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Liver Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Liver Cancer. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

About the liver

The liver is the largest internal organ in the body. It plays a key role in the digestion of food. No one can live without a liver. Functions of the liver include:

  • Collecting and filtering blood from the intestines

  • Processing and storing needed nutrients absorbed by the intestines

  • Converting some nutrients into energy or into substances needed to repair and build tissue

  • Producing some of the body’s blood-clotting factors

  • Removing toxins from the body

  • Helping maintain the proper sugar level in the body

About liver cancer

Cancer begins when healthy cells change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

It is more common for cancer that started in another part of the body to spread to the liver. This is not liver cancer, but rather metastatic cancer of another organ. For instance, pancreatic, colon, stomach, breast, lung, or other cancer that has spread to the liver is still named according to the organ in which it started. For more information about cancer that started in another part of the body and has spread to the liver, read about that specific cancer type.

This section only provides information about cancer that begins in the liver. This is known as primary liver cancer.

Types of adult primary liver cancer

There are a number of types of adult primary liver cancer. They are named for the type of cell from which the cancer develops.


Type of Liver Cancer


Description


How Common

Hepatocellular carcinoma (HCC)

Hepatocellular carcinoma can have different growth patterns. Some spread tentacle-like growths through the liver. This pattern is the most common one in the United States. Some start as a single tumor that spreads to other parts of the liver as the disease develops. Others develop as nodules at several different places in the liver. Occasionally, a pattern isn't clear.

Approximately 80% of adult primary liver cancers are hepatocellular carcinomas.

Cholangiocarcinoma, also called bile duct cancer

A cholangiocarcinoma develops from cells in the bile duct of the liver. The bile duct is a thin tube that extends from the liver to the small intestine. The bile duct starts inside the liver as several smaller tubes that join together.

About 10% to 20% of adult primary liver cancers are cholangiocarcinomas.

Angiosarcoma

Angiosarcoma starts in the blood vessels of the liver and grows very quickly.

About 1% of adult primary liver cancers are angiosarcomas.

 

The rest of this section provides information on the most common type of adult primary liver cancer, hepatocellular carcinoma (HCC). For information about bile duct cancer and angiosarcoma, use the links in the chart above.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to this type of cancer. This fact sheet is available as a PDF, so it is easy to print out.

  • Cancer.Net En Español: Read about liver cancer in Spanish. Infórmase sobre cáncer de hígado en español.

The next section in this guide is Statistics. It helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Liver Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will find information about how many people are diagnosed with this type of cancer each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu.

This year, an estimated 39,230 adults (28,410 men and 10,820 women) in the United States will be diagnosed with primary liver cancer.

It is estimated that 27,170 deaths (18,280 men and 8,890 women) from this disease will occur this year. Liver cancer is the 10th most common cancer and the 5th most common cause of cancer death among men. It is also the 8th most common cause of cancer death among women.

When compared with the United States, liver cancer is much more common in developing countries within Africa and East Asia. In some countries, it is the most common cancer type.

The 1-year survival rate tells you what percent of people live at least 1 year after the cancer is found. Percent means how many out of 100. The 1-year survival rate for people with liver cancer is 44%. The 5-year survival rate is 17%.

For the 43% of people who are diagnosed at an early stage, the 5-year survival rate is 31%. If liver cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 11%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 3%. However, even if the cancer is found at a more advanced stage, treatments are available that help many people with liver cancer experience a quality of life similar to that of before their diagnosis, at least for some time.

It is important to remember that statistics on how many people survive this type of cancer are an estimate. The estimate comes from data based on thousands of people with this cancer in the United States each year. So, your own risk may be different. Doctors cannot say for sure how long anyone will live with liver cancer. Also, experts measure the survival statistics every 1 year. This means that the estimate may not show the results of better diagnosis or treatment available for less than 1 year. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2016.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will find a basic drawing of the location of the liver in the body. To see other pages, use the menu.

