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What Is Liver Cancer?

The liver is the largest internal organ that lives in the upper right portion of the abdomen beneath the lung. The primary function of the liver is to regulate most chemical levels in the blood and excrete a product called bile. This helps carry away waste products from the liver. 

Liver cancer starts when cells in the liver begin to grow out of control. The liver is made up mainly of cells called hepatocytes that can form cancerous and non-cancerous tumors.

Primary liver cancer forms in the liver and begins in the hepatocyte cells of the liver.

The most common type of primary liver cancer is called hepatocellular carcinoma. Secondary liver cancer, cancer that spreads, or metastasizes, to the liver from somewhere else in the body, is more common than primary liver cancer. Cancer that originates in another part of the body such as lung, esophagus, or colon then migrates to the liver is called liver metastasis or hepatic metastasis and is named for the organ in which it began. 

According to the American Cancer Society, more than 42,200 new cases of primary liver cancer are diagnosed and there are an estimated 30,200 deaths from the disease each year. Primary liver cancer is more prevalent in men than women with an 8.3% higher incidence rate and a 5.7% higher death rate over women. Since 1980, liver cancer incidence rates have more than tripled and death rates have more than doubled.

In Colorado, there are an estimated 600 new cases and 420 deaths from primary liver cancer each year.

Liver cancer is much more common in countries in Southeast Asia and sub-Saharan Africa than in the United States. In many of these countries it is the most common type of cancer. Each year more than 800,000 people are diagnosed with liver cancer around the world. Liver cancer is also the leading cause of cancer deaths worldwide, accounting for more than 700,000 deaths each year. 

Why Come to CU Cancer Center for Liver Cancer 

CU Cancer Center doctors offer patients a comprehensive evaluation of benign and cancerous conditions of the liver. The CU Cancer Center is also one of four National Cancer Institute Designated Comprehensive Cancer Centers in the Rocky Mountain region. We have doctors who provide top-notch, multidisciplinary, patient-centered care and treatment options not available at most other medical centers in the country.

Our doctors are the only physicians in a 500-mile radius who are part of the National Comprehensive Cancer Network (NCCN) advisory panel. The NCCN establishes treatment guidelines that doctors all across the United States use as a reference. 

There are over 100 liver cancer clinical trials, which includes several trials dedicated to the treatment of liver cancer, currently being offered by CU Cancer Center members, giving patients many different treatment options. 

The Liver Multidisciplinary Clinic at the CU Cancer Center brings together a team of expert surgical oncologists, liver transplant surgeons, interventional radiologists, pathologists, medical oncologists, radiologists, radiation oncologists, and more to focus on problems affecting the liver. Together, the team analyzes a patient’s diagnosis and recommends a specific treatment plan for the individual by the end of the visit. Twenty to 30% of patients who are evaluated using a multidisciplinary approach have a change in their original diagnosis or treatment plan. 

Our clinical partnership with UCHealth has produced survival rates higher than the state average for all stages of liver cancer.

Liver Cancer Graph
Number of Patients Diagnosed – UCHealth 1,800 – State of Colorado 8046
Number of Patients Surviving – UCHealth 436 – State of Colorado 1505 
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)

Types of Liver Cancer

There are two types of liver cancers, primary liver cancers, and secondary liver cancers. 

The two most common forms of primary liver cancers are:

Hepatocellular carcinoma (HCC), the most common form of liver cancer in adults, can have different growth patterns. Some hepatocellular cancers start as a single tumor that grows slowly over time. Others start as many cellular nodules throughout the liver, not one single tumor.

Intrahepatic cholangiocarcinoma (bile duct cancer) starts in the cells that line the small bile ducts within the liver. Cholangiocarcinomas account for 10%-20% of cancers that start in the liver.

Secondary liver cancer is cancer that did not start in the liver but spread (metastasized) to the liver from another part of the body. Liver metastases, cancerous tumors that spread to the liver, commonly start as cancer in the colon or rectum. 

Angiosarcoma and hemangiosarcoma are rare cancers that start in the cells that line the blood vessels of the liver. Fast growing tumors, angiosarcoma, and hemangiosarcoma are often treated with chemotherapy and radiation because they grow too quickly to be removed surgically.

In addition to treating all types of liver cancer, CU Cancer Center doctors are also experienced in treating a variety of benign (non-cancerous) liver tumors. Several types of tumors can form from the different types of cells that make up the liver. The causes of these tumors vary and require different treatments. CU Cancer Center experts treat the following non-cancerous liver tumors:

Hemangioma are the most common benign liver tumor. Hemangiomas are abnormal blood vessels that don’t often cause symptoms but may bleed or cause pain. 

Focal nodular hyperplasia, tumors that derive from several cell types, hepatocytes, bile ductules, and Kupffer cells, do not bleed or become cancerous but are commonly removed because they can grow very large, causing symptoms similar to liver cancers.

Adenoma are benign hepatocyte tumors that can rupture and bleed and become cancerous. For this reason, they are commonly removed. 

Cyst, a cavity in the liver that contains fluid that can become enlarged or infected and require removal.  

Other tumor types that don’t typically require treatment include hamartomas, regenerative nodules, and lipomas.

Gallbladder cancer is abnormal cell growth in the small, pear-shaped organ that lives beneath the liver. Gallbladder cancer is a very uncommon cancer that often goes undiscovered until later stages. Because gallbladder cancer tends to migrate to the liver, the two require similar treatments. Aside from resection of the gallbladder and possibly a portion of the liver, this cancer can be treated with chemotherapy, radiation, targeted drugs, and immunotherapy.

Causes of Liver Cancer

Liver cancer is caused by DNA changes or mutations that occur within healthy cells. Normal cells in the body go through a life cycle where they grow and divide to form new cells and then die when the body no longer needs them. Cells contain DNA that tells the cell what to do. When a cell’s DNA is damaged, cells continue to grow and divide where they aren’t needed by the body. This buildup of cells becomes a tumor. 

Certain chemicals can cause damage to the DNA in the liver cells and this damage can cause abnormal or mutated cells to grow. The hepatitis virus and chronic hepatitis infections are also known to cause liver cancer.

Risk Factors for Liver Cancer

There are several factors that might increase the chance of developing liver cancer. These risk factors include:

Gender: Hepatocellular carcinoma is more common in men than in women.  

Race: Of all racial groups in the United States, Asian Americans and Pacific Islanders have the highest incidence rates of liver cancer.

Chronic viral hepatitis: Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) is the most common risk factor for liver cancer.

Cirrhosis: An irreversible condition that causes damage to liver cells and creates scar tissue. Cirrhosis is a progressive disease that increases the chances of developing liver cancer. 

Weight: Non-alcoholic fatty liver disease is common among obese people. Non-alcoholic steatohepatitis, a subtype of this disease can cause cirrhosis and lead to an increased risk of liver cancer. 

Inherited liver diseases: Hereditary hemochromatosis and Wilson’s disease can increase the risk of developing liver cancer.

Diabetes: People with diabetes have a greater risk of liver cancer than other people.

Excessive alcohol use: Alcohol abuse over many years can lead to irreversible liver damage linked with an increased risk of liver cancer.

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Information reviewed by Christopher Lieu, MD, in September 2022.