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Liver cancer was once rare, but it’s on the rise. It mostly affects people over 55. Obesity and hepatitis B or C virus infections are risk factors.
Your treatment goals may be to cure the cancer or ease problems it causes. Your multidisciplinary team will develop a plan to fit your needs.
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Fatigue is a feeling of tiredness that makes it hard to do daily activities. It may be physical or mental, and it can affect your mood. It can cause you to have trouble going to work or spending time with friends and family. It is important to talk to your healthcare provider about fatigue. They can help you find ways to manage it and treat the underlying causes.
In some cases, cancer can cause fatigue by itself or with other symptoms such as nausea or vomiting. It is also common for fatigue to be a side effect of certain medications, especially chemotherapy drugs. You can improve your energy by eating a healthy diet, getting more rest and exercising regularly. If your fatigue doesn’t go away after making lifestyle changes, you should see a doctor.
Your doctor will start by asking questions about your medical history, including any recent stressors. They will also do a physical exam and ask about the types of treatment you are receiving. They will also want to know if any of your medications are known to cause fatigue.
Some noncancerous (benign) tumors can cause fatigue, such as hepatocellular adenomas or hemangioma. In rare cases, these tumors can develop into liver cancer.
Liver cancer can also cause a build-up of fluid in your abdomen, which is called ascites. This can happen if the cancer blocks lymph or blood vessels and forces fluid to leak into your abdomen. The swollen belly can make you feel uncomfortable and breathless, and it might hurt when you bend over or cough. Your doctor can treat this by giving you diuretics, which are water pills. They can also do a procedure called paracentesis to drain the fluid from your abdomen.
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In some cases, cancer treatments can cause nausea. This may include chemotherapy, radiation or other types of treatment. Anti-sickness medicines are usually recommended to control this side effect. It’s also important to eat healthy and stay well-hydrated. An oncology dietitian can help you with this.
Occasionally, the cancer in the liver can affect the way the body processes certain chemicals that are needed for normal functions. For example, a tumour in the liver can interfere with the proteins that make blood clots. This can lead to problems with bleeding, such as nosebleeds or blood in the stool. It can also cause anemia (low levels of red blood cells), which can make you feel tired.
The tumour can also irritate nerves that send pain signals to the brain, often causing a feeling of pressure or pulling on the belly or chest. This type of pain is sometimes referred to as “rib ache.”
Liver cancer can spread to the bones, causing high levels of calcium in the blood, called hypercalcaemia. This can also cause nausea and vomiting. Drinking more water and taking drugs to lower the calcium levels may help.
If you have a tumour in the liver that has spread to the brain, it can lead to confusion and changes in thinking, which is referred to as encephalopathy. This can be hard to describe and can vary from person to person. It is not uncommon for people to experience this in addition to other symptoms of liver cancer.
It is not unusual to be very tired after a diagnosis of liver cancer or when receiving treatment. However, this is different from normal fatigue and does not improve with rest.
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Vomiting (also called emesis) is the forceful emptying of stomach contents through the mouth or sometimes through the nose. It can be triggered by a wide range of things including smell, taste, anxiety, pain, or motion. Nausea is the feeling that you are going to vomit, but not all nausea results in vomiting. In some people, the discomfort associated with nausea does not result in vomiting and is instead referred to as regurgitation, which is the expulsion of undigested food from the mouth or esophagus without any forceful expulsion or abdominal distress.
Liver cancer can cause an obstruction of the bile ducts, which can lead to stagnation of bile flow and induce vomiting. The color of the skin and whites of the eyes can also be a sign of liver cancer, if they become yellow from excess bilirubin (yellow pigment that is the result of breaking down red blood cells).
A loss of appetite and weight loss may occur with any type of cancer and is often accompanied by vomiting. If you are experiencing these symptoms, it is important to talk to your healthcare provider.
When you see your healthcare provider, they will ask you questions about your symptoms and do a physical examination. They will also order a variety of tests, such as blood tests and X-rays, to help find out the stage of your cancer. This information helps your healthcare provider decide what treatment is best for you. The staging of your cancer is based on how many tumors there are, what size they are, and whether the cancer has spread to your lymph nodes or large blood vessels. It is also based on your age and health history.