Larger Image

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease and ways to lower your risk. Or, use the menu to choose another section to continue reading this guide. 

Liver Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer and ways to lower your risk. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors can raise a person’s risk of developing HCC. The main risks in the United States are cirrhosis of the liver and nonalcoholic fatty liver disease (NAFLD).

  • Viral hepatitis.Hepatitis viruses are viruses that infect the liver. Two common types are hepatitis B and hepatitis C. Viral hepatitis is the largest risk factor for this type of cancer worldwide. Hepatitis C has become much more common than hepatitis B because there is no vaccine to prevent hepatitis C.

    Viral hepatitis can be passed from person to person through exposure to another person's blood or bodily fluids. This can happen through injury, by sharing needles during drug use, or by sexual contact. In the case of hepatitis B, an unborn baby or infant can get the virus if the mother has it. This can be avoided by vaccinating the baby.

    If you develop acute hepatitis B or C and then “clear the virus,” you have no increased risk of liver cancer. Only people who do not clear the virus and have a persistent infection have an increased risk. Your doctor will be able to perform blood tests that tell if you have cleared the virus.

  • Cirrhosis. Cirrhosis develops when liver cells are damaged and replaced by scar tissue. Most cirrhosis in the United States is caused by alcohol abuse. Other causes are viral hepatitis (types B and C, as mentioned above), too much iron in the liver from a disease called hemochromatosis, and some other rare types of chronic liver disease. Combined alcohol abuse and hepatitis virus infection puts people at high risk of cirrhosis and HCC.

  • Obesity, NAFLD, and diabetes. Obesity causes fat to be deposited in the liver, which leads to a condition known as NAFLD. Over the past decade, strong evidence has emerged suggesting that NAFLD and diabetes, a related disorder, are increasingly important risk factors for HCC in the United States. 

  • Age. In the United States, adult primary liver cancer occurs most often in people older than 60.

  • Gender. Men are more likely than women to develop this type of cancer.

  • Environmental factors. Some environmental factors may increase the risk of liver cancer, such as exposure to certain chemicals or eating food contaminated with aflatoxin. Aflatoxin is a toxin made by a mold that can grow on stored nuts and grains. There is less risk of this in the United States.

Risk factors are cumulative. This means that having more than 1 risk factor increases the risk of developing liver cancer even more. For instance, a person who carries both hepatitis B and C has a higher risk than a person carrying 1 type of the virus.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

In the United States, HCC can usually be avoided by preventing viral hepatitis and cirrhosis. A vaccine can protect healthy people from contracting hepatitis B. In fact, the U.S. Centers for Disease Control and Prevention recommends that all children should have this vaccination. There is no vaccine against hepatitis C, which is most often associated with current or previous intravenous (IV) drug abuse. Blood banks in the United States check donated blood to make sure that blood carrying the hepatitis viruses is not used.

Cirrhosis can be avoided by not abusing alcohol and preventing viral hepatitis. Most industrialized countries have regulations to protect people from cancer-causing chemicals. In the United States, such regulations have virtually eliminated these chemicals as a cause of HCC.

There is increasing evidence that certain medications can control chronic hepatitis B or C infection. This can reduce the inflammation and damage these viruses cause in the liver. There have been major advances in recent years in antiviral therapy, particularly for chronic hepatitis C virus infection. This is likely to have a major positive impact on liver cancer prevention, particularly if taken before cirrhosis develops. For information about these types of treatments, it is important to talk with a hepatologist. A hepatologist is a doctor who specializes in diseases of the liver.

