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What is Liver Cancer?

The Florida Hospital Cancer Institute offers the latest and most effective diagnosis, treatments and therapies for liver cancer in Orlando for residents of Central Florida and the surrounding regions. The liver is the second largest organ in the body (behind skin) and is the largest gland. It is located in the upper right portion of the abdomen.  It lies just below the diaphragm, next to the stomach.  The liver plays a vital role in the metabolic activity of the human body and is essential for life. Primary liver cancer is one of the most common cancers in the world, but is not very frequent in the US.  Due to its size, location in the body, and blood supply, the liver is also a frequent site of spread from other cancers, most commonly colorectal cancer in the US. To learn more about treatment for liver cancer in Orlando, or to request an appointment, call (407) 303-1700 between 8 a.m. and 4 p.m. (Eastern Time) Monday through Friday. Or fill out our online assistance form and one of our coordinators will get back to you within one business day.

Primary Liver Cancer (Hepatocellular Carcinoma)

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death worldwide.  In the US, it is far less common but its incidence is rising.  HCC almost always arises in the backround of chronic liver injury that can lead to irreversible liver damage and failure called cirrhosis.  The most common causes of chronic liver injury and cirrhosis in the US include alcohol abuse, chronic hepatitis B or C infection, steatohepatitis due to fatty liver from diabetes and/or obesity, autoimmune hepatitis, and certain genetic diseases.  Other risk factors for HCC include male gender, exposure to certain chemicals, and dietary exposure to aflatoxins.

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Symptoms of Liver Cancer

Early on, liver cancer doesn't always produce identifiable symptoms.  As a result, it often evades detection until progressing to later stages. Often the symptoms that develop first are symptoms of liver disease from cirrhosis including:

  • Abdominal tenderness or pain in the upper right portion of the abdomen.
  • Frequent bruising or bleeding
  • Swollen abdomen
  • Jaundice, appearing as yellowish skin or eyes

When patients are diagnosed with cirrhosis, then regular follow up is necessary to evaluate for the development of HCC.  Usually, a blood test called an alpha fetoprotein level or AFP level and an ultrasound of the liver are reasonable screening tests.  If a mass or tumor is seen in the liver, then further studies are necessary.

To learn more about treatment for liver cancer in Orlando, or to request an appointment, call (407) 303-1700 between 8 a.m. and 4 p.m. (Eastern Time) Monday through Friday. Or fill out our online assistance form and one of our coordinators will get back to you within one business day.

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Tests to Diagnose Liver Cancer

When HCC is suspected, imaging studies of the liver including CT and/or MRI scans with intravenous contrast are performed to identify the number, size, and location of the cancer in the liver.  Biopsy is often performed to confirm the diagnosis.  In addition, additional scans may be necessary to evaluate for spread of liver cancer to other parts of the body. 

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Staging Liver Cancer

HCC is staged based on the size, number, and vascular invasion of the tumor, spread to local lymph nodes, and spread to distant sites.  Current staging is as follows:

  • Stage I: Single tumor that has not invaded any blood vessels and has not spread.
  • Stage II: Any size single tumor that has invaded into blood vessels, or multiple tumors less than 5 cm in diameter with no vascular invasion. The cancer has not spread to nearby lymph nodes or other parts of the body.
  • Stage IIIA: Multiple tumors over 5 cm in diameter, no vascular invasion, no spread to lymph nodes or other parts of the body.
  • Stage IIIB: Single tumor or multiple tumors of any size that have invaded a major branch of the portal vein or hepatic vein, no spread to lymph nodes, no spread to other parts of the body
  • Stage IIIC: Any tumor with direct invasion into an adjacent organ or perforation of the capsule of the liver, no spread to lymph nodes, no spread to other parts of the body.
  • Stage IVA: Any tumor in the liver with spread to lymph nodes, no spread to other parts of the body.
  • Stage IVB: Tumor spread beyond the lymph nodes to other parts of the body.
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Treatment for Liver Cancer

Treatment for HCC can include surgical resection, liver transplantation, or local tumor treatments.  In general, these treatments are only beneficial if the tumor has not spread to lymph nodes or to other parts of the body.  Once the tumor has spread, surgical therapy rarely improves outcome.  In these circumstances, chemotherapy can offer some benefit for prolonging survival, including Nexavar (Sorafenib toslate), an oral medication that inhibits tumor growth and is effective in treatment of HCC.

Surgical Resection

Surgical resection involves complete surgical removal of the tumor with negative margins.  The liver is one of the few organs in the body that can regenerate after part of it is removed.  In a healthy liver, 75% of the liver can be removed, and the remaining 25% will be sufficient for survival and will regrow to almost normal liver size.  Unfortunately, the majority of HCC occurs in livers that are not healthy and have chronic liver damage and cirrhosis.  In the setting of liver damage and cirrhosis, the liver loses the ability to regenerate, and much less liver can be removed.  In the worst cases, no liver surgery can be performed as the liver is too damaged.  In HCC, only about 20 - 30% of patients can have resection for their tumors as a treatment option.

Transplantation

Liver transplantation is another surgical option for patients with HCC.  Transplantation plays a very important role in the treating patients with HCC in the setting of cirrhosis because transplantation addresses both the damaged liver by replacing it with a new one and the cancer by removing the tumor with the old liver.  However, the requirements to be a candidate for transplantation are fairly strict, and there are a limited number of livers available.  For HCC, the tumor requirements are generally based on Milan criteria, which is a solitary tumor ≤ 5 cm or no more than 3 tumors with the largest ≤ 3 cm.  Patients outside these criteria are generally not candidates for transplantation

Local tumor treatments

For patients who are not candidates for transplantation or resection, there are many local tumor treatments that can be used to control the disease.  Many of these treatments do not require surgery and are effective at controlling the cancer. In some cases these treatments can cure the cancer.  The major types of treatments are listed below.

  • Local injection
    • Alcohol
    • Acetic acid
  • Freezing
    • Cryoablation
    • Heating
    • Microwave ablation
    • Radiofrequency ablation
    • Laser ablation
  • Intraarterial therapy
    • Bland embolization
    • Chemoembolization
    • Radioembolization
  • Directed radiation therapy
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Prognosis

Survival with HCC can vary widely due to variability in presentation as well as variability in the underlying health of the liver.  Long term survival is possible in patients with early stage disease that are treated with optimal therapy.  Because of the complex nature and the multitude of choices for treatment, HCC is a disease that should be evaluated and treated at medical centers with a multidisciplinary liver tumor program and access to liver transplantation.

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Metastatic Cancer to the Liver

The liver is a frequent site of metastasis or spread of other types of cancer.  Nearly all types of cancer can spread to and grow in the liver.  The most common cancers that spread to the liver are from the gastrointestinal (GI) tract.  In the US, the most common GI cancer that involves the liver is colorectal cancer.  For the majority of cancers that spread to the liver, cure is not possible and surgery is rarely performed.  However, for colorectal cancer aggressive surgical treatment can lead to a cure in about 30% of patients.  For most metastatic cancer to the liver, the only surgical option is resection of the tumor to a negative margin.  Transplantation is almost never an option for metastatic disease.  Unlike HCC, chemotherapy often plays an important role with surgery to achieve optimal outcomes.  With metastatic disease, there are many treatment options combining chemotherapy, surgery, and possibly radiation therapy.  Patients with metastatic disease to the liver should seek an opinion from centers expert in the care of metastatic disease to the liver to obtain an optimal outcome.

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Request an Appointment

To learn more about treatment for liver cancer in Orlando, or to request an appointment, call (407) 303-1700 between 8 a.m. and 4 p.m. (Eastern Time) Monday through Friday. Or fill out our online assistance form and one of our coordinators will get back to you within one business day.

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