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Weight loss is common with liver cancer, especially when it’s in the advanced stages. This may occur because the cancer interferes with the body’s ability to store and use nutrients. It may also be because of a lack of appetite or because the cancer causes you to feel full easily.
The cancer may also cause blood clots to form more quickly, leading to bleeding in the skin and internal organs. This may happen as a result of the cancer spreading from other parts of the body to the liver, called metastatic disease. You can also have blood clots in the lungs (pulmonary embolism) and in your legs (deep vein thrombosis).
If the cancer is in the early stages, you may have few symptoms or no symptoms at all. If you do have symptoms, they may include jaundice (yellowing of the skin or whites of the eyes) and a swollen abdomen. This is because the liver can’t make enough of a protein called albumin to keep you healthy.
If you have a diagnosis of cancer in the liver, your doctor will discuss treatment options with you. Depending on the stage of your liver cancer, treatment may include chemotherapy drugs that kill or shrink the cancer cells and ablation therapy procedures. This involves inserting small particles into the hepatic artery to create a partial blockage, which reduces the flow of blood to the tumor. The rest of your liver continues to get nourishment from a different blood vessel. Other treatments for primary liver cancer that hasn’t spread to other organs include targeted therapy, which uses medications that decrease the growth and spread of cancer cells. These are fine-tuned to target only cancer cells and leave healthy cells alone.
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A liver cancer that has spread to the abdomen can cause pain in different ways, depending on where it is and how advanced the disease is. It can be caused by pressure from the tumor pressing on other organs, or by blood vessels or nerves in the area that have been irritated by the cancer. The pain can feel like a stabbing or burning sensation, but it can also be deep and dull.
It can also be caused by an infection called primary biliary cholangitis, which is a condition that affects the tubes (ducts) that carry bile from the liver to the gallbladder. This can cause the ducts to become blocked, which leads to a build-up of bile. The bile then spills into the systemic blood circulation and causes itching all over the body, which often begins in the feet and hands but can be felt all over the body.
Liver cancer can also cause bleeding from the stomach or esophagus. This occurs if the liver isn’t working properly and can’t make proteins that help blood clot. The cancer may also bleed internally or spread to bones in the body, where it can cause fractures and bruising.
If you develop one or more of these symptoms, talk to your doctor right away. Your doctor can test for a number of things to find out what is causing the symptoms. They can also recommend treatment to ease the symptoms and help you manage them. For example, radiation therapy can sometimes shrink tumors and relieve pain. Your doctor can also prescribe medications that can treat nausea, vomiting and fatigue. They can also recommend programs and services to help you quit smoking or drinking alcohol, if needed.
Physicians at Perlmutter Cancer Center use a variety of minimally invasive techniques to destroy tumors that begin in the liver (primary liver cancer) and those that spread from other parts of the body to the liver (metastasis).[1] These include ablation therapies.
In RFA, electricity flows through needle electrodes that are inserted into the liver. The electric current heats the tumor to high temperatures and kills it. It also closes nearby blood vessels to limit bleeding.
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Ablation destroys a tumour without removing it, and is an option for people who cannot have surgery or are waiting for a liver transplant. During this procedure, the doctor inserts a needle into your abdomen and sends heat from radio waves or microwaves through it into the tumour. This kills the cancer cells and shrinks the tumour. Then they put a bandage over the area to stop any bleeding. They may also connect you to monitors that track your heart rate and blood pressure.
The procedure is done under general anaesthetic in the x-ray department or operating theatre. It usually takes 1-2 hours. You may need to stay overnight in hospital, but most people can leave soon after treatment. You may have pain or nausea, but this can be managed with medicines. The area where the probe was inserted (the puncture site) will be sore for a day or two. It may bleed a little, but this is unlikely.
If the tumour does not completely disappear or grows back, you may need to have the area treated again. You can have thermal ablation again a few weeks after the first procedure.
Other forms of ablation use cold or chemicals rather than heat. They are usually only used for a few small tumors. Your doctor will explain which form is best for you.