Because NAFLD linked to obesity is becoming an increasingly important risk factor for HCC, people are also encouraged to follow established guidelines for good health, such as maintaining a healthy weight, eating a balanced diet, and participating in moderate physical activity. Your doctor can help you create an appropriate exercise plan based on your needs, physical abilities, and fitness level.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Screening

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

Cancer ScreeningON THIS PAGE: You will find out more about screening for this type of cancer. You will also learn the risks and benefits of screening. To see other pages, use the menu.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for liver cancer

If you know you have cirrhosis or other risk factors, it is extremely important to talk with your doctor about whether you should be regularly screened for liver cancer. Finding a cancer before any symptoms have developed will increase the chance of successful treatment. Hepatologists are the doctors with the most experience in screening for primary liver cancer. You may also see the term “surveillance” used to explain this, but this means the same as screening.

Screening options include testing the blood for a substance called alpha-fetoprotein (AFP), which may be produced by cancer cells, or having imaging tests like an ultrasound, computed tomography (CT or CAT) scan, or magnetic resonance imaging (MRI). More information about these tests can be found in the Diagnosis section.

Talk with a hepatologist about which screening tests he or she recommends and how often to have them based on your medical history. Different guidelines apply to different causes of liver disease.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages in this guide, use the menu.

People with HCC may experience no symptoms, particularly when the tumor is detected early as part of a screening program. When symptoms or signs do occur, they include:

  • Pain, especially at the top right of the abdominal area, near the right shoulder blade, or in the back

  • Unexplained weight loss

  • A hard lump under the ribs on the right side of the body, which could be the tumor or a sign that the liver has gotten bigger

  • Weakness or fatigue

When HCC is diagnosed, some people will already know that they have cirrhosis and will be receiving care from a doctor. Some symptoms experienced by patients with HCC may be caused by cirrhosis rather than the tumor. These symptoms include abdominal swelling from ascites (fluid accumulation) and needing more diuretics (water tablets) to control the fluid accumulation. Hepatic encephalopathy (mental confusion) and bleeding from the esophagus or stomach, or any worsening of the condition, may also indicate cancer.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. HCC is often diagnosed without a biopsy. This is discussed in more detail below.

Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

The following tests may be used to diagnose HCC. This list describes options for diagnosing this type of cancer, but not all tests listed below will be used for every person.

  • Physical examination. If a person has symptoms of HCC, the doctor will feel the abdomen to check the liver, spleen, and other nearby organs for lumps, swelling, or other changes. The doctor will also look for an abnormal buildup of fluid in the abdomen and for signs of jaundice, which include yellowing of the skin and whites of the eyes.

  • Blood tests. At the same time as the physical examination, the doctor will most likely do a blood test to look for a substance called AFP. In the United States, AFP is found in elevated levels in the blood of about 50% to 70% of people who have HCC. The doctor will also test the patient’s blood to see if he or she has hepatitis B or C. Other blood tests can show how well the liver is working.

In addition, other tests are commonly needed to diagnose HCC, to find where the tumor is located in the liver, and to see if it has spread to other parts of the body. After the physical examination and blood tests, the doctor may recommend one or more of the following tests:

  • Ultrasound. An ultrasound uses sound waves to create a picture of the structures inside the body, using a small amount of radiation. The sound waves bounce off the liver, other organs, and tumors. Each creates a different picture on a computer monitor.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow. Often, HCC can be diagnosed based on features specific to the cancer that are seen on a CT scan. This helps patients avoid a liver biopsy (see below). A CT scan can also be used to measure the tumor’s size.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Angiogram. An angiogram is an x-ray picture of the blood vessels. A dye is injected into the bloodstream so the blood vessels of the liver show up on an x-ray.

  • Laparoscopy. Laparoscopy is a test that allows the doctor to see inside the body with a thin, lighted, flexible tube called a laparoscope. The person is sedated as the tube is inserted through a small incision in the abdomen. Local anesthetic to numb the area is also used.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

    The type of biopsy performed will depend on the location of the cancer. The biopsy can be done during a laparoscopy, a fine-needle aspiration, or a core biopsy. During a fine-needle aspiration, cells are removed using a thin needle inserted into the tumor. A core biopsy uses a thicker needle. Either procedure is done by a radiologist who uses an ultrasound to direct him or her to the particular part of the liver with the tumor. The actual biopsy procedure usually lasts for less than 1 minute. It is typically not painful, and few people have complications from the procedure.

