small meals or losing your appetite in general
- Fever
- Jaundice (yellowing of the skin, eyes and mouth, dark urine, pale stools and itchiness)
- Nausea or vomiting
- Pain in your back, typically near your right shoulder blade
- Swollen abdomen
- An uncomfortable feeling or hard lump on the right side of your abdomen
- Unexplained weight loss
Liver cancer by the stages
There are several staging systems that experts use to categorize liver cancer. The most common is the Barcelona Clinic Liver Cancer system, which looks at how much the cancer has spread, how well the liver is functioning, the patient’s overall health and their symptoms. In this system, the stages of liver cancer are:
- Stage 0 (very early) – One liver tumor that’s less than 2 cm across. Liver function and overall health are unaffected.
- Stage A (early) – One tumor that’s less than 5 cm across, or 2-3 tumors that are less than 3 cm across.
- Stage B (intermediate) – Numerous tumors. The liver is still functioning well, but it’s starting to affect overall health.
- Stage C (advanced) – The cancer has become symptomatic. Tumors have spread to the liver’s main blood vessel, or to nearby areas like the lymph nodes.
- Stage D (severe) – Symptoms increase. The liver no longer functions well, which is severely affecting overall health.
Screenings for liver cancer are not universally recommended. This is because screenings have a chance of giving false negative or false positive results, which may delay necessary care or cause unnecessary stress. Because of this, screenings are generally only recommended for people who already have symptoms or risk factors of liver cancer.
Liver cancer screenings can involve several kinds of tests. A blood test may be used to test liver function and look for substances that may indicate tumor growth. Imaging tests like ultrasounds, CT scans or MRI scans may be used to get a better look at the liver itself.
In some cases, particularly if other tests have confirmed that tumors are present, minor surgical procedures may also be used for screening and diagnosis. These include a laparoscopy, which involves inserting a very small tube with a camera on it into the liver, and a biopsy, which is when a tissue sample is taken from a tumor to examine it more closely.
Risk factors for liver cancer include hepatitis, heavy alcohol use and other conditions
Many of the risk factors for liver cancer are things that affect the liver’s function or put additional stress on it. These include:
- Alcohol consumption
- Being overweight
- Chronic hepatitis B or C infections
- Cirrhosis (scarring of the liver that can result from hepatitis or heavy alcohol use)
- Consuming aflatoxins, which are produced by mold and can contaminate crops in warm, humid climates
- Diabetes
- Nonalcoholic fatty liver disease
Heredity may be a risk factor for liver cancer
A family history of liver cancer is considered a risk factor for liver cancer. However, the exact nature of the risk isn’t clear. There are inheritable conditions like hemochromatosis and Wilson’s disease that may increase your risk, but that increased risk could also result from shared environmental factors, such as secondhand smoke or dietary habits.
Ablation, embolization and other liver cancer treatments
Surgery is generally the best treatment for liver cancer. However, many people with liver cancer aren’t eligible for surgery due to the cancer’s specific location, stage or other factors. Because of this, there are a number of methods that are used to treat liver cancer, including:
- Partial hepatectomy – Removing the part of the liver where the cancer is growing.
- Liver transplant – If the cancer has not spread beyond the liver, the liver may be replaced with a healthy donor liver. Other treatments may be used to manage the cancer while waiting for a donor.
- Ablation therapy – Small, specialized instruments are used to apply heat, cold or pure alcohol directly to tumors in order to break them down.
- Embolization therapy – If surgery and ablation therapy are not possible and the cancer has not spread beyond the liver, blood flow through the hepatic artery can be limited to keep the tumor from getting the oxygen and nutrients it needs to grow. Healthy liver tissue is unaffected.
- Targeted therapy – Specific drugs or chemicals are used to disrupt the function of cancer cells.
- Immunotherapy – Special drugs or chemicals are used to strengthen or direct the immune system against the cancer cells.
- Radiation therapy – High-energy X-rays or other forms of radiation are directed at areas of tissue affected by the cancer.
Talk with an expert if you have risk factors for liver cancer
Understanding your personal risk of liver cancer is the first step to lowering it. Your primary care doctor can assess any genetic, environmental or lifestyle-based risk factors you have and explain which screenings you’ll benefit from. They can also give you recommendations for managing risk factors you can change, like alcohol use or diabetes.
