Liver Cancer

Primary liver cancer is cancer that forms in the tissues of the liver, while secondary liver cancer is cancer that has spread (metastasized) to the liver from another part of the body.

One of the largest organs in the body, the liver has four lobes and fills the upper right side of the abdomen inside the rib cage. Important functions of the liver are: to filter harmful substances from the blood so they can be passed in stools and urine, to make bile to help digest fat that comes from food and to store glycogen (sugar), which the body uses for energy.

Two main types of adult primary liver cancer are:

Hepatocellular carcinoma, the most common type
Cholangiocarcinoma, which starts in the bile ducts

Less common types of primary liver cancer include mixed hepatocellular carcinoma and cholangiocarcinoma; angiosarcoma; and hemangioendothelioma.

Liver cancer was once thought to be untreatable. However, advances in medicine have resulted in new curative options. Our board certified surgeons offer a full range of state-of-the-art treatment modalities, including liver resection, cryoablation and radiofrequency ablation, using minimally invasive surgery technologies. Surgeons specializing in hepatobiliary diseases at Brigham and Women’s Hospital (BWH) are the surgical team for the Gastrointestinal Cancer Treatment Center at Dana-Farber Brigham Cancer Center, a unique center uniting the world’s best GI cancer experts.

Learn more about liver cancer.

Liver Cancer Surgeons

Risks Factors for Liver Cancer

Factors that contribute to an increased risk for liver cancer include:

Hepatitis B or hepatitis C Having both hepatitis B and hepatitis C increases the risk.
Cirrhosis, which can be caused by:
- Hepatitis (especially hepatitis C)
- Alcohol abuse or excessive alcohol use
Eating foods tainted with aflatoxin
Hemochromatosis, a condition in which the body takes up and stores iron
Diabetes
Obesity
Exposure to certain chemicals

Learn if you are at risk for liver cancer.

Symptoms of Liver Cancer

Symptoms associated with liver cancer include:

A hard lump on the right side just below the rib cage
Discomfort in the upper rights side of stomach
A swollen abdomen
Pain near the right shoulder blade or in the back
Jaundice
Easy bruising or bleeding
Unusual tiredness
Nausea and vomiting
Loss of appetite
Weight loss

Diagnosis of Liver Cancer

If you are having symptoms of liver cancer, your surgeon will ask about your health history, your family’s history of cancer and risk factors. Diagnostic tests may include:

Computed tomography scan (CT or CAT scan)
Magnetic resonance imaging (MRI)
Ultrasound
Serum tumor marker test
Liver function tests
Liver biopsy

Learn more about diagnostic tests for liver cancer.

Stages of Liver Cancer

After liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body. The process used to find out if cancer has spread is called staging.

With the result of diagnostic tests, your doctor will assign your cancer a stage, depending upon the size and spread of the cancer.

The Barcelona Clinic Liver Cancer Staging System may be used to stage adult primary liver cancer. The BCLC staging system has five stages:

Stage 0: Very early
Stage A: Early
Stage B: Intermediate
Stage C: Advanced
Stage D: End-stage

Treatment for Liver Cancer

Surgical Treatment

Removing the tumor surgically is the only way to cure liver cancer. Taking the whole tumor out will give you the best chance of survival. However, it can be hard to remove the whole tumor, even if it has not spread beyond the liver. Surgery may not be an option for people with cirrhosis who do not have enough healthy liver tissue. Surgery is not an option if the cancer has spread past the liver to other parts of the body. Surgeons at BWH are internationally recognized surgical specialists who are faculty at Harvard Medical School. They have years of experience in liver cancer surgery and offer many of the most progressive surgical procedures, including:

Hepatectomy (liver resection) is surgery to remove the part of the liver where cancer is found. This can be done by open surgery or laparoscopy. A wedge of tissue (partial hepatectomy), an entire lobe (total hepatectomy), or a larger portion of the liver, along with some of the healthy tissue around it is removed. The remaining liver tissue takes over the functions of the liver and may regrow.
- Robotic technology allows surgeons to use advanced instruments and three-dimensional imaging to navigate intricate spaces more easily. In April 2017, BWH was the first hospital in Boston to successfully complete a robotic hepatectomy.
Liver transplant removes and replaces diseased liver with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.
Ablation therapy destroys liver tumors without removing them and does not kill healthy liver cells. These approaches may be a good option for people with many small liver tumors. It may also be a good choice for people with hepatitis, cirrhosis and other liver problems. Our surgeons are skilled at the following types of ablation treatment:
- Radiofrequency ablation uses a heated probe inside the tumor to kill it. You may have RFA done at the same time as surgery. Your surgeon places a scope through a small cut in your abdomen (laparoscopic ablation) or through your skin (percutaneous ablation).
- Microwave therapy
- Percutaneous ethanol injection inserts a needle through the skin and injects ethanol into the tumor.
- Cryoablation passes very cold gases through a metal probe inserted into the tumor.
- Electroporation therapy

Non-Surgical Treatment

Radiation Therapy
Chemotherapy
Targeted Therapy

Learn about treatment options by stage for primary liver cancer.

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have liver cancer and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced surgeon are important to the successful outcome for patients with liver cancer.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken cared for in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with liver cancer. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

The Gastrointestinal Cancer Treatment Center at Dana-Farber Brigham Cancer Center provides the world’s most advanced and innovative multidisciplinary care for patients with gastrointestinal diseases, such as liver cancer. Our treatment team includes surgeons, medical and radiation oncologists, nutritionists, pathologists, anesthesiologists and gastroenterologists. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

Cancer Surgery Appointments and Locations

Contact one of our cancer surgeons in the list at the top of the page to make an appointment.

Cancer Surgery Locations

Resources

Learn more about liver cancer in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Visit the Weiner Center for Preoperative Evaluation.