    Before the biopsy, your doctor will test your blood to make sure it clots normally. This decreases the risk of bleeding after the procedure. Sometimes your doctor might perform a laparoscopy and biopsy to look at the non-cancerous part of the liver to find out if you have cirrhosis, which will help determine the best treatment options.

    When the AFP blood test strongly indicates HCC, and other test results are typical of HCC, a biopsy may not be needed. Also, most surgeons will recommend that a biopsy be done as part of surgery if all or part of the liver is being removed, rather than as a separate procedure beforehand. See the Treatment Options section for more information about surgery for liver cancer.

    It is also important to note that with newer imaging methods, very small masses are easier to find. However, it is not always possible to identify what a very small mass is and if it is cancer. In these instances, especially when the mass is 1 centimeter or smaller in size, the doctor may recommend a “watch and wait” approach, also called active surveillance or watchful waiting. This means that the scans are repeated in 3 to 6 months. If the later scan shows that the size hasn’t changed, the surveillance approach is continued. If it grows, the doctor will then do a biopsy.

  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see Treatment Options).

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is HCC, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Staging a cancer helps determine the prognosis of the disease and the types of treatment that are most appropriate. In general, only early-stage liver cancer can be cured.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor decide what kind of treatment is best and may help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

There are 2 types of liver cancer: primary and metastatic. Primary liver cancer begins in the liver. Metastatic (secondary) liver cancer is cancer that has spread from another part of the body. This section describes the stages of primary liver cancer. For information about the stages of metastatic liver cancer, read about the primary type of cancer. For example, lymphoma that has spread to the liver will still be staged as lymphoma.

BCLC staging system

For HCC, doctors often use the Barcelona Clinic Liver Cancer (BCLC) system to describe the cancer and recommend treatment. The BCLC system categorizes HCC based on characteristics of the tumor, liver function, performance status, and cancer-related symptoms.

BCLC stage groupings include:

  • Very early stage. The tumor is smaller than 2 cm. There is no increased pressure in the portal vein. Bilirubin levels are normal. Surgery is usually recommended.

  • Early stage. The tumor is smaller than 5 cm. Liver function varies. There may be no increased pressure in the portal vein, increased portal vein pressure and normal bilirubin levels, or increased portal vein pressure and increased bilirubin levels. People with early-stage disease may be candidates for a liver transplant, surgery, or radiofrequency ablation (RFA).

  • Intermediate stage. The tumor may be large or there may be multiple tumors. Doctors usually recommend regional therapies, such as transarterial chemoembolization.

  • Advanced stage. The tumor has invaded the portal vein or spread to other parts of the body, such as the lungs and bones. Doctors usually recommend targeted therapy.

TNM staging system

There is another staging system, called the TNM system, which is used for most cancers. However, the TNM system has significant limitations for staging HCC, especially if there is cirrhosis of the liver. Cirrhosis can become equally or even more important than tumor characteristics when it comes to prognosis and treatment options. It is included here for completeness.

In TNM, doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

There are 4 stages: stages I through IV (one through four).

Here are more details on each part of the TNM system for liver cancer.

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. If there is more than 1 tumor, the lowercase letter “m” (multiple) is added to the “T” category. Specific tumor stage information for HCC is listed below.

TX: The primary tumor cannot be evaluated.

T0: There is no evidence of a primary tumor.

T1: The tumor is 2 cm or smaller. It does not involve nearby blood vessels.

T2: Either of these:

  • Any tumor that involves nearby blood vessels.

  • More than 1 tumor, but none larger than 5 cm.

T3a: There is more than 1 tumor, and at least 1 is larger than 5 cm.

T3b: A tumor of any size involves the major veins around the liver.

