Liver Cancer

Memorial Hermann’s team of affiliated liver cancer specialists provides advanced, personalized care for our patients diagnosed with liver cancer. Working hand in hand, these oncologists, surgeons and other health care providers employ the latest therapies and surgical techniques to help patients achieve positive outcomes.

To make the patient experience as seamless and comfortable as possible, our experienced oncology nurse navigators support our patients throughout their cancer journeys, from diagnosis through survivorship. And through our cancer survivorship and wellness programs, cancer survivors receive the education and emotional support they need, for life.

Liver cancer (primary liver cancer and intrahepatic bile duct cancer) is the sixth leading cause of cancer death in the United States. The American Cancer Society (ACS) estimates that in 2024:

• 41,630 people in the United States will be diagnosed with liver cancer, including 28,000 men and 13,360 women.
• Liver cancer will claim an estimated 29,840 lives in the United States, including the lives of 19,120 men and 10,720 women.
• For localized liver cancers, the five-year relative survival is 37%; for regional cancers it is 14%; and for distant cancers it is 4%. The five-year survival rate for all liver stages combined is 22%, the second lowest survival rate for all major cancers.

Types of Liver Cancer

Liver cancer starts in the liver, the largest internal organ, which lies under the right ribs just beneath the right lung. Among the liver’s many important functions, it makes bile to help digest fat from food; it stores sugar, which the body uses for energy; and it filters harmful substances, such as alcohol, drugs and toxic wastes, from the blood.

Liver cancer that starts in the liver is called primary liver cancer, the most common forms of which are hepatocellular carcinoma (HCC) and bile duct cancer (cholangiocarcinoma).

Some of the more common symptoms of liver cancer include:

• Upper abdominal pain or discomfort on the right side
• Swelling or fluid build-up in the abdomen
• Hard lump on the right side just beneath the rib cage
• Pain near the right shoulder blade or in the back
• Nausea and vomiting
• General weakness and fatigue
• Yellowing of the skin and eyes (jaundice)
• Unintended weight loss
• Lack of appetite or feeling full after eating a small meal
• White, chalky stools and dark urine
• Fever

Having one or more of these symptoms doesn’t necessarily mean you have liver cancer, but it’s a good idea to discuss any symptoms with your doctor, as they may indicate other health problems.

Causes of Liver Cancer

The leading  cause of HCC is cirrhosis of the liver, which may be caused by:

• Alcohol abuse
• Nonalcoholic steatohepatitis (NASH), a form of fatty liver disease which can result from obesity, diabetes and high cholesterol
• Hepatitis B or C virus infection. People with hepatitis B or C are at risk for liver cancer, even if they have not developed cirrhosis.

You are at higher than average risk of liver cancer if you are male; over the age of 55; Asian/Pacific Islander, American Indian/Alaska Native or Hispanic; have certain medical conditions; have a family history of liver cancer; use tobacco; and/or have been exposed to certain chemicals and toxins.

To diagnose liver cancer, your doctor may use one or more of the following tests:

• Physical exam and health history
• Imaging tests, such as CT scan, MRI or ultrasound
• Blood tests, including a test to detect alpha-fetoprotein (AFP), which can indicate liver cancer, and tests to measure how well your liver is functioning
• Biopsy, a procedure in which a sample of tissue is removed and examined under a microscope

Liver Cancer Stages

If you are diagnosed with liver cancer, your doctor will determine if the cancer has spread to other parts of your body through a process known as staging. Staging helps your medical team determine the best treatment plan.

The system most often used for primary liver cancer staging is the Barcelona Clinic Liver Cancer (BCLC) Staging System, which incorporates four factors:

• Whether the cancer has spread within the liver or to other parts of the body
• How well the liver is working
• The general health and wellness of the patient
• The symptoms caused by the cancer

The BCLC staging system uses five stages:

• Stage 0: Very early state
• Stage A: Initial stage
• Stage B: Intermediate stage
• Stage C: Advanced stage
• Stage D: Terminal stage

Stages are also grouped according to how the cancer may be treated:

• Localized liver cancer has not spread outside the liver and can be removed by surgery. This includes BCLC stages 0, A, and B.
• Locally advanced liver cancer has not spread from the liver to distant parts of the body but cannot be safely removed by surgery. This includes BCLC stage C.
• Metastatic liver cancer is cancer that has spread from the liver to distant parts of the body. Metastatic liver cancer cannot be completely removed by surgery. This includes BCLC stage D.
• Recurrent liver cancer is cancer that has come back (in the liver or other parts of the body) after treatment.

Your medical team will work together to create a personalized treatment plan for you based on your specific type and stage of cancer, your liver functionality and your overall health.

If your cancer is localized and smaller than 1 centimeter, your doctor may closely watch (surveil) your condition, regularly performing examinations and tests to determine if your condition is worsening.

If your cancer is early stage and the rest of your liver is healthy, your doctor may perform a surgical procedure called a partial hepatectomy, to remove (resect) the diseased part of your liver. In some cases, this may cure your cancer.

If your cancer is early stage, but you’re not a candidate for surgery (either the rest of your liver is unhealthy or your tumor is in a part of the liver considered in accessible via surgery), you may be a candidate for a liver transplant.

In addition to surgery, doctors use several treatments or therapies to shrink tumors prior to surgery, to serve as an adjunct (accompaniment) to surgery, to control cancer growth, to provide symptomatic relief or to prevent cancer recurrence.

These include:

• Chemotherapy, the use of none or more drugs to kill or retard the growth of cancer cells and provide relief of cancer-related symptoms.
• Embolization therapies, minimally invasive procedures used to block the hepatic artery, blocking blood flow to a tumor. Procedures performed include transarterial embolization (TAE), which involves injecting an artery-blocking substance through a catheter (small tube) to the tumor site, and transarterial chemoembolization (TACE), a similar procedure in which chemotherapy drugs are administered through the catheter.
• Ablation, a minimally invasive procedure that uses high-energy radio waves, called radiofrequency ablation (RFA), or electromagnetic waves, called microwave ablation (MWA), to heat and destroy tumor tissue.
• Targeted therapy, newer drugs that specifically target the changes in cells that cause cancer. Because these drugs enter the bloodstream and reach virtually all of the body, they can be useful in treating cancers that have spread to distant parts of the body.
• Radiation therapy, use of high-energy rays to kill cancer cells. To target liver tumors while protecting surrounding healthy tissue, doctors affiliated with Memorial Hermann perform relatively new radiation techniques, such as stereotactic body radiation therapy (SBRT). Unlike other types of radiation therapy, SBRT requires very few treatments, ranging from one to five sessions, which can typically be completed in one week or less.
• Immunotherapy, a treatment that uses the patient’s immune system to fight cancer.

Why Choose Memorial Hermann for Treatment?

Memorial Hermann Cancer Centers are accredited by the American College of Surgeons’ (ACoS) Commission on Cancer (CoC). When you choose Memorial Hermann Cancer Centers for your cancer treatment, you will receive high-quality care delivered by a compassionate team of caregivers in a calm, healing environment.