Liver Cancer

When cancer starts in the tissue of the liver, it is known as primary liver cancer.

When cancer has spread (or metastasized) from another organ into the liver, it is called secondary liver cancer or metastatic liver cancer. In the U.S., metastatic liver cancer is more common than primary liver cancer.

Types of Liver Cancer

• Hepatocellular carcinoma is the most common type of liver cancer, accounting for 80% of primary liver cancer cases.
• Bile duct cancer (also known as intrahepatic cholangiocarcinoma or Klatskin’s tumor) is the second most common type of primary liver cancer.
• Hepatoblastoma is a rare childhood cancer that can develop in children younger than 4 years old.
• Metastatic liver cancer occurs when other cancers spread (or metastasize) from another organ to the liver.

Liver Cancer Symptoms

Symptoms of liver cancer may not be present until the disease is advanced. Signs and symptoms of liver cancer include the following:

• A hard lump just under the rib cage on the right side
• Jaundice (yellowing of the skin or whites of the eyes)
• Abdominal swelling
• Pain or discomfort on the upper right side of the abdomen
• Easy bruising or bleeding

Liver Cancer Risk Factors

If you have any of these risk factors, your doctor may recommend regular surveillance and screening. This can help detect tumors at an early stage when liver cancer is easier to treat.

Liver cancer risk factors include the following:

• Hepatitis B
• Hepatitis C
• Alcohol abuse
• Cirrhosis from any cause (liver damage that leads to scarring and liver failure)
• Metabolic syndrome, a set of conditions including excess abdominal fat, high blood sugar, high blood pressure, high levels of triglycerides and low levels of high-density lipoproteins in the blood
• Fatty liver disease
• Obesity
• Primary sclerosing cholangitis (inflammation and narrowing of the bile ducts)

Liver Cancer Treatment at Rush

Liver cancer experts at Rush work together to create an individualized care plan for you. Treatment may include some of the following:

Drug Therapies

Liver cancer does not respond well to medications alone. However, your treatment may include drug therapies used in combination with each other or other liver cancer treatments.

• Chemotherapy: You may receive chemotherapy directly into the liver via a catheter in the bloodstream of the liver to reduce the size of the tumor. You may also have the option of using oral therapy (a pill). Chemotherapy is also sometimes used to shrink the cancerous area in the liver before surgery.
• Targeted therapy: Using drugs that identify and attack cancer cells without harming normal cells, targeted therapy drugs stop cancer cells from dividing; prevent the growth of blood vessels that feed the tumor; and target proteins on cancer cells that help them grow.
• Immunotherapy: Rush offers the most advanced immunotherapies that help your body fight cancer.

Liver Cancer Surgery

The best option to cure liver cancer is to surgically remove the tumor or have a liver transplant. Your surgeon may remove part of the liver, leaving healthy tissue. The remaining liver will take over and may even regenerate itself.

Liver Transplant

If the tumor cannot be removed surgically, a liver transplant may be an option.

• Your transplant surgeon will remove the entire liver and replace it with a healthy donor liver.
• Liver Transplant Services at Rush will provide expert care before, during and after your transplant.

Minimally Invasive Procedures

• Tumor ablation: Ablation therapy destroys liver cancer cells with radio waves, microwaves or cryoablation (extreme cold). Ablation is typically used when surgery is not an option because of poor overall health or liver function.
• NanoKnife: The NanoKnife destroys cancer cells by using bursts of electricity administered through needle-like probes. This procedure is typically used on small tumors. NanoKnife can be used to treat both primary liver cancer and metastatic liver cancer.

Embolization

Embolization uses substances to block or reduce the blood flow to cancer cells in the liver. It is typically used for larger tumors that cannot be removed surgically.

• Chemoembolization: Your doctor will inject an anticancer drug that gets trapped close to the tumor. This helps cut off the flow of blood to the tumor from the hepatic artery. The healthy parts of your liver are nourished by a hepatic portal vein.
• Radioembolization: Your doctor will inject radioactive microbeads through the blood vessels to the tumor. These microbeads deliver targeted radiation for several days.

Radiation Therapy

Radiation therapy may be a good option if your tumor cannot be removed surgically or if ablation or embolization did not work; however, it may not be a good option if you have liver damage from cirrhosis or hepatitis.

Your provider will discuss your radiation options with you, including the following:

• External beam radiation: High-energy radiation used to destroy tumor cells. It cannot be used at high doses because it can easily damage normal liver tissue.
• Three-dimensional conformal radiation therapy: Advanced technology precisely maps the tumor in 3D. This allows your doctor to better target the tumor, while sparing healthy surrounding tissue.
• Stereotactic body radiation: Special equipment delivers focused beams of high-dose radiation directly to the tumor over just a few days. In comparison, external beam radiation is delivered five days a week for several weeks.

Rush Excellence in Liver Cancer Care

• Team-based approach: At our downtown Chicago location, a team of liver cancer specialists (known as multidisciplinary care) collaborate to create personalized plans. The team includes experts in medical oncology, hepatology, liver transplant and interventional radiology. This team works closely with hepatologists across the Rush System.
• Pediatric surgery for hepatoblastoma: Rush University Children's Hospital pediatric surgeons provide surgical care in Chicago, Oak Park and Aurora/Fox Valley for children with hepatoblastoma. These surgeons specialize in cancer surgery for children. Child life specialists and licensed clinical psychologists at Rush University Children’s Hospital can help you and your child prepare for surgery.
• Exceptional liver transplant outcomes: Rush Liver Transplant Services has been successfully performing liver transplants for more than 30 years. Our exceptional outcomes help make our program a leader among transplant programs in the area. Rush has better-than-expected rates of one-year adult patient survival after liver transplant, according to the most recent Scientific Registry of Transplant Recipients (SRTR) data. Rush's outcomes are the best in Illinois.
• Advanced radiation capabilities: Radiation oncologists at Rush have extensive experience and access to advanced radiation technologies. They are able to conform radiation beams to tumors with great precision, avoiding as much healthy tissue as possible.
• Latest technology: Interventional radiologists at Rush use the most advanced technology, such as the NanoKnife and radioactive microbeads. These advanced technologies allow Rush cancer experts to target liver tumors more precisely, while sparing surrounding healthy tissue.
• Nationally recognized cancer care: Cancer care at Rush University Medical Center is ranked among the best in the nation by U.S. News & World Report.