T4: Either of these:

  • The tumor has spread to the organs near the liver, except the gallbladder.

  • The tumor has broken through the visceral peritoneum, which is the layer of tissue that lines the abdomen.

Node (N)

The "N" in the TNM staging system stands for lymph nodes. These tiny, bean-shaped organs help fight infection. Lymph nodes near the liver are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): Cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to the regional lymph nodes.

Metastasis (M)

The “M” in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis.

MX: The tumor cannot be evaluated.

M0 (M plus zero): The cancer has not spread to other parts of the body.

M1: The tumor has spread to another part of the body.

Cancer stage grouping using TNM

Doctors assign the stage of the HCC by combining the T, N, and M classifications.

Stage I: This is the earliest stage of HCC. The tumor has not spread to the blood vessels, lymph nodes, or other parts of the body (T1, N0, M0).

Stage II: The tumor involves nearby blood vessels, but it has not spread to the regional lymph nodes or other parts of the body (T2, N0, M0).

Stage IIIA: The cancer has not spread beyond the liver, but the area of the cancer is larger than stage I or II (T3a, N0, M0).

Stage IIIB: The cancer involves a major vein around the liver, but it has not spread to nearby lymph nodes or other parts of the body (T3b, N0, M0).

Stage IIIC: Any tumor that has spread to the organs near the liver (except the gallbladder), or if the tumor has broken through the visceral peritoneum. There is no spread to nearby lymph nodes or other parts of the body (T4, N0, M0).

Stage IVA: Any tumor that has spread to the regional lymph nodes but not to other parts of the body (any T, N1, M0).

Stage IVB: Any tumor that has spread to other parts of the body (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer has returned, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

TNM system outline used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat people with HCC. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for HCC. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment options and recommendations depend on several factors:

  • How much of the liver is affected by the cancer

  • Whether the cancer has spread

  • The patient’s preferences and overall health

  • The damage to the remaining cancer-free area of the liver

When a tumor is found at an early stage and the patient’s liver is working well, treatment is aimed at trying to eliminate the cancer. The care plan may also include treatment for symptoms and side effects, an important part of cancer care. When liver cancer is found at a later stage, or the patient’s liver is not working well, the patient and doctor should talk about the goals of each treatment recommendation. At this point, the goals of treatment may focus on slowing growth of the cancer and relieving symptoms to improve quality of life.

The various disease-directed treatment options can be grouped according to whether they may cure the cancer or will improve survival but will most likely not eliminate the cancer. Descriptions of the most common treatment options, both disease-directed and those aimed at managing side effects and symptoms, are listed below. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Disease-directed treatments to eliminate HCC

These treatments are generally recommended when the tumor has been found at an early stage. Many doctors will not use these treatments if the tumor is larger than 5 cm. These treatments are surgery, thermal ablation, percutaneous ethanol injection, and radiation therapy.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with a tumor smaller than 5 cm. If the tumor has spread outside the liver, or if the patient has other serious illnesses, surgery may not be an option. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Learn more about the basics of cancer surgery.

Two types of surgery are used to treat HCC:

  • Hepatectomy. When a portion of the liver is removed, the surgery is called a hepatectomy. A hepatectomy can be done only if the cancer is in one part of the liver and the liver is working well. The remaining section of liver takes over the functions of the entire liver. The liver may grow back to its normal size within a few weeks. A hepatectomy may not be possible if the patient has advanced cirrhosis, even if the tumor is small.

    The side effects of a hepatectomy may include pain, weakness, fatigue, and temporary liver failure. The health care team will watch for signs of bleeding, infection, liver failure, or other problems that need immediate treatment.

  • Liver transplantation. Sometimes, a liver transplantation can be done. This procedure is possible only when the cancer has not spread outside the liver, a suitable donor is found, and very specific criteria are met in terms of tumor size and number. These criteria usually are a single tumor 5 cm or smaller or 3 or fewer tumors, all of which are smaller than 3 cm. It is important to understand that the number of donor livers available is very limited, so transplantation is not always an option.

