What Patients Need to Know About Liver Cancer, From Diagnosis to Treatment

Getting a cancer diagnosis can be overwhelming and frightening. This guide is designed to help you understand liver cancer and equip you with the right questions to ask your medical team.

Overview

Liver cancer, also known as primary liver cancer, is a type of cancer that starts in the liver itself. This is different from a cancer that begins elsewhere in the body and spreads to the liver, which is called a secondary or metastatic liver cancer. Your doctor will determine which type you have, as the treatment approaches can differ.

The liver is the body's largest internal organ and is located in the upper right part of the abdomen. It performs many vital functions, including filtering toxins from the blood, producing bile to aid digestion, and storing energy. The most common type of primary liver cancer is hepatocellular carcinoma (HCC), which starts in the main liver cells.

Certain risk factors are associated with liver cancer, with chronic infections from hepatitis B virus (HBV) and hepatitis C virus (HCV) being the most common. Other risk factors include a history of cirrhosis (scarring of the liver), heavy alcohol use and certain inherited liver diseases. It's important to remember that having a risk factor doesn't mean you'll definitely get cancer, and many people without these risk factors still develop it.

Diagnosis

The diagnostic process for liver cancer often involves a combination of tests. Your doctor will likely begin with a physical exam and a review of your medical history. From there, they may order:

• Blood tests: These tests can measure liver function and check for tumor markers, like alpha-fetoprotein (AFP), which can be elevated in some people with liver cancer.
• Imaging tests: These are crucial for visualizing the liver and any tumors present. Common imaging tests include ultrasound, CT scans, and MRI scans. In many cases, a diagnosis of HCC can be made based on how a tumor appears on these scans, without the need for a biopsy.
• Biopsy: If imaging results are not conclusive, your doctor may recommend a biopsy. This procedure involves removing a small tissue sample from the liver to be examined under a microscope for cancer cells.

Once a diagnosis is confirmed, further imaging tests may be used to stage the cancer, which determines its size, location and whether it has spread. This information is critical for creating your treatment plan.

Treatment Options

The best course of treatment for liver cancer depends on several factors, including the cancer's stage, the health of your liver and your overall health. Treatment is often a collaborative effort among a team of specialists.

• Surgery: For small tumors in a healthy liver, surgery to remove the cancerous part (partial hepatectomy) may be a curative option. In some cases, a liver transplant may be an option if the cancer is in an early stage and your liver function is severely compromised.
• Local Therapies: These are procedures that target the tumor directly while sparing the healthy liver tissue. They include ablation, which uses heat or electricity to destroy cancer cells, and embolization, which involves blocking the blood supply to the tumor, often combined with chemotherapy (chemoembolization) or radiation beads (radioembolization).
• Radiation Therapy: This treatment uses high-energy beams to destroy cancer cells. Techniques like stereotactic body radiation therapy (SBRT) deliver highly focused radiation doses to the tumor, minimizing damage to surrounding tissue.

“Seeing a radiation oncologist is important for most patients who have liver cancer,” Dr. Laura Dawson, a professor and chair of the department of Radiation Oncology at the University of Toronto, and a practicing radiation oncologist in the Radiation Medicine Program at Princess Margaret Cancer Center, University Health Network in Toronto, told CURE. “It doesn't mean radiation therapy would be offered, but it may be, and it's good to have multiple options and more people who can be a part of the circle of care for patients. I think that's the main advice for patients — ask to see a radiation oncologist — and hopefully [they will in turn] benefit from radiation.”

• Systemic Therapies: These are drugs that travel throughout the bloodstream to kill cancer cells. Targeted therapy drugs focus on specific weaknesses within cancer cells, while immunotherapy boosts your body's own immune system to fight the cancer. Chemotherapy is also used in some cases, often for advanced disease.

Side Effects

It's natural to be concerned about the side effects of treatment. Most side effects are manageable, and your oncology team will work with you to find solutions.

• Surgery: Common side effects include pain, fatigue and a temporary loss of appetite.
• Radiation therapy: You may experience fatigue, nausea or skin changes in the treated area. A more serious but less common side effect is radiation-induced liver disease (RILD), which can cause temporary liver damage.
• Local and Systemic Therapies: Side effects vary greatly depending on the specific treatment. Common ones can include fatigue, nausea, diarrhea, skin rashes and a decrease in appetite. Immunotherapy can also cause a range of immune-related side effects, such as inflammation in various organs. Your doctor will discuss specific risks associated with your treatment plan.

Conclusion

A liver cancer diagnosis is a major life event, but it's important to remember that there are many effective treatments available. This is just an introductory guide. The best thing you can do for yourself is to be an active participant in your care.

Prepare for your appointments by writing down any questions you have. Consider bringing a friend or family member with you to help take notes. This is a journey, and you don't have to go through it alone.

Here are some questions you may want to ask your oncologist:

• What type of liver cancer do I have, and what is its stage?
• What is the goal of the treatment you're recommending? Is it to cure the cancer or to control it and improve my quality of life?
• What are the potential side effects of this treatment, and how will they be managed?
• How will we know if the treatment is working?
• Are there any clinical trials I should consider?
• What changes should I make to my diet or daily activities during treatment?

This guide is designed to be a starting point. Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice. Please contact your healthcare team with any questions or concerns.

Reference

1. “SBRT May Be a Viable Option for Patients With Liver Cancer,” CURE, Jan. 13, 2025; https://www.curetoday.com/view/sbrt-may-be-a-viable-option-for-patients-with-liver-cancer

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