Of all the unsung heroes in the human body, the liver performs hundreds critical tasks and goes unnoticed until disease or chronic abuse make us sit up and take notice of this astonishing organ – the largest in our bodies.
The liver has a remarkable capacity for self-repair but when abnormal cell growth occurs because of environmental factors, disease or heredity, cancer can develop.
The liver’s primary work is to remove harmful substances from the blood, make enzymes and bile that help digest food, and convert food into substances needed for life and growth. You cannot live without a liver.
Whether due to behaviors like excessive drinking, obesity, or not taking precautions against infections like Hepatitis B or C, physicians have been seeing an uptick in liver cancers in men in the U.S. In 2011 there were 26,190 new cases of primary liver and bile duct cancer and 19,500 died from the disease. The cancer is more common in men than in women, with an average man’s lifetime risk of getting liver or bile duct cancer about 1 in 94, while an average woman’s risk is about 1 in 212.
What causes it?
- Hepatitis B and C, diseases that are commonly contracted through exposure to blood products, needle sharing or unsafe sex. Untreated hepatitis B and C are responsible for 78 percent of global cases of liver cancer.
- Long-standing alcohol abuse, which in turn, causes cirrhosis – inflammation and scarring of the liver.
- Fatty liver disease not due to alcoholism – referred to as N.A.S.H. (for non alcoholic steatohepatitus) – it is liver inflammation caused by a buildup of fat in the liver – possibly due to metabolic syndrome-related disease like diabetes or obesity.
Other causes of liver cancer are cirrhosis caused by inherited disease, autoimmune disease, and exposure to toxins and chemicals in the environment. Environmental pollutants like polyvinyl chloride used in manufacturing plastic, and a common mold found in peanuts, called aflatoxin, can all cause liver cancer. Asian-Americans and other ethnic groups may be more likely to be diagnosed with liver cancer.
What are the symptoms?
In the early stages, liver cancer usually has no symptoms. As the disease progresses, symptoms can include:
- Pain in the upper right side of the abdomen
- Yellowing of the skin and eyes
- Swelling of the abdomen
- Dark urine and pale stools
- Loss of appetite
- Weight loss
- Fatigue and weakness
I have symptoms, what next?
Early diagnosis will indicate whether the cancer originated in the liver (primary cancer) or another organ (metastasis, or secondary cancer). Understanding the stage and the type of cancer you have can mean the difference between a cancer that is treatable and one that is not.
Depending on the type of cancer, treatment is aimed at removing or destroying the cancer through surgery, chemotherapy or ablation. Techniques are:
- Surgical resection
- Radiofrequency ablation
- Transarterial chemoembolization
- Percutaneous ethanol or acetic acid ablation
- Radiation therapy, stereotactic radiotherapy
- Systemic chemotherapy, molecularly targeted therapy called Sorafenib
If treatment is unsuccessful or your liver is so damaged it cannot keep working, a liver transplant through organ donation is the last available option for treatment. Your name will be placed on the United Network for Organ Sharing waiting list.
How can I help myself?
If you have a diagnosis of liver cancer, there are many things you can do to cope and improve your quality of life.
- Learn about it. By understanding the disease you’ll be able to work together with your medical team to make informed decisions about your treatment.
- Try to avoid stress – it can trigger an immune response by the body’s endocrine system unleashing a cascade of hormones that impacts the entire body. Learn relaxation techniques and do things you enjoy. Reach out to your partner, friend or a professional, or join a support group to talk about how you feel.
- Follow a healthy diet that is primarily made up of fruits and vegetables. Try to eliminate processed and fatty foods. Don’t drink.
- Exercise regularly under medical supervision. Exercise helps combat weakness and fatigue, plus you’ll get an additional boost from endorphins,the “feel good” chemicals that are triggered when you exercise.
How do I avoid it in the first place?
The liver is a very forgiving organ – it often takes years of abuse to develop scarring and cancer:
- Cut back on drinking alcohol.
- Practice safe sex by using condoms. Don’t share needles. Use caution when getting tattooed.
- Get vaccinated against hepatitis B to prevent infection.
- Take care of your health with nutritious food and exercise.
If you have any suspicions, seek medical advice right away.
For local resources and more information on liver cancer, visit
Ashok N. Shah M.D., MACG, is a professor of medicine in URMC’s Dept of Gastroenterology and Hepatology and one of the most experienced gastroenterologists in the region. Shah has over 35 years experience in gastroenterology and has particular interests in IBD, pancreatic disease, liver diseases and celiac disease. He was recently honored with the M.A.C.G. Award by the American College of Gastroenterology for his achievements in clinical gastroenterology and education. He is a founding member of both the CCFA of Rochester and the Celiac Society of Rochester. He earned his medical degree from B. J. Medical College in India, with subsequent Gastroenterology fellowships at The Lahey Clinic in Boston and at the University of Rochester.
Rajiv Sharma, MBBS, is a fellow in URMC’s Dept. of Gastroenterology and Hepatology. He attended medical school at Dayanand Medical College, India, and did his residency at Loma Linda University, California.