    After a transplant, the patient will be watched closely for signs that the body might be rejecting the new liver or that the tumor has come back. The patient must take medication to prevent rejection. These drugs can cause side effects, such as puffiness in the face, high blood pressure, or increased body hair.

    Liver transplantation is a particularly effective treatment for people with a small tumor because transplantation removes the tumor and the damaged liver. However, there are few donors, and people waiting for a liver transplant may have to wait for a long time before a liver becomes available. During this time, the disease may get worse. The transplant center will advise you on how long the wait is likely to be and what rules are used to prioritize people on the waiting list.

Thermal ablation

Radiofrequency ablation (RFA) and microwave therapy both use heat to destroy cancer cells. They may be given through the skin, through laparoscopy, or during a surgical operation while a patient is sedated. Sedation is giving medication to become more relaxed, calm, or sleepy.

Percutaneous ethanol injection

Percutaneous ethanol injection is when alcohol is injected directly into the liver tumor to destroy it. Side effects include fever and pain after the procedure. In general, the procedure is simple, safe, and particularly effective for a tumor smaller than 3 cm. However, if the alcohol escapes from the liver, a person may have brief but severe pain. This option is currently being used less often and has been largely replaced by RFA (see above).

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

  • Stereotactic body radiation therapy (SBRT). SBRT is a term that describes several methods of delivering high doses of radiation to a tumor while limiting the amount of radiation to which healthy tissues are exposed. This is important because healthy liver tissue can be damaged by radiation. SBRT effectively treats tumors that are approximately 5 cm or smaller. However, it is still considered investigational compared to thermal ablation (see above) because little long-term information about its effectiveness exists.

  • Radioembolization is similar to chemoembolization (see below), except that during radioembolization, a doctor places radioactive beads into the artery that supplies the tumor with blood. The beads deliver radiation directly into the tumor when they become trapped in the small blood vessels of the tumor.

Side effects may include damage to the stomach and lungs. However, these side effects can often be prevented. Learn more about the basics of radiation therapy.

Disease-directed treatments to improve survival

If the doctor feels the cancer cannot be eliminated (cured) using 1 of the treatments listed above, he or she may recommend 1 of the following options to shrink the tumor and/or slow tumor growth. While these treatments will most likely not eliminate the cancer, they have been shown to improve duration of survival (length of life).

Chemoembolization

This is a type of chemotherapy treatment that is similar to hepatic arterial infusion (see below). Chemotherapy is the use of drugs to destroy cancer cells. During this procedure, drugs are injected into the hepatic artery, and the flow of blood through the artery is blocked for a short time so the chemotherapy stays in the tumor longer. Blocking the blood supply to the tumor also destroys cancer cells.

In addition to being used as a primary treatment for HCC, chemoembolization may be used to slow tumor growth for people who are on the waiting list for liver transplantation.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

For HCC, anti-angiogenesis drugs are the most common targeted therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. This is one of the ways sorafenib (Nexavar) is thought to work. Sorafenib is one of the treatment options for advanced HCC that cannot be completely removed with surgery. It is taken as pill that is swallowed (orally). The side effects of sorafenib include diarrhea and certain skin problems. Talk with your doctor about the possible side effects for a specific medication and how they can be managed.

Other treatment options

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Currently, immunotherapy is mainly being researched in clinical trials for HCC and is not considered a standard treatment option.

Side effects of biologic therapy are similar to the flu and can include fatigue, fever, chills, muscle pain, and headache. Learn more about the basics of immunotherapy.

Other clinical trials

In addition to the treatment options described above, the doctor may suggest participating in a clinical trial that is evaluating a new treatment approach for HCC. This is particularly important for a disease like HCC, where options for treating advanced disease are very limited and there is ongoing research to expand treatment options.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Metastatic HCC

If cancer has spread to another location in the body, it is called metastatic cancer. People with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer because there can be different opinions about the best treatment plan. Learn more about getting a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials studying new treatments.

