Cancer, BMT, Hematology
Liver Cancer
HFFY#7755
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Hepatocellular Carcinoma (HCC)
What is the liver?
The liver is the largest organ inside the
body. It breaks down food. The liver has
many other functions. It collects and filters
blood from the intestines. It also removes
toxic wastes from the body. It stores energy
and makes proteins. No one survives
without a liver.
What is liver cancer?
Cancer starts when normal cells change and
grow out of control. They form a mass
called a tumor. A tumor can be cancerous or
benign. A cancerous tumor is malignant.
This means it can spread to other parts of the
body. A benign tumor will not spread.
What is HCC?
HCC is a primary liver cancer. In the United
States, about 33,000 adult cases are found
each year. Liver cancer is much more
common in developing countries within
Africa and Asia.
What are the risk factors for HCC?
• Excessive alcohol use/cirrhosis of
the liver- Liver cells are damaged.
They are replaced by scar tissue.
• Non-alcoholic fatty liver disease
(NAFLD)- Fat builds up in the liver.
It may be caused by obesity or
diabetes.
• Viral Hepatitis- Hepatitis viruses can
infect the liver. The 2 most common
types are Hepatitis B and Hepatitis
C.
• Age- Occurs most often in people
older than 60.
• Gender- Men are more likely than
women to get HCC.
• Environmental factors- Certain
chemical exposures may increase
risk.
• Race and ethnicity- Rates are highest
in Asian Americans and Pacific
Islanders.
What are the symptoms of HCC?
• Pain: Mainly in the top right belly
area. Can also be near the right
shoulder blade or in the back.
• Unexplained weight loss
• Weakness or fatigue
• Decrease in appetite
• Nausea and vomiting
• Jaundice: Yellowing of the skin and
eyes. Occurs when the liver does not
work right.
• Swelling in the belly (ascites) or
bloating
What are symptoms of bile duct cancer?
• Changes in stool or urine color-
Stool may look lighter or chalky in
color. Urine may look dark (like
cola).
What is the prognosis?
The prognosis (chance of recovery) depends
on:
• The stage when it is found.
• If the cancer has spread.
• If the cancer is a new diagnosis or
has come back.
How is it diagnosed?
• History and physical exam- A
review of symptoms, health habits,
past illnesses and treatments.
• Blood tests- Blood tests can check
liver function. A hepatitis panel may
also be done. For HCC, a test for
alpha-fetoprotein (AFP) is done.
AFP is high in 50-70% of people
with HCC.
• Ultrasound- Uses sound waves to
create a picture of the liver.
• CT scan- A series of computerized
pictures of the inside of the body.
This is taken after drinking or
injecting into a vein special dye.
• MRI- This uses a magnet, radio
waves and a computer to take
pictures of the inside of the body.
• Angiogram- A X-ray picture of the
blood vessels. A dye is injected into
the bloodstream. This shows blood
vessels of the liver on x-ray.
• Laparoscopy- A surgery done with
a scope. This lets the surgeon check
the belly cavity for signs of cancer.
• Biopsy- Checks tissue under a
microscope. This shows if it is
cancer and where it came from.
Biopsies may be done during surgery
or during a procedure with the help
of a CT scan or ultrasound.
How is HCC staged?
Staging describes where the cancer is
located. It looks if or where it has spread. It
looks at if it affects other parts of the body.
Knowing the stage helps to decide on
treatment options. It can help predict
prognosis. One tool doctors use to describe
the stage is the TNM system. Tumor (T)-
How large is the tumor? Where is it located?
Node (N)- Has the tumor spread to lymph
nodes? Metastasis (M)- Has the cancer
spread to other parts of the body?
Other Staging terms:
• Localized Resectable- The cancer is
only in one place in the liver. Other
parts of the liver are healthy.
Resectable means it can be removed
with surgery.
• Localized Unresectable- The cancer
is found in only one part of the liver.
But it cannot be removed by surgery.
• Advanced- Cancer has spread
throughout the liver and/or to other
parts of the body.
• Recurrent- This is a cancer that has
come back after treatment.
How is HCC treated?
Treatment options depend on if the cancer is
only in the liver, where it started or spread,
overall health, and future damage to
nonaffected area.
Surgery- Removal of the tumor and
surrounding tissue during an operation
• Hepatectomy- This is when a part of
the liver is removed. This is done
when the cancer is only in one part of
the liver and the liver works well.
• Liver Transplantation- This is done
only when the cancer has not spread
out of the liver. A suitable donor
needs to be found. Very specific
criteria need to be met.
Thermal ablation- Radiofrequency ablation
(RFA) and microwave therapy both use heat
to kill cancer cells. It may be given through
the skin. It can also be done through
laparoscopy or during a surgery while you
are asleep.
Chemoembolization- This is a type of
treatment in which drugs are injected into
the artery that enters the liver (hepatic
artery). The flow of the blood through this
artery is blocked for a short time. This
allows the drugs to stay in the tumor longer.
This also decreases the blood supply to the
tumor.
Radiation Therapy- A treatment that uses
high energy x-rays or other types of
radiation to kill cancer cells, or slow their
growth. Radiation treats a very specific area.
This is called regional therapy.
Targeted Therapy- This is most often
given in a pill form. The treatment targets a
specific function of the cancer cell. In HCC,
this therapy stops new blood vessels from
forming. This blocks the growth and spread
of cancer cells.
Chemotherapy- Drugs are used to kill
cancer cells or stop them from dividing.
Chemotherapy can be injected
intravenously (IV) or taken orally in the
pill form. It enters the bloodstream. It can
kill each cancer cell throughout the body.
This is called systemic therapy.
Clinical Trials
You may have the chance to take part in a
clinical trial. Clinical trials are controlled
research studies. They are voluntary. They
find out if new cancer treatments are safe
and effective. They may find better
treatments for cancer than the standard
treatments.
Follow-up Tests
During your treatments you will need blood
tests and scans to see how well the treatment
is working. These tests help guide decisions
to keep going, stop, or change treatments.
Blood tests and scans will be done from time
to time after you have finished your
treatments. They can show if your condition
has changed or the cancer has recurred, or
come back.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 3/2018 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7755