There are two subtypes of liver cancer: hepatocellular carcinoma (HCC), which is the most common, and cholangiocarcinoma, which grows in the bile ducts of the liver.
Knowing your subtype is important because it helps your physician better understand what treatment types are best for you and if they are working like they should. It also helps them know what side effects might occur during your treatment.
Hepatocellular
Hepatocellular carcinoma (HCC) causes cancer cells to form in the liver tissues. It is the most common type of liver cancer. Here are some facts about HCC:
- About 80 percent of primary liver cancers are HCCs, which begin in liver cells called hepatocytes.
- HCCs occur most often in people who have livers that have been damaged — for example, by chronic infection with the hepatitis B or C virus or by alcohol abuse.
- People with diabetes, hyperlipidemia and obesity (metabolic syndrome) are also at higher risk, often because they develop fatty liver disease.
- Some cases of HCC are caused by benign (noncancerous) tumors called hepatic adenomas.
- The disease is also called hepatocellular cancer or hepatoma.
Intrahepatic Cholangiocarcinoma
Most primary liver cancers that are not hepatocellular carcinoma (HCC) are intrahepatic cholangiocarcinoma (ICC). Here are some facts about ICC:
- It is similar to cells that line the bile ducts inside the liver.
- People with chronic inflammation and damage to their liver (such as those with cirrhosis, sclerosing cholangitis, pyogenic cholangiohepatitis or choledochal cysts) are at higher risk for ICC.
- Treatment for ICC is often similar to treatment for HCC.
Rare Primary Liver Cancers
- Angiosarcoma, hemangiosarcoma, hemangiopericytoma and hepatic epithelioid hemangioendothelioma: Start in the liver’s blood vessels.
- Hepatoblastoma: A disease that affects children.
- Biliary cystadenocarcinoma: Occurs mainly in women.
- Fibrolamellar hepatocellular carcinoma: Usually affects people younger than 40.
Secondary Liver Cancers
Secondary liver cancer means that cancer cells have spread from one part of the body (metastasized) to the liver. The most common types of liver metastases come from the colon.
Staging Liver Cancer
Staging means finding out how widespread liver cancer is in your body. Knowing the stage of your cancer helps your physician predict which treatments are most likely to control your disease or put it into remission. There are several systems used to stage liver cancer, and Fred Hutch mainly uses the Barcelona Clinic Liver Cancer (BCLC) staging system.
Staging Tests
To diagnose the stage of your liver cancer, you might have imaging tests or a biopsy of your liver.
Imaging Tests to Stage Liver Cancer
Imaging tests to stage liver cancer include:
- Ultrasound
- Computed tomography (CT) scan
- Angiogram
- Magnetic resonance imaging (MRI)
- Bone scan
Liver Biopsy to Stage Liver Cancer
Sometimes a biopsy is needed to help stage liver cancer and help your physicians understand how the liver is currently functioning. There are a few types of liver biopsy your physician may choose from, depending on your situation. But the most common is called percutaneous liver biopsy.
During this procedure, the physician will put a small needle into your liver to take a tissue sample. You’ll be given a local anesthetic first, so you won’t feel any pain, but you’ll probably feel some pressure.
Liver Function Test
Liver cancer can develop in people who have liver damage caused by other conditions, like hepatitis or cirrhosis. In order to properly treat you and check the overall health of your liver, your physician may need to do a blood test called a liver function test.
Knowing the results of this test is just as important as knowing the stage of your liver cancer. That’s because the noncancerous part of your liver needs to be healthy enough for you to have surgery, especially if a large part of your liver needs to be removed. It’s also important because chemotherapy or other treatments might not be good options for you if your liver health is poor.
Types of Treatment for Liver Tumors and Cancer
Today, there are more treatment options for liver cancer than ever before. When you come to Fred Hutch, you will have access to the full range of therapies as well as the latest innovations through clinical trials.
Benign Liver Tumors
Many liver tumors are benign (noncancerous). Still, sometimes they need treatment because they cause symptoms or can turn into cancers. These benign tumor types include:
- Hemangioma: Tumors made up of a tangle of blood vessels. They rarely cause symptoms or require treatment, and there is no evidence that they turn into cancer. These are the most common.
- Focal nodular hyperplasia: Tumor-like masses that are usually discovered when a physician is diagnosing, monitoring or treating some other condition. They usually do not cause symptoms or require treatment.