Your health care team may recommend a treatment plan that includes a combination of chemotherapy (including sorafenib, see Targeted therapy above), radiation therapy, and/or other options. At this stage, the goal of treatment is typically to slow the cancer’s growth. Palliative care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with HCC. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

The number of clinical trials focused on HCC has increased in recent years. Many of these clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating HCC. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with HCC.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for HCC, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about HCC and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about HCC, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Cancer vaccines. Cancer vaccines are treatments that may help the immune system recognize and attack HCC cells. Sometimes the vaccine is given with an immune system stimulant, such as sargramostim (Leukine, Prokine).

  • Combination chemotherapy. Different drugs destroy cancer cells in different ways. Using a combination of drugs can increase the chance more cancer cells will be destroyed. Many times, 1 drug will help the other drug work better.

  • Combining therapies. Researchers are looking into whether combining treatments, such as RFA and chemoembolization, is more effective than using these treatments separately.

  • Anti-angiogenesis drugs. In addition to sorafenib, which is discussed in the Treatment Options section, several other anti-angiogenic drugs are being tested in clinical trials.

  • Greater use of liver transplantation. Researchers are investigating the possibility of expanding the criteria for liver transplantation for HCC. This would make more patients eligible for the procedure.

  • Gene therapy. This new treatment changes a gene to fight cancer. Although gene therapy is in the very early stages of development, some clinical trials are already underway. In 1 example, the new gene makes chemotherapy work better. In this type of treatment, a gene can be directly injected into the tumor. The doctor then gives the patient an inactive drug, and the new gene helps activate the drug in the tumor. This approach is also being tested in combination with the other treatments listed above.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current HCC treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding liver cancer, explore these related items that take you outside of this guide:

  • Visit the website of the Conquer Cancer Foundation to find out how to help support research for every cancer type. Please note this link takes you to a separate ASCO website. 

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for HCC are described in the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with HCC. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

Research to find ways to prevent second cancers and recurrent HCC is ongoing, but there is no standard prevention method at this time.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from HCC are encouraged to follow established guidelines for good health, such as not smoking, limiting or avoiding alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type and subtype of liver cancer do I have?

  • How large is the tumor?

  • What is the stage of my cancer? What does this mean?

  • Can the tumor be removed surgically? What does this mean?

  • Can you explain my pathology report (laboratory test results) to me?

  • Am I a carrier of hepatitis B or C? What does this mean?

Questions to ask about risk factors

  • Do I have cirrhosis of the liver? What does this mean?

  • Do I have NAFLD? What does this mean?

  • What are my treatment options?

Questions to ask about choosing a treatment and managing side effects

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the chances for success with the planned treatment?

  • Do I need to start treatment right away?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call for questions or problems?

  • Is there anything else I should be asking?

  • How much of my liver will be removed?

Questions about surgery

  • Will I need a liver transplant?

  • If I need a liver transplant, am I likely to be prioritized on the transplant waiting list? How long should I expect to wait?

  • How long will the operation take?

  • Will I need to stay in the hospital for this surgery? If so, for how long?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible side effects of my surgery, in the short term and the long term?

  • What type of treatment is recommended?

Questions about chemotherapy, targeted therapy, and immunotherapy

  • What is the goal of this treatment?

  • How will it be delivered (through an IV, a catheter, or a pill)?

  • What does the preparation for this treatment involve?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to prevent or manage these side effects?

  • What type of treatment is recommended?

Questions about radiation therapy

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to prevent or manage these side effects?

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

Questions to ask about planning follow-up care

  • What follow-up tests will I need, and how often do I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

Liver Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Liver Cancer. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Liver Cancer. Use the menu to select another section to continue reading this guide.