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Louisville, KY 40202
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Learn More About
Liver Cancer
Anatomy and Function of the Liver
The liver is the largest internal organ. It lies under your right ribs just beneath your right lung. It has two lobes (sections).
The liver has 2 main sections (lobes). Both are made up of 8 segments. The segments are made up of a thousand small lobes (lobules). The lobules are connected to small ducts (tubes) that connect with larger ducts to ultimately form the common hepatic duct. The common hepatic duct transports bile made by the liver cells to the gallbladder and the first part of the small intestine (the duodenum). Bile is a clear yellow or orange fluid that helps digest food.
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When the liver has broken down harmful substances, they are excreted into the bile or blood. Bile by-products enter the intestine and ultimately leave the body in bowel movements. Blood by-products are filtered out by the kidneys and leave the body in the form of urine.
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Types of Liver Cancer
Hepatocellular Carcinoma:
This is the most common form of liver cancer in adults. Making up roughly 90% of all liver cancers diagnosed in the United States.
Hepatocellular cancers can have different growth patterns:
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A single tumor that grows larger. Only late in the disease does it spread to other parts of the liver.
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Multiple small cancer nodules throughout the liver, not just a single tumor. This is seen most often in people with cirrhosis (chronic liver damage) and is the most common pattern seen in the United States.
Doctors can classify several subtypes of HCC. Most often these subtypes do not affect treatment or prognosis (outlook).
Intrahepatic cholangiocarcinoma (bile duct cancer):
About 10% to 20% of cancers that start in the liver are intrahepatic cholangiocarcinomas. These cancers start in the cells that line the small bile ducts (tubes that carry bile to the gallbladder) within the liver. Most cholangiocarcinomas, however, actually start in the bile ducts outside the liver.
Although the rest of this information is mainly about hepatocellular cancers, cholangiocarcinomas are often treated the same way.
Primary hepatic neuroendocrine tumors (PHNETs):
Primary hepatic neuroendocrine tumors (PHNETs), are rare neuroendocrine tumors originating in the liver. PHNETs account for less than 1% of all neuroendocrine tumors and less than 0.3% of liver tumors, as most neuroendocrine tumors found in the liver are actually metastatic, having spread from other parts of the body rather than originating in the liver itself.
Metastatic Liver Cancer :
Most of the time when cancer is found in the liver it does not start there but has spread (metastasized) from somewhere else in the body, such as the pancreas, colon, stomach, breast, or lung. Because this cancer has spread from its original (primary) site, it is called a secondary liver cancer. These tumors are named and treated based on their primary site (where they started). For example, cancer that started in the lung and spread to the liver is called lung cancer with spread to the liver, not liver cancer. It is also treated as lung cancer.
In the United States and Europe, secondary (metastatic) liver tumors are more common than primary liver cancer. Roughly 5% of all cancers become secondary liver cancers.
Causes and Risk Factors
Behaviors and conditions that increase risk for getting liver cancer are:
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Being overweight or having obesity.
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Having a long-term hepatitis B virus or hepatitis C virus infection.
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Smoking cigarettes.
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Drinking alcohol.
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Having cirrhosis (scarring of the liver, which can also be caused by hepatitis and alcohol use).
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Having nonalcoholic fatty liver disease
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(extra fat in the liver that is not caused by alcohol).
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Having diabetes.
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Having hemochromatosis, a condition in which the body takes up and stores more iron than it needs.
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Eating foods that have aflatoxin (a fungus that can grow on foods, such as grains and nuts that have not been stored properly).
Symptoms
In its early stages, liver cancer may not have symptoms that can be seen or felt. Most of the early stage liver cancers are picked up on scans (CT, MRI, Ultrasound) during and evaluation of other symptoms. However, as the cancer grows larger, people may notice one or more of these common symptoms. It's important to remember that these symptoms could also be caused by other health conditions. If you have any of these symptoms, talk to your doctor.
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Liver cancer symptoms may include:
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Discomfort in the upper abdomen on the right side.
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A swollen abdomen.
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A hard lump on the right side just below the rib cage.
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Pain near the right shoulder blade or in the back.
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Jaundice (yellowing of the skin and whites of the eyes).
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Easy bruising or bleeding.
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Unusual tiredness.
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Nausea and vomiting.
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Loss of appetite.
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Weight loss for no known reason.
How many Americans are diagnosed with
Liver Cancer?
The American Cancer Society’s estimates for primary liver cancer and intrahepatic bile duct cancer in the United States for 2024 are:
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About 41,630 new cases (28,000 in men and 13,630 in women) will be diagnosed
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About 29,840 people (19,120 men and 10,720 women) will die of these cancers
Diagnosis
How do healthcare providers diagnose liver cancer?
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Your healthcare provider may suspect you have liver cancer if they find liver cancer signs and symptoms during your physical examination. They may order the following tests to learn more:
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Blood tests: Healthcare providers may do blood tests for cancer, such as a liver function test, to check on liver enzymes, proteins and other substances that show whether your liver is healthy or damaged. They may test for alfa-fetoprotein (AFP). High AFP levels may indicate liver cancer.
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Ultrasound (sonography): This test provides pictures of your soft tissue structures. Healthcare providers use ultrasound to look for liver tumors.
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Computed tomography (CT) scan: This special type of X-ray takes detailed images of your liver, providing information about liver tumor size and location.
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Magnetic resonance imaging (MRI): This test produces very clear images of your body using a large magnet, radio waves and a computer.