Another way to kill a tumour is to block the blood supply. The doctor can do this by blocking the artery that supplies oxygen and nutrients to the tumour. The doctor puts special needles through a nick in your skin into the liver tumour. They use CT, ultrasound or MRI scans to guide them.
This is called arterial embolization (ar-TEER-ee-ul EM-boh-lih-zay-shun). It is often used for hepatocellular carcinoma, or HCC, but can be used for other tumours. It has the same success rates as RFA and ethanol injection, but has lower side effects.
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Cryoablation involves the use of cold temperatures to destroy a tumor. It’s used for small tumors and in hard-to-operate areas of the liver, and for people who aren’t healthy enough for surgery. It can also be used to treat hepatocellular carcinoma (HCC), and it’s often combined with other treatments, including radiation and chemotherapy.
The surgeon uses an ultrasound or CT scan to guide a needle into the liver tumor. Liquid nitrogen or high-pressure argon gas is then sprayed onto the damaged or cancerous cells, freezing them. This process may last for a few seconds or a few minutes, depending on the amount of tissue treated.
When the treatment is complete, your doctor removes the needle and covers the area with a dressing. You’ll need to stay in bed for a few hours, but you can begin eating and drinking once you feel ready. You’ll need to wait about a week before you have another scan, so that your doctor can check how well the treatment worked.
The main side effect of cryoablation is pain and fever. These symptoms can start a few days after the procedure and last up to a week. They are due to a condition called post ablation syndrome. It’s important to tell your doctor if you have any of these symptoms, so that they can prescribe medicines to help relieve them.
Another possible side effect of cryoablation is blood vessels rupturing. This can be a problem because it reduces your blood supply, which could lead to serious complications. In some cases, it can also lead to liver failure. If this happens, you may need a liver transplant.
Cryoablation can also cause a rare and life-threatening problem called hepatic necrosis. This is a condition that occurs when the tissue gets so cold that it kills the cells in the liver. If you have this condition, it’s very important to tell your doctor immediately.
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The goal of chemoembolization is to block the blood supply to tumors in the liver. This is a treatment for primary liver cancer and cancer that has spread to the liver from another part of the body (metastasis).
In this procedure, your interventional radiologist inserts a catheter through a small nick in your skin and guides it into a blood vessel in your groin or femoral artery. Your doctor may inject dye through the catheter to map the arteries that feed blood to the liver. This helps your doctor find the best location to place the chemoembolization mixture or beads. Then your doctor injects the chemoembolization mixture into your liver artery.
This can be done in combination with other treatments, such as radiation and chemotherapy, to improve your chances of a cure. It also can be used to treat tumors that are too large or invasive to surgically remove.
A few risks of chemoembolization include bleeding and damage to structures near the liver, such as the bile ducts, gallbladder or bowel. But these are rare because your doctor uses scans to guide the needle to the right spot.
Chemoembolization is not a cure, but about 70 percent of patients see their tumors stop growing or shrink, and this can help improve quality of life and survival.
Your health care provider will discuss this with you in detail before you have the procedure. The most common side effects of chemoembolization are pain, nausea and fever, which can be controlled with medications. But these symptoms usually come and go, and most people feel better within a few days. You can go home after treatment if you are comfortable and your pain, nausea and fever are controlled with medication. Some people may need to stay overnight in the hospital. You should contact your doctor if you have severe pain, nausea and fever that doesn’t respond to medication. This could be a sign of infection or an abscess in the liver. This is a rare complication of the procedure, and it needs to be treated right away.
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Ablation may be used in some cases to destroy small tumors that started in your liver (primary liver cancer). You may also have ablation to treat other types of cancer that began elsewhere in the body and spread to your liver. Your doctor uses a needle or similar device to put heat, cold, or chemicals directly into your tumor. This stops the cancer cells from growing or spreading to other parts of your body.
During ablation, your doctor will use a CT scan or ultrasound to guide a needle through your skin into your liver tumor. If you have radiofrequency ablation, the needle will be attached to a probe that creates high heat and kills your tumor cells. If you have microwave ablation, the probe will be attached to a needle that sends out microwaves to destroy your cancer cells. You have RFA or MWA under general anaesthetic or sedation, but the procedure only takes about 30 minutes to a couple of hours.
