Liver CancerLast Updated: July 27, 2011 This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/11 Overview
About the liver The liver is the largest internal organ in the body, and its functions are vital to the digestion of food. No one can survive without a liver. Functions of the liver include:
Types of liver cancer Cancer begins when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Primary liver cancer is cancer that begins in the liver. It is more common for the liver to be the site of metastasis (spreading) of a cancer that started in another place, such as pancreatic, colon, stomach, breast, or lung cancer. However, these are not primary liver cancer. For more information about cancer that started in another part of the body and spread to the liver, please read about that specific cancer type. This section covers only adult primary liver cancer. The subtypes of adult primary liver cancer are named for the type of cell from which they develop. These subtypes are described below: Types of adult primary liver cancer
The remainder of this section discusses the most common type of adult primary liver cancer, hepatocellular carcinoma (HCC). Find out more about basic cancer terms used in this section. Looking for More of an Overview? If you would like additional introductory information, explore these related items on Cancer.Net:
Or, choose “Next” (below, right) to continue reading this detailed section. To select a specific topic within this section, use the icon panel located on the right side of your screen. Statistics
This year, an estimated 26,190 adults (19,260 men and 6,930 women) in the United States will be diagnosed with primary liver cancer. An estimated 19,590 deaths (13,260 men and 6,330 women) from this disease will occur this year. Liver cancer is the fifth most common cause of cancer death among men, and ninth most common cause of cancer death among women. As compared to 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 five-year relative survival rate (percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) of people with liver cancer is 14%. Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with liver cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics. Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2011. Medical Illustrations
Risk Factors and Prevention
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can 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 chronic liver infection with the hepatitis B or hepatitis C virus or cirrhosis of the liver. HCC usually develops several decades after such an infection starts. Viral hepatitis. Viral hepatitis is the largest risk factor for this type of cancer. Hepatitis viruses are viruses that infect the liver. Two common types are hepatitis B and hepatitis C. People who have the hepatitis B virus face up to a 100-fold increased risk of developing HCC. Viral hepatitis can be passed from person to person through exposure to another person's blood or bodily fluids 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, although 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 don’t clear the virus (those who become “carriers”) 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 are 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. 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, 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, meaning that having more than one risk factor increases the risk even more. For instance, a person who carries both hepatitis B and C has a higher risk than a person carrying one type of the virus. Prevention and Early Detection 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, and thereby reduce the inflammation (swelling) these viruses cause in the liver. This may reduce the risk of cancer, particularly if the medications are taken before cirrhosis develops. For information these types of treatments, it is important to talk with a hepatologist, a doctor who specializes in diseases of the liver. If you know you have cirrhosis or other risk factors, it is important to talk with your doctor about whether you should be regularly screened for liver cancer. Finding a cancer before any symptoms have developed may 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. Symptoms and Signs
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:
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. Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often. If cancer is diagnosed, relieving symptoms and side effects 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. Diagnosis
Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. Your doctor may consider these factors when choosing a diagnostic test:
The following tests may be used to diagnose HCC: 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 (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 alpha-fetoprotein (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 and to find where the tumor is in the liver and 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 internal organs. 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 three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (special dye) is injected into a patient’s vein to provide better detail. 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). Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture. 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. This test 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. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluates cells, tissues, and organs to diagnose disease). The type of biopsy performed will depend on the location of the cancer. The biopsy can be taken during a laparoscopy, by fine needle aspiration (cells are removed using a thin needle inserted into the tumor), or by using a thick needle (a core biopsy). Most often it 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 one 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 to decrease 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 is done as part of surgery if all or part of the liver is being removed, rather than as a separate procedure beforehand. 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 these masses are and if they are cancer. In these instances, particularly when the mass is one centimeter or less in size, the doctor may recommend a “watch and wait” (also called active surveillance and watchful waiting) approach. This means that the scans are repeated in three to six months. If the later scan shows that the size hasn’t changed, the surveillance approach is continued. If it grows, however, the doctor will then do a biopsy. Learn more about what to expect when having common tests, procedures, and scans. After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. Learn more about the first steps to take after a diagnosis of cancer. Staging
There are two types of liver cancer: primary and metastatic. Primary liver cancer begins in the liver; metastatic (secondary) liver cancer has spread to the liver from a cancer that started in another part of the body. For information about staging of secondary liver cancer, read about the primary type of cancer, because there are different stage descriptions for different types of cancer. For example, lymphoma that has spread to the liver is still staged as lymphoma. Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). For liver cancer, the staging information below is specifically for HCC. This staging system is most useful for patients whose tumor can be surgically removed (called resectable; see Treatment). When resection is not an option, the doctor will use other factors, such as overall liver function, to determine the treatment plan and predict prognosis. One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are four stages: stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the site 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 one 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 centimeters (cm) or smaller. It does not involve nearby blood vessels. T2: Either of these:
T3a: There is more than one tumor, and at least one is larger than 5 cm. T3b: The tumor (of any size) involves the major veins around the liver. T4: Either of these:
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that 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: Cancer has not spread to the regional lymph nodes. N1: The cancer has spread to the regional lymph nodes. Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body. MX: The tumor cannot be evaluated. M0: 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 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). HCC is different from other types of cancers because the treatment is determined not only by the staging (using the TNM system) but also by how well the liver is working. For example, early-stage disease may not always be removable by surgery because the liver is seriously damaged (usually with cirrhosis) and there would not be enough of the liver left after the operation to keep a person healthy. Therefore, sometimes a patient’s condition is described using one of the four descriptions below as well as the stage. Localized resectable: Cancer is in one place in the liver, and the other part of the liver is healthy. The cancer is resectable, meaning it can be removed through surgery. Localized unresectable: Cancer is found in one part of the liver, but it cannot be removed by surgery (unresectable). Advanced: Cancer has spread throughout the liver and/or to other parts of the body, such as the lungs and bones. Recurrent: Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (re-staging) using the system above. 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 (2010) published by Springer-Verlag New York, www.cancerstaging.net. Treatment
This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials and Current 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. Treatment options and recommendations depend on several factors:
When a tumor is found at an early stage and the patient’s liver is working well, treatment is aimed at slowing, stopping, or eliminating the cancer (also called disease-directed treatment). 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. Descriptions of the most common treatment options, both disease-directed and supportive care therapies, are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Learn more about making treatment decisions. Surgery Surgery is the removal of the tumor and surrounding tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with small tumors (smaller than 5 cm). A surgical oncologist is a doctor who specializes in treating cancer using surgery. Two types of surgery are used to treat HCC. The part of the liver with the cancer may be removed in a hepatectomy, or a liver transplantation may be done. Both procedures are described below. However, if the tumor has spread outside the liver, or if the patient has other serious illnesses, surgery may not be an option. Learn more about cancer surgery.
Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. External-beam radiation therapy is radiation given from a machine outside the body. External-beam radiation therapy is not often used for HCC. Internal radiation therapy or brachytherapy may be used for HCC. Brachytherapy is radiation treatment using implants. Internal radiation therapy for HCC involves placing radioactive beads into the artery that supplies the tumor with blood in a manner similar to chemoembolization (see below). Depending on the type of radiation therapy used, your doctor will explain ways to help protect your other organs from radiation during treatment and the side effects that may be expected. The general side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. For internal radiation therapy, the side effects may include damage to the stomach and lungs. However, these can often be avoided by special pre-treatment preventive measures. Learn more about radiation therapy. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of drugs at the same time. Chemotherapy for HCC may be given in the two different ways described below:
The side effects of chemotherapy depend on the individual and the dose used, but they can include nausea and vomiting, loss of appetite, diarrhea, fatigue, low numbers of blood cells, bleeding or bruising after minor cuts or injuries, numbness and tingling in the hands or feet, headaches, hair loss, and darkening of the skin and fingernails. These side effects usually go away once treatment is finished. Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases. 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 normal cells, usually leading to fewer side effects than other cancer medications. 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. As a result, doctors can 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 targeted treatments. For HCC, anti-angiogenic 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 found in 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 the standard treatment for advanced HCC that cannot be removed with surgery. It is given orally (by mouth). The side effects of sorafenib include diarrhea and certain skin problems. Other treatment options All treatments are more effective when the tumor is small; many doctors will not use the following treatments if the tumor is larger than 5 cm.
In addition to the treatment options described above, the doctor may suggest that the patient enroll in a clinical trial, which is a research study that evaluates new treatments. Recurrent HCC Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear. 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 therapies described above (such as surgery, chemotherapy, and radiation therapy) but 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. 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. Metastatic HCC If cancer has spread to another location in the body, it is called metastatic cancer. Patients 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 seeking 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 not to cure the cancer, but to slow its growth. In addition to disease-directed treatment, an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time. If disease-directed treatment is not successful, this may also be called advanced cancer. This diagnosis is stressful, and it may be difficult to discuss. 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. Learn more about advanced cancer care planning. Find out more about common terms used during cancer treatment. About Clinical Trials
Doctors and scientists are always looking for better ways to treat patients with HCC. To make scientific advances, doctors create research studies involving people, called clinical trials. The number of clinical trials focused on HCC has increased in recent years. Many of these clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. 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 are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease. Patients 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, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. 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. 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 that 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. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find clinical trials. For specific topics being studied for liver cancer, learn more in the Current Research section. 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. 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. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Be sure to talk with your doctor about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with HCC. Learn more about caregiving. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. For many patients, a diagnosis of HCC is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team, who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care. A side effect that occurs more than five years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor. After Treatment
After treatment for HCC ends, talk with your doctor about developing a follow-up care plan. This plan will include regular physical examinations, imaging tests (such as ultrasound), and blood tests to monitor your recovery for the coming months and years. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed. Careful follow-up care is important no matter what type of treatment was used. Follow-up care will not only measure how effective the treatment has been, but also allow early detection of any recurrence. This is particularly important because there is always a risk that the tumor will come back after treatment, or that another tumor will develop. Research to find ways to prevent second cancers and recurrent HCC is ongoing, but there is no standard prevention method at this time. People recovering from HCC are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help you rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes. Find out more about common terms used after cancer treatment is complete. Current Research
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. These are treatments that may help the patient's 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 kill cancer cells in different ways. Using a combination of drugs increases the chance more cancer cells will be killed; many times one 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 (see the Treatment section), several other anti-angiogenic agents are being tested in clinical trials. Greater use of liver transplantation. The possibility of expanding the criteria for liver transplantation (allowing more patients to be eligible) is being studied for HCC. 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 one 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 the inactive drug and this new gene helps activate the drug in the tumor. These and the targeted therapy sorafenib (see Treatment) are being tested in combination with other treatments as listed above. Supportive 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. Learn more about common statistical terms used in cancer research. Looking for More about Current Research? If you would like additional information about the latest areas of research regarding liver cancer, explore these related items:
Or, choose “Next” (below, right) to continue reading this detailed section. Questions to Ask the Doctor
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. General questions
For patients who need surgery
For patients who need chemotherapy/targeted therapy/immunotherapy
For patients who need radiation therapy
After treatment
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