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Angiogram: This test helps healthcare providers examine your liver’s blood vessels. During this test, your healthcare provider injects dye into an artery so they can track blood vessel activity and look for blockages.
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Biopsy: Healthcare providers remove liver tissue to look for signs of cancer. Biopsies are the most reliable way to confirm a liver cancer diagnosis.
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Your healthcare provider may do the following test if they think you may have Intrahepatic cholangiocarcinoma (bile duct cancer):
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Endoscopic retrograde cholangiopancreatography (ERCP): ERCP uses an endoscope and a catheter (thin, flexible tubes) to examine your bile ducts.
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Percutaneous transhepatic cholangiography (PTC): A PTC creates X-rays of your bile ducts like an ERCP. Instead of an endoscope and catheter, your healthcare provider delivers contrast dye by inserting a needle directly into your bile ducts and liver. A PTC is usually only for people who can’t have an ERCP.
Staging
Hepatocellular Carcinoma
Healthcare providers stage Hepatocellular Carcinoma using standards set by the Barcelona Clinic Liver Cancer system (BCLC). This system evaluates HCC liver on characteristics, including whether your liver is working well, tumor size and your symptoms. Healthcare providers may use different terms for each BCLC stage; sometimes, presented as being stages I to IV or 0-C or by terms such as early and advanced stage HCC.
Hepatocellular carcinoma stages include the following:
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Stage I/very early stage/stage 0: You have a single tumor in your liver that measures less than 2 centimeters (cm). Blood tests show your bilirubin level is normal.
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Stage II/early stage/stage A: You have a single tumor that measures 5 cm or less or you have more than one tumor that measures less than 3 cm. The tumor may have spread to your blood vessels.
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Stage III/intermediate stage/stage B: In this stage, you may have more than one tumor and/or a tumor that measures more than 5 cm. The tumor may have spread to your lymph nodes, large blood vessels or another organ.
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Stage IV/advanced stage/stage C: The cancer has spread (metastasized) to other places in your body, such as your lungs or bones, as well as lymph nodes.

Created with BioRender.com, Publication license n. TN25KYSTLY.
The figure illustrates the BCLC staging and classification system for hepatocellular carcinoma (HCC). This widely accepted system stratifies HCC patients into different stages based on tumor characteristics, liver function, and pathologic stage (PS). The BCLC classification provides a comprehensive framework for guiding treatment decisions, prognosis assessment, and survival outcomes in HCC. The stages range from early-stage tumors amenable to curative treatments (Stage 0–A) to advanced-stage disease requiring systemic therapy (Stage C). The BCLC staging system serves as a valuable tool in clinical practice and clinical trial design, aiding in the management and evaluation of HCC patients.​
Staging for Cholangiocarcinoma is divided into three types.
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Intrahepatic bile duct tumors (intrahepatic cholangiocarcinoma)
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Perihilar bile duct tumors (extrahepatic cholangiocarcinoma), also known as Klatskin tumor
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Distal bile duct tumors (extrahepatic cholangiocarcinoma)
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Primary hepatic neuroendocrine tumors (PHNETs)
Neuroendocrine tumors originating in the liver are very rare, and do not have a specific staging system like more common liver cancers (such as hepatocellular carcinoma) or neuroendocrine tumors found in other parts of the body. However, physicians often adapt existing staging guidelines from the American Joint Committee on Cancer (AJCC) or the European Neuroendocrine Tumor Society (ENETS) for liver cancers and neuroendocrine tumors to assess and manage PHNETs. Here’s how they may generally be staged:
1. Tumor Size and Local Invasion (T)
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T1: The tumor is small and limited to the liver, without significant spread to nearby structures.
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T2: The tumor has grown larger and may have invaded blood vessels or nearby liver tissues.
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T3: There are multiple tumors, or one large tumor that has invaded major blood vessels or surrounding liver structures.
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T4: The tumor has invaded adjacent organs or distant parts of the liver significantly.
2. Lymph Node Involvement (N)
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N0: No lymph nodes are involved.
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N1: Regional lymph nodes are involved, meaning the cancer has spread from the liver to nearby lymph nodes.
3. Distant Metastasis (M)
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M0: No distant metastasis is present.
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M1: The cancer has metastasized to distant organs, such as the lungs or bones.
Emotional and Social Support
A liver cancer diagnosis can be emotionally challenging. Patients should seek emotional support from healthcare providers, therapists, support groups, and loved ones.
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The American Liver Foundation and the Cholangiocarcinoma Foundation are two great resources for patients diagnosed with liver cancer and their families.
Treatment Options
Treatment depends on the stage and type of liver cancer. Common treatment options include:
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Surgery: Depending on the tumor's location and stage.
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Chemotherapy: Powerful drugs are used to kill cancer cells or slow their growth.
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Liver Transplant: The liver is replaced with a donor organ, especially beneficial for small, confined tumors.
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Microwave Ablation (MWA): Microwaves heat and kill cancer cells using a small needle like probe.
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Transarterial Chemoembolization (TACE): Chemotherapy is delivered via blood vessels, blocking the tumor's blood supply.
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Radioembolization (Y90): Tiny radioactive beads are injected to deliver targeted radiation to the tumor.
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Radiation Therapy: High-energy rays are targeted at the cancer to destroy cancer cells or shrink tumors.
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Immunotherapy: This treatment aims to boost the patient's immune system to fight cancer.
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Palliative Care: This focuses on improving the patient's quality of life and managing symptoms, especially in advanced cases.