After your treatment, the area where the needle went into your skin might be sore for a few days. You might also have a pain in your belly or shoulder that travels along a nerve connected to your liver. This is called referred pain and lasts for a few days. It is very important that you tell your doctors or nurses if you have pain that doesn’t go away.
Some liver tumors can’t be treated with thermal ablation because they are near bile ducts or blood vessels. Your doctor can then use a technique called irreversible electroporation (ee-LEK-troh-por-AY-shun). This method uses short electrical pulses to punch holes in the membrane of cancer cells and damage them.
Another way to treat a liver tumor is with radiation therapy, also called selective internal radioembolization (RAY-dee-oh-EM-boh-LIH-shun). Your interventional radiologist will place tiny beads filled with radiation (yttrium-90 or Y90) into the hepatic artery that supplies blood to the tumor. The radiation kills your cancer cells that are close to the artery. Your doctor may use this technique in combination with other treatments, such as chemoembolization or surgery.
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Liver cancer can develop when cells grow abnormally and form a tumor. It often starts in liver cells, but can also start in the tissues that line the bile ducts.
Doctors treat liver cancer by lowering the cancer cells’ blood supply. They do this by using targeted therapy, which involves injecting medications that decrease cancer growth or kill cancer cells.
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Cholangitis can be a sign of liver cancer, especially in cases of primary sclerosing cholangitis (PSC). PSC is an auto-immune disease that attacks the bile ducts. Chronic inflammation leads to scarring, which narrows the ducts and restricts the flow of bile (biliary stricture). Without bile, the liver is damaged over time.
A common symptom of PSC is pain in the upper right side of the abdomen or shoulder blade. This pain can be sharp or cramp-like and it may come and go. It can also cause clay-colored or pale stools. You may also have dark urine or a fever with this condition.
In severe cases, cholangitis can cause sepsis, a whole-body shock response that shuts down your organs. Your healthcare provider will prescribe antibiotics, which can treat the infection causing the cholangitis. They’ll likely order a blood test to check your white blood cell count and liver function. They may also recommend a cholecystectomy (surgery to remove your gallbladder) or ERCP (endoscopic retrograde cholangiopancreatography).
If you have cholangitis, it can be hard to tell what the cause is. That’s why it’s important to visit your healthcare provider for routine screenings. They can help you prevent complications like bile duct obstruction and anemia, which can lead to liver failure.
The most common complication of cholangitis is bacterial infections in the bile ducts. These infections can be dangerous because they could spread to the blood vessels in your liver and enter your systemic circulation, which can kill you.
Bacterial infections in the bile ducts can be treated with antibiotics, but you need to get them diagnosed quickly because a delay in treatment can be life-threatening.
The causes of cholangitis vary, but it’s often related to alcohol use, genetics and certain health conditions, such as diabetes. It can also happen after a gallstone attack or after having a cholecystectomy or ERCP surgery. It’s most common in middle age and more common in women than men.
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The liver is the largest solid organ in the body, located in your right upper abdomen just below the ribs. It has many vital functions, including producing proteins, processing nutrients, removing toxins from the blood, and regulating blood sugar levels. A tumor in the liver can disrupt these vital functions.
Liver cancer symptoms can affect the entire body, from the skin to your bones. Symptoms typically worsen with time and may vary depending on the type of cancer and where it has spread.
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and accounts for about 90% of all cases. It begins in the hepatocytes, which are the liver cells that perform a wide range of vital functions.
If your liver cancer becomes advanced, it can obstruct the bile ducts that connect the liver to the gallbladder and pancreas. This can lead to a buildup of bilirubin, which causes the whites of your eyes and your skin to become yellow or discolored. It can also lead to itchy skin and light-colored stools.
Another early warning sign of liver cancer is abdominal pain and bloating. These can develop due to the liver enlarging or retaining fluids, which are called hepatomegaly and ascites, respectively.
As your liver cancer continues to grow, you may experience more frequent and severe abdominal pain. This is a sign that your body is struggling to compensate for the damaged liver.
In addition, if your tumor is near or pressing against your diaphragm, it can cause pain in the right shoulder area. The phrenic nerve carries a referred pain impulse from the liver to the right side of the chest, and this can be caused by anything that presses against or irritates the diaphragm, such as a tumor, infection, abscess, or trauma.
If you are experiencing any of these symptoms, it is important to seek a professional evaluation. From his offices in Borough Park, Brooklyn and New York City, vascular surgeon Enrico Ascher can help diagnose your liver cancer and recommend the best treatment options for your unique needs. Schedule a consultation over the phone or online today.
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Unexpected and unexplained weight loss can be a sign of liver cancer. When a tumor in the liver increases inflammation, it disrupts hormones that regulate appetite and promotes muscle wasting. A growing tumor also uses a lot of energy and may increase your resting energy expenditure (REE), or how much energy your body burns at rest.
In time, fluid build-up in the abdomen — called ascites — can cause your clothes to feel tight and to fit differently. The enlarged abdomen can also put pressure on blood vessels upstream, including those in the esophagus, which can cause pain and make it difficult to swallow.
The liver itself does not have nerve tissue, but the thin layer of tissue that covers it (the Glissonean capsule) does contain lots of nerve fibers. When a tumor in the liver enlarges, it can cause abdominal pain by putting pressure or stretching on the Glissonean capsule. Often, this pain feels like a dull ache that doesn’t seem related to what you eat and can radiate into the right shoulder (or down the bra line in women).
Liver cancer treatments can also take their toll on your health and lead to unexplained weight loss. If you’re experiencing this symptom in combination with other symptoms on this list, talk to your healthcare provider.
Jaundice, or yellowing of the skin and eyes, can also be a sign of liver cancer. This is because the cancer causes your liver to make less bile, which makes it harder for you to digest fat. The lack of bile also causes you to lose more nutrients and can make your bowel movements appear pale and whitish instead of brown.
Itching is another symptom that can occur in combination with jaundice or as a result of a swollen liver (ascites). The itching is caused by the build-up of bile salts under your skin, which is why this symptom is sometimes described as a prickly feeling. If you experience itching, contact your healthcare provider.
Unexplained and unexpected weight loss can also indicate an iron deficiency, which can be a symptom of liver cancer. Your doctor can prescribe vitamin supplements or recommend a diet that will help you get the iron you need.
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Passing wind or farting is normal for everyone. However, excessive farting can indicate a medical condition that needs to be investigated. It can be a sign of some gastrointestinal conditions such as irritable bowel syndrome (IBS), Crohn’s disease, celiac disease or diabetes. It can also be a sign of underlying cancers including liver cancer.
When cancer cells grow, they can enlarge the abdominal space and cause it to expand beyond its normal size. This can lead to increased pressure on the digestive tract which can result in gas and bloating. This can affect a person’s ability to eat and exercise, as well as their appearance.
The pain and discomfort of excess gas can often be relieved with lifestyle changes, over-the-counter medications and supplements, and diet. Avoiding chewing gum and carbonated drinks, eating fewer dairy products and choosing low-lactose options, avoiding foods that contain gluten, and taking a digestive enzyme such as alpha-galactosidase can help reduce gas. Keeping a diary of when symptoms occur and what types of physical activities or meals are surrounding them can also help to identify patterns that might be contributing to the gas, Chey and Yadlapati say.
Liver cancer can also affect the bile duct, which is a passageway that carries bile, a fluid that helps digest fats. This can cause a build-up of bile salts in the skin that makes it look yellow and causes itching. In some cases, a doctor can insert a small tube, called a stent, to keep the bile duct open.
A doctor can diagnose this symptom by asking about your health history, conducting a physical exam and running tests such as blood work, stool tests or a CT scan. An X-ray or ultrasound may also be used to see if there is an obstruction. Other structural tests that may be useful include methods that quantify gut transit time, assess carbohydrate absorption or measure flatus production. If you are diagnosed with this symptom, your healthcare provider will advise on appropriate treatment.
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