Liver Cancer: 10 Things Doctors Want You to Know

  • Male doctor talking to female patient wearing masks during COVID-19
    Liver Cancer Doctors Provide Key Information About This Rising Cancer
    Liver cancer is on the rise in the United States. About 42,000 Americans are expected to be diagnosed with it this year and about 30,000 to die from it, making it the sixth deadliest cancer in the U.S. By 2030, liver cancer is expected to be the nation's third deadliest cancer.

    A major risk factor for primary liver cancer is cirrhosis of the liver, damage often caused by hepatitis B and C, excess alcohol use, or obesity. Three liver cancer doctors spoke to us about risk factors, prevention steps, and exciting new treatment options you should know about.
  • senior hispanic or latino man hiking
    1. “Obesity is a growing risk factor for liver cancer in America.”
    About 24% of Americans are estimated to have nonalcoholic fatty liver disease (NAFLD), which is linked to obesity, says Dr. Mark Yarchoan, MD, an oncologist at Johns Hopkins Medicine in Baltimore. About 20% of those with NAFLD develop nonalcoholic steatohepatitis (NASH), Dr. Yarchoan says, a progressive condition that further increases liver cancer risk. Many of those with this disease have no idea they have it; yet, some will develop liver cancer. "There's a huge number of Americans at risk for this, and many of them just aren't aware this is something that could affect them," says Dr. Yarchoan.
  • Female doctor talking to young patient with father in hospital waiting room
    2. "Early diagnosis is key to successful treatment—but too often, symptoms don't show up right away."
    “While many patients may not have signs until the disease is advanced, there are some liver cancer symptoms to watch for,” says Dr. Amit Mahipal, MD, oncologist at Mayo Clinic in Rochester, Minn. These include jaundice (yellowing of the skin or eyes), fatigue, unintentional weight loss, and abdominal swelling. Another sign, says Dr. Douglas Rubinson, MD, oncologist at Dana Farber Cancer Institute in Boston, “new abdominal pain, especially underneath the rib cage on the right side, where your liver is located.”
  • Doctor showing x-ray to a female patient
    3. "Liver cancer diagnosis does not always require a biopsy."
    "Liver cancer is probably the only type of cancer that we can diagnose without a biopsy in many patients," says Dr. Rubinson. "It has a very distinctive look on certain types of scans and can be associated with elevation of a tumor marker called AFP." If there is uncertainty about a liver cancer diagnosis based on scans and tests, "a needle biopsy in the liver is something that we routinely do and is quite safe," he says. Such biopsies are usually done by interventional radiologists under sedation, usually as an outpatient procedure.
  • Man drinking pint of beer
    4. "Alcohol use is rising due to COVID, and we may see more liver cancer as a result."
    "Alcohol intake is going up," says Dr. Yarchoan. "I'm quite worried about this. Anecdotally, a lot of people are drinking more because of COVID. I do worry that we may see an epidemic of liver cancer in the coming decades, in part due to this time of COVID." A lot of liver cancer seen now, he says, is from people who started drinking during the Great Recession in 2007, demonstrating how long it can take for liver damage to turn into liver cancer.
  • Happy friends enjoying Christmas party at home
    5. "You can help prevent liver cancer by limiting your alcohol intake."
    "The best amount of alcohol to drink would be zero, from a cancer perspective," says Dr Yarchoan. "But we do see an abrupt increase in liver damage above 1 to 2 drinks per day."

    In general, women are advised to limit alcohol to no more than one drink per day and men two, says Dr. Mahipal. Binge drinking also should be avoided, he says. "You don't want someone drinking seven drinks on a weekend because they didn't drink the whole week."

    Other steps to prevent liver cancer Dr. Yarchoan recommends: eating healthy foods, exercising regularly, and not smoking.
  • Close-up of unseen woman's arm getting IV blood draw
    6. "Get tested for hepatitis C exposure."
    A history of hepatitis C is a common risk factor for liver cancer—so common that the CDC recommends all adults be tested at least once for it. Dr. Rubinson says having this screening is "the most important thing we can suggest to people" because it can let you know whether you need further monitoring, which could help find cancer early. Dr. Rubinson suggests talking to your primary care physician to make sure you've been tested. Even if you've been successfully treated for hepatitis C, it can still cause liver cancer later in life, Dr. Rubinson says.
  • Indian doctor performing heart ultrasound on a middle aged male patient
    7. "Get monitored and screened if you have liver cancer risk factors."
    "A history of cirrhosis is a major risk factor for liver cancer," says Dr. Yarchoan. "Unfortunately, many patients are not in screening programs and don't know they have cirrhosis."

    Dr. Mahipal says patients with cirrhosis should get ultrasound and other testing every six months to a year. If you have other risk factors—such as a history of hepatitis, alcohol use disorder, or conditions such as hemochromatosis or Wilson's disease—Dr. Mahipal advises seeing a gastroenterologist or hepatologist (a doctor who specializes in liver conditions) to check for cirrhosis.
  • female doctor with digital tablet talking to female patient in medical exam
    8. "Our treatments for liver cancer have gotten a lot better in a little amount of time."
    Five years ago, patients with advanced hepatocellular carcinoma (the most common liver cancer) had one drug treatment, called sorafenib. Today, nine different liver cancer treatments exist, says Dr. Yarchoan, including a combination therapy using two drugs (an immunotherapy drug and a monoclonal antibody that limits blood supply to tumors) that has extended patients' lives and shrunken tumors. The combination is now “the standard of care in advanced liver cancer,” says Dr. Rubinson.

    "Our patients are not only living longer than ever before with liver cancer, but also generally feeling better because treatments are better tolerated," says Dr. Yarchoan.
  • Multi-ethnic doctors operating on patient at hospital
    9. "If your liver cancer is caught early enough, we have a chance to cure it with a transplant or surgery."
    "Transplants or surgery to remove tumors can only be done if the cancer is confined to three or fewer sites within the liver, with tumors below a certain size,” says Dr. Rubinson. Liver transplants can cure both cancer and underlying liver disease, and are done either with deceased or living donors (who contribute about 35% of their livers), says Dr. Mahipal.

    Other treatments for earlier stages of liver cancer include ablation (destroying tumors by burning them), radiation therapy, or placing chemotherapy or radioactive beads into a cancer site "to treat the cancer from the inside out," says Dr. Rubinson.
  • hands of researcher in medical lab
    10. "New medicines and therapies for liver cancer are on the horizon."
    Five-year relative survival statistics for liver cancer are only 20% (or 34% if cancer is caught early), according to the American Cancer Society, but these are compiled from data collected before today's more effective new medications became widely available. "That's something we talk to our patients about, that our patients are living longer," says Dr. Yarchoan.

    Other new drug therapies also are in clinical trials or have recently completed trials, says Dr. Rubinson. "There are some new combinations that we're really excited about. We’re waiting to see if they could supplant some of the therapies we currently have available."
Liver Cancer: 10 Things Doctors Want You to Know - Healthgrades
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About The Author

Lorna Collier has been reporting on health topics—especially mental health and women’s health—as well as technology and education for more than 25 years. Her work has appeared in the AARP Bulletin, Chicago Tribune, U.S. News, CNN.com, the APA’s Monitor on Psychology, and many others. She’s a member of the American Society of Journalists and Authors and the Association of Health Care Journalists.
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Last Review Date: 2021 Oct 7
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