- Liver adenoma: These tumors often develop in long-time users of contraceptives that are high in estrogen. They can also be caused by other hormone imbalances, like those that happen with polycystic ovarian syndrome. Most of these tumors do not cause symptoms, but they may bleed. They can also turn into a cancerous condition called hepatocellular carcinoma (HCC), but this is rare.
Liver Cysts
Cysts are benign (non-cancerous) encapsulated structures that contain fluid. Liver cysts are common, but they rarely cause symptoms, so most people do not know they have them.
- Simple cysts: The most common and the least likely to cause symptoms.
- Complex cysts: Have features that may be signs of an underlying disease. They may need treatment.
- Polycystic liver disease: A rare, inherited condition that causes many cysts to grow in the liver. If there are too many or if they grow too large, they may cause symptoms and need treatment.
- Echinococcal cysts: This cyst develops because a person has a disease that is caused by a type of tapeworm.
- Choledochal cysts: Part of a condition that appears at birth (congenital). It blocks the flow of bile from the liver to the gallbladder and intestine. It is usually treated in childhood. Children who have these cysts are at higher risk of developing a type of bile duct cancer called cholangiocarcinoma.
- Biliary cystadenomas: These are fluid-filled tumors associated with the bile ducts that occur mainly in women, but they are rare. They may become cancerous and often need surgery.
Cancers in Related Organs and Structures
Cancers in organs and structures related to the liver include:
- Extrahepatic cholangiocarcinoma: Begins in the bile duct outside the liver that drains into the intestine.
- Hilar cholangiocarcinoma: Begins in the bile ducts, specifically where the right and left hepatic ducts meet to form the common hepatic duct. These are sometimes called Klatskin tumors.
- Gallbladder carcinoma: A rare cancer, often associated with gallstones. It begins in the lining of the gallbladder.
Resources
There are many resources online for learning about your disease. Health educators at the Fred Hutch Patient and Family Resource Center have compiled a list of trusted sources to help you get started.
Whether you are newly diagnosed, going through treatment or know someone with cancer, our staff are available to tailor personalized resources and answer questions about support options in the community.
Cancer Research Organizations
Our list of online resources provides accurate health information from reliable and reputable sources, like the National Cancer Institute (NCI), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN)."
American Cancer Society
American Cancer Society (ACS): Overview of Liver Cancer
If you have liver cancer or are a caregiver for someone who does, knowing what to expect can be helpful. Here you can find out all about liver cancer in adults, including risk factors, symptoms and how they are found and treated.
American Society of Clinical Oncology
American Society of Clinical Oncology (ASCO): Guide to Liver Cancer
This is Cancer.Net's Guide to liver cancer. Here you can learn more about liver cancer, treatment, the latest research and clinical trials.
CancerCare
CancerCare Treatment Update: Liver Cancer
The CancerCare Connect® Booklet Series offers up-to-date, easy-to-read information on the latest treatments, managing side effects and coping with cancer.
CancerCare
CancerCare: Liver Cancer General Information and Support
CancerCare provides free, professional support services for people affected by liver cancer, as well as liver cancer treatment information and additional resources, including financial and co-pay assistance.
National Cancer Institute
National Cancer Institute (NCI): Liver and Bile Duct Cancer-Patient Version
The NCI is the federal government's principal agency for cancer research and training. Here you can find more information about liver cancer treatment, research and coping with cancer.
National Comprehensive Cancer Network
National Comprehensive Cancer Network (NCCN) Guidelines for Patients: Liver Cancer / Hepatobiliary Cancers
This step-by-step guide to the latest advances in cancer care features questions to ask your physician, patient-friendly illustrations and glossaries of terms and acronyms.
Cancer Support Organizations
Our list includes local and national organizations that are dedicated to improving the quality of life for patients and family members through providing emotional support, education and community.
American Liver Foundation
American Liver Foundation provides education, advocacy, support services and research for the prevention, treatment and cure of liver disease.
Blue Farey
Blue Farey's mission is to prevent, treat and cure primary liver cancer, specifically Hepatocellular Carcinoma, through research, education and advocacy.
Cancer Support Community
Cancer Support Community is dedicated to ensuring that all people impacted by cancer are empowered by knowledge, strengthened by action, and sustained by community.
Cholangiocarcinoma Foundation
Cholangiocarcinoma Foundation’s mission is to find a cure and improve the quality of life for those affected by cholangiocarcinoma (bile duct cancer), which is a type of liver cancer.