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LiverCancer

NATIONAL INSTITUTES OF HEALTHNational Cancer Institute

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This booklet is about liver cancer. TheCancer Information Service can help youlearn more about this disease. The staff cantalk with you in English or Spanish.

The number is 1–800–4–CANCER(1–800–422–6237). The number for deafand hard of hearing callers with TTYequipment is 1–800–332–8615. The call isfree.

Este folleto es acerca del cáncer del higado.Llame al Servicio de Información sobre elCáncer para saber más sobre estaenfermedad. Este servicio tiene personalque habla español.

El número a llamar es el1–800–4–CANCER (1–800–422–6237).Personas con problemas de audición y quecuentan con equipo TTY pueden llamar al1–800–332–8615. La llamada es gratis.

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Contents

The Liver 2

Understanding Cancer 3

Liver Cancer: Who’s at Risk? 4

Symptoms 6

Diagnosis 7

Staging 9

Treatment 10

Side Effects of Treatment 18

Pain Control 20

Nutrition 21

Continuing Care 23

Support for People with Liver Cancer 23

The Promise of Cancer Research 24

Dictionary 26

National Cancer Institute Information Resources 35

National Cancer Institute Booklets 36

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESPublic Health ServiceNational Institutes of Health

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*Words that may be new to readers are in italics. The “Dictionary”section gives definitions of these terms. Some words in the“Dictionary” have a “sounds-like” spelling to show how topronounce them.

What You Need To Know About™ Liver Cancer

his National Cancer Institute (NCI) booklet hasimportant information about cancer* that begins

in the liver. It discusses possible causes, symptoms,diagnosis, and treatment of liver cancer. It also hasinformation to help patients cope with this disease.

Information specialists at the NCI’s CancerInformation Service at 1–800–4–CANCER can helppeople with questions about cancer and can send NCIpublications. Also, many NCI publications are on theInternet at http://cancer.gov/publications. People inthe United States and its territories may use this Website to order publications. This Web site also explainshow people outside the United States can mail or faxtheir requests for NCI publications.

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Primary and Secondary CancersCancer that begins in the liver is called

primary liver cancer. In the United States, thistype of cancer is uncommon. However, it iscommon for cancer to spread to the liver from thecolon, lungs, breasts, or other parts of the body.When this happens, the disease is not liver cancer.The cancer in the liver is a secondary cancer. It isnamed for the organ or the tissue in which itbegan.

This booklet is only about cancer that begins inthe liver. It is not about cancer that spreads to theliver from other parts of the body.

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The Liver

he liver is the largest organ in the body. It is foundbehind the ribs on the right side of the abdomen.

The liver has two parts, a right lobe and a smaller leftlobe.

The liver has many important functions that keep aperson healthy. It removes harmful material from theblood. It makes enzymes and bile that help digest food.It also converts food into substances needed for life andgrowth.

The liver gets its supply of blood from two vessels.Most of its blood comes from the hepatic portal vein.The rest comes from the hepatic artery.

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This picture shows the liver and nearby organs.

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Understanding Cancer

ancer is a group of many related diseases. Allcancers begin in cells, the body’s basic unit of

life. Cells make up tissues, and tissues make up theorgans of the body.

Normally, cells grow and divide to form new cells asthe body needs them. When cells grow old and die,new cells take their place.

Sometimes, this orderly process goes wrong. Newcells form when the body does not need them, or oldcells do not die when they should. These extra cells canform a mass of tissue called a growth or tumor. Tumorscan be benign or malignant:

• Benign tumors are not cancer. Usually, doctors canremove them. In most cases, benign tumors do notcome back after they are removed. Cells from benigntumors do not spread to tissues around them or toother parts of the body. Most important, benigntumors are rarely a threat to life.

• Malignant tumors are cancer. They are generallymore serious and may be life threatening. Cancercells can invade and damage nearby tissues andorgans. Also, cancer cells can break away from amalignant tumor and enter the bloodstream or thelymphatic system. That is how cancer cells spreadfrom the original cancer (the primary tumor) to formnew tumors (secondary tumors) in other organs. Thespread of cancer is called metastasis. Different typesof cancer tend to spread to different parts of thebody.

Most primary liver cancers begin in hepatocytes(liver cells). This type of cancer is called hepatocellularcarcinoma or malignant hepatoma.

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Children may develop childhood hepatocellularcarcinoma or hepatoblastoma. This booklet does notdeal with childhood liver cancer. Printed material isavailable at http://cancer.gov. Also, the CancerInformation Service (1–800–4–CANCER) can provideinformation about liver cancer in children.

When liver cancer spreads (metastasizes) outside theliver, the cancer cells tend to spread to nearby lymphnodes and to the bones and lungs. When this happens,the new tumor has the same kind of abnormal cells asthe primary tumor in the liver. For example, if livercancer spreads to the bones, the cancer cells in thebones are actually liver cancer cells. The disease ismetastatic liver cancer, not bone cancer. It is treated asliver cancer, not bone cancer. Doctors sometimes callthe new tumor “distant” disease.

Similarly, cancer that spreads to the liver fromanother part of the body is different from primary livercancer. The cancer cells in the liver are like the cells inthe original tumor. When cancer cells spread to the liverfrom another organ (such as the colon, lung, or breast),doctors may call the tumor in the liver a secondarytumor. In the United States, secondary tumors in theliver are far more common than primary tumors.

Liver Cancer: Who’s at Risk?

esearchers in hospitals and medical centers aroundthe world are working to learn more about what

causes liver cancer. At this time, no one knows its exactcauses. However, scientists have found that people withcertain risk factors are more likely than others todevelop liver cancer. A risk factor is anything thatincreases a person’s chance of developing a disease.

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Studies have shown the following risk factors:

• Chronic liver infection (hepatitis)—Certain virusescan infect the liver. The infection may be chronic. (Itmay not go away.) The most important risk factor forliver cancer is a chronic infection with the hepatitisB virus or the hepatitis C virus. These viruses can bepassed from person to person through blood (such asby sharing needles) or sexual contact. An infant maycatch these viruses from an infected mother. Livercancer can develop after many years of infectionwith the virus.

These infections may not cause symptoms, but bloodtests can show whether either virus is present. If so,the doctor may suggest treatment. Also, the doctormay discuss ways of avoiding infecting other people.

In people who are not already infected with hepatitisB virus, hepatitis B vaccine can prevent chronichepatitis B infection and can protect against livercancer. Researchers are now working to develop avaccine to prevent hepatitis C infection.

• Cirrhosis—Cirrhosis is a disease that develops whenliver cells are damaged and replaced with scar tissue.Cirrhosis may be caused by alcohol abuse, certaindrugs and other chemicals, and certain viruses orparasites. About 5 percent of people with cirrhosisdevelop liver cancer.

• Aflatoxin—Liver cancer can be caused by aflatoxin,a harmful substance made by certain types of mold.Aflatoxin can form on peanuts, corn, and other nutsand grains. In Asia and Africa, aflatoxincontamination is a problem. However, the U.S. Foodand Drug Administration (FDA) does not allow thesale of foods that have high levels of aflatoxin.

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• Being male—Men are twice as likely as women toget liver cancer.

• Family history—People who have family memberswith liver cancer may be more likely to get thedisease.

• Age—In the United States, liver cancer occurs moreoften in people over age 60 than in younger people.

The more risk factors a person has, the greater thechance that liver cancer will develop. However, manypeople with known risk factors for liver cancer do notdevelop the disease.

People who think they may be at risk for livercancer should discuss this concern with their doctor.The doctor may plan a schedule for checkups.

Symptoms

iver cancer is sometimes called a “silent disease”because in an early stage it often does not cause

symptoms. But, as the cancer grows, symptoms mayinclude:

• Pain in the upper abdomen on the right side; thepain may extend to the back and shoulder

• Swollen abdomen (bloating)

• Weight loss

• Loss of appetite and feelings of fullness

• Weakness or feeling very tired

• Nausea and vomiting

• Yellow skin and eyes, and dark urine from jaundice

• Fever

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These symptoms are not sure signs of liver cancer.Other liver diseases and other health problems can alsocause these symptoms. Anyone with these symptomsshould see a doctor as soon as possible. Only a doctorcan diagnose and treat the problem.

Diagnosis

f a patient has symptoms that suggest liver cancer,the doctor performs one or more of the following

procedures:

• Physical exam—The doctor feels the abdomen tocheck the liver, spleen, and nearby organs for anylumps or changes in their shape or size. The doctoralso checks for ascites, an abnormal buildup of fluidin the abdomen. The doctor may examine the skinand eyes for signs of jaundice.

• Blood tests—Many blood tests may be used tocheck for liver problems. One blood test detectsalpha-fetoprotein (AFP). High AFP levels could be asign of liver cancer. Other blood tests can show howwell the liver is working.

• CT scan—An x-ray machine linked to a computertakes a series of detailed pictures of the liver andother organs and blood vessels in the abdomen. Thepatient may receive an injection of a special dye sothe liver shows up clearly in the pictures. From theCT scan, the doctor may see tumors in the liver orelsewhere in the abdomen.

• Ultrasound test—The ultrasound device uses soundwaves that cannot be heard by humans. The soundwaves produce a pattern of echoes as they bounceoff internal organs. The echoes create a picture(sonogram) of the liver and other organs in theabdomen. Tumors may produce echoes that aredifferent from the echoes made by healthy tissues.

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• MRI—A powerful magnet linked to a computer isused to make detailed pictures of areas inside thebody. These pictures are viewed on a monitor andcan also be printed.

• Angiogram—For an angiogram, the patient may bein the hospital and may have anesthesia. The doctorinjects dye into an artery so that the blood vessels inthe liver show up on an x-ray. The angiogram canreveal a tumor in the liver.

• Biopsy—In some cases, the doctor may remove asample of tissue. A pathologist uses a microscope tolook for cancer cells in the tissue. The doctor mayobtain tissue in several ways. One way is byinserting a thin needle into the liver to remove a

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small amount of tissue. This is called fine-needleaspiration. The doctor may use CT or ultrasound toguide the needle. Sometimes the doctor obtains asample of tissue with a thick needle (core biopsy) orby inserting a thin, lighted tube (laparoscope) into asmall incision in the abdomen. Another way is toremove tissue during an operation.

Staging

f liver cancer is diagnosed, the doctor needs toknow the stage, or extent, of the disease to plan

the best treatment. Staging is an attempt to find out thesize of the tumor, whether the disease has spread, andif so, to what parts of the body. Careful staging showswhether the tumor can be removed with surgery. This

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A patient who needs to have a biopsy may wantto ask the doctor some of the following questions:

• Why do I need a biopsy? How will the biopsyaffect my treatment plan?

• What kind of biopsy will I have?

• How long will it take? Will I be awake? Will it hurt?

• Is there a risk that the biopsy procedure will cause the cancer to spread? What are the chances of infection or bleeding after the biopsy? Are there any other risks?

• How soon will I know the results?

• If I do have cancer, who will talk with meabout treatment? When?

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is very important because most liver cancers cannot beremoved with surgery.

The doctor may determine the stage of liver cancerat the time of diagnosis, or the patient may need moretests. These tests may include imaging tests, such as aCT scan, MRI, angiogram, or ultrasound. Imaging testscan help the doctor find out whether the liver cancerhas spread. The doctor also may use a laparoscope tolook directly at the liver and nearby organs.

Treatment

any people with liver cancer want to take anactive part in decisions about their medical care.

They want to learn all they can about their disease andtheir treatment choices. However, the shock and stressthat people often feel after a diagnosis of cancer canmake it hard for them to think of everything they wantto ask the doctor. Often it helps to make a list ofquestions before an appointment. To help rememberwhat the doctor says, patients may want to take notesor ask whether they may use a tape recorder. Somepatients also want to have a family member or friendwith them when they talk to the doctor—to take part inthe discussion, to take notes, or just to listen.

At this time, liver cancer can be cured only when itis found at an early stage (before it has spread) andonly if the patient is healthy enough to have anoperation. However, treatments other than surgery maybe able to control the disease and help patients livelonger and feel better. When a cure or control of thedisease is not possible, some patients and their doctorschoose palliative therapy. Palliative therapy aims toimprove the quality of a person’s life by controllingpain and other problems caused by the disease.

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The doctor may refer patients to doctors whospecialize in treating cancer, or patients may ask for areferral. Specialists who treat liver cancer includesurgeons, transplant surgeons, gastroenterologists,medical oncologists, and radiation oncologists.

Getting a Second OpinionBefore starting treatment, a patient may want to get a

second opinion about the diagnosis, the stage of cancer,and the treatment plan. Some insurance companiesrequire a second opinion; others may cover a secondopinion if the patient requests it.

There are a number of ways to find a doctor for asecond opinion:

• The doctor may refer patients to one or morespecialists. At cancer centers, several specialistsoften work together as a team.

• The Cancer Information Service(1–800–4–CANCER) can tell callers abouttreatment facilities, including cancer centers andother programs supported by the National CancerInstitute, and can send printed information aboutfinding a doctor.

• A local medical society, a nearby hospital, or amedical school can usually provide the names ofspecialists.

• The Official ABMS Directory of Board CertifiedMedical Specialists lists doctors’ names along withtheir specialty and their educational background.This resource is available in most public libraries.The American Board of Medical Specialties(ABMS) also offers information by telephone and onthe Internet. The public may use these services tocheck whether a doctor is board certified. Thetelephone number is 1–866–ASK–ABMS(1–866–275–2267). The Internet address ishttp://www.abms.org/newsearch.asp.

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Treatment ChoicesThe doctor can describe treatment choices and

discuss the results expected with each treatment option.The doctor and patient can work together to develop atreatment plan that fits the patient’s needs.

Cancer of the liver is very hard to control withcurrent treatments. For that reason, many doctorsencourage patients with liver cancer to consider takingpart in a clinical trial. Clinical trials are researchstudies testing new treatments. They are an importantoption for people with all stages of liver cancer. Thesection called “The Promise of Cancer Research” hasmore information about clinical trials.

The choice of treatment depends on the condition ofthe liver; the number, size, and location of tumors; andwhether the cancer has spread outside the liver. Otherfactors to consider include the patient’s age, generalhealth, concerns about the treatments and their possibleside effects, and personal values.

Usually, the most important factor is the stage of thedisease. The stage is based on the size of the tumor, thecondition of the liver, and whether the cancer hasspread. The following are brief descriptions of thestages of liver cancer and the treatments most oftenused for each stage. For some patients, other treatmentsmay be appropriate.

Localized resectable cