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Health Library : Liver, Biliary, and Pancreatic Disorders

 

Liver Tumors

What is a tumor?

Tumors are abnormal masses of tissue that form when cells begin to reproduce at an increased rate. The liver can grow both non-cancerous (benign) and cancerous (malignant) tumors.

What are non-cancerous liver tumors?

Non-cancerous (benign) tumors are quite common and usually do not produce symptoms. Often, they are not diagnosed until an ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) scan is performed. There are several types of benign liver tumors, including the following:

  • hepatocellular adenoma
    This benign tumor is linked to the use of certain drugs. Most of these tumors remain undetected. Sometimes, an adenoma will rupture and bleed into the abdominal cavity, requiring surgery. Adenomas rarely become cancerous.
  • hemangioma
    This type of benign tumor is a mass of abnormal blood vessels. Treatment is usually not required. Sometimes, infants with large liver hemangiomas require surgery to prevent clotting and heart failure.

What are cancerous liver tumors?

Cancerous (malignant) tumors in the liver have either originated in the liver (primary liver cancer) or spread from cancer sites elsewhere in the body (metastatic liver cancer). Most cancerous tumors in the liver are metastatic.

What is hepatoma (primary liver cancer)?

Also called hepatocellular carcinoma, this is the most common form of primary liver cancer. Chronic infection with hepatitis B and C increases the risk of developing this type of cancer. Other causes include cancer-causing substances, alcoholism, and chronic liver cirrhosis.

What are the symptoms of a liver hepatoma?

The following are the most common symptoms of a liver hepatoma. However, each individual may experience symptoms differently. Symptoms may include:

  • abdominal pain
  • weight loss
  • nausea
  • vomiting
  • large mass can be felt in upper, right part of abdomen
  • fever
  • jaundice - yellowing of the skin and eyes.

The symptoms of a liver hepatoma may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is liver hepatoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for a liver hepatoma may include the following:

  • liver function tests - a series of special blood tests that can determine if the liver is functioning properly.
  • abdominal ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, spleen, and kidneys and to assess blood flow through various vessels.
  • computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • hepatic arteriography - x-rays taken after a substance in injected into the hepatic artery.
  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

Treatment for liver hepatoma:

Specific treatment for liver hepatoma will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance of specific medicines, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include:

  • surgery
    In some cases surgery may be used to remove cancerous tissue from the liver. However, the tumor must be small and confined.
  • external beam radiotherapy
    EBRT uses carefully aimed beams of X-rays to kill cancer cells. EBRT is painless and takes a few minutes to deliver. The treatment plan is developed by a doctor called a Radiation Oncologist. Special techniques such as 3D-conformal, Intensity-Modulated Radiotherapy (IMRT), and Tomotherapy are often used to minimize the dose of radiation to normal tissues to reduce side effects, while still delivering enough radiation to kill tumor cells and shrink tumors. EBRT is also used to ease symptoms (palliate) such as pain, blockage, or bleeding. Stereotactic Body Radiotherapy (SBRT) is a form of EBRT that focuses high doses of X-rays on the tumor with great accuracy in one to five treatments. X-ray pictures or CT scans are done on the treatment table before each treatment to insure accuracy.
  • intra-arterial radiotherapy (Y-90 microspheres)
    For some liver tumors, a radioactive element called yttrium-90 (Y-90) may be infused into the liver via the arteries that supply blood to the liver. This concentrates the radiation dose in the liver tumors and reduces to dose to normal tissues. The Hollings Cancer Center is one of only three South Carolina facilities that provide this option to their patients and we have the largest experience with this technique in the state. This treatment offers an outpatient treatment alternative to patients who may have few other available options.
  • chemotherapy
    Chemotherapy is the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. For example, the Food and Drug Administration has recently approved the use of Nexavar (sorafenib), which is the first targeted drug therapy to be approved for liver cancer. It has been shown to significantly improve overall survival. Targeted drugs work by blocking certain proteins that cause cancer cells to divide and control the growth of new blood vessels that normally feed tumors. The oncologist will recommend a treatment plan for each individual.
    • intra-arterial chemotherapy - chemotherapy is delivered directly to the liver tumor by injecting the anticancer drugs into an artery that supplies the liver.
    • chemoembolization - the blood supply to the liver tumor is blocked surgically or mechanically and anticancer drugs are given directly into the tumor. This allows a higher concentration of an anticancer drug to be in contact with the tumor for a longer period of time.
  • radiofrequency ablation
    A special probe is used to kill the cancer cells with heat. The physician may insert the probe through the skin, using local anesthesia, or it may be inserted through a small incision in the abdomen, using general anesthesia. Laser and microwave therapy are other treatment therapies that use heat to destroy tumors in the liver.
  • liver transplantation
    A liver transplantation may be a surgical option for a few patients.

What are other types of primary liver cancers?

Other, less common primary liver cancers include the following:

  • cholangiocarcinoma - a cancer that originates in the lining of the bile channels in the liver or in the bile ducts.
  • hepatoblastoma - a cancer in infants and children, sometimes causing the release of hormones that result in early puberty.
  • angiosarcoma - a rare cancer that originates in the blood vessels of the liver.

What are the stages of liver cancer?

When a physician diagnoses liver cancer, the next step is to determine how far the cancer cells have spread (a process called staging). The National Cancer Institute defines the following stages for primary liver cancer:

localized resectable Cancer is in the liver only, has not spread, and can be removed completely with surgery.
localized unresectable Cancer is in the liver only, has not spread, but cannot be totally removed.
advanced Cancer has spread throughout the liver or to other parts of the body.
recurrent Cancer has come back after it was treated.

What is metastatic liver cancer?

Cancer that has spread from other areas in the body to the liver usually originated in the lung, breast, colon, pancreas, and stomach. Leukemia and other blood cancers sometimes also spread to the liver.

What are the symptoms of metastatic liver cancer?

The following are the most common symptoms of metastatic liver cancer. However, each individual may experience symptoms differently. Symptoms may include:

  • weight loss
  • poor appetite
  • enlarged, hard and tender liver
  • fever
  • enlarged spleen
  • ascites - fluid build-up in the abdominal cavity.
  • jaundice - yellowing of the skin and eyes.
  • confusion
  • drowsiness

The symptoms of metastatic liver cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is metastatic liver cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for metastatic liver cancer may include the following:

  • liver function tests - a series of special blood tests that can determine if the liver is functioning properly.
  • abdominal ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver spleen, and kidneys and to assess blood flow through various vessels.
  • computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

Treatment for metastatic liver cancer:

Specific treatment for metastatic liver cancer will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance of specific medicines, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include:

  • surgery
    In some cases surgery may be used to remove cancerous tissue from the liver. However, the tumor must be small and confined.
  • external beam radiotherapy (EBRT)
    EBRT uses carefully aimed beams of X-rays to kill cancer cells. EBRT is painless and takes a few minutes to deliver. The treatment plan is developed by a doctor called a Radiation Oncologist. Special techniques such as 3D-conformal, Intensity-Modulated Radiotherapy (IMRT), and Tomotherapy are often used to minimize the dose of radiation to normal tissues to reduce side effects, while still delivering enough radiation to kill tumor cells and shrink tumors. EBRT is also used to ease symptoms (palliate) such as pain, blockage, or bleeding. Sterotactic Body Radiotherapy (SBRT) is a form of EBRT that focuses high doses of X-rays on the tumor with great accuracy in one to five treatments. X-ray pictures or CT scans are done on the treatment table before each treatment to insure accuracy.
  • intra-arterial radiotherapy (Y-90 microspheres)
    For some liver tumors, a radioactive element called yttrium-90 (Y-90) may be infused into the liver via the arteries that supply blood to the liver. This concentrates the radiation dose in the liver tumors and reduces the dose to normal tissues. The Hollings Cancer Center is one of only three South Carolina facilities that provide this option to their patients and we have the largest experience with this technique in the state. This treatment offers an outpatient treatment alternative to patients who may have few other available options.
  • chemotherapy
    Chemotherapy is the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.
    • intra-arterial chemotherapy - chemotherapy is delivered directly to the liver tumor by injecting the anticancer drugs into an artery that supplies the liver.
  • chemoembolization - the blood supply to the liver tumor is blocked surgically or mechanically and anticancer drugs are given directly into the tumor. This allows a higher concentration of an anticancer drug to be in contact with the tumor for a longer period of time.

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Online Resources of Liver, Biliary, `amp; Pancreatic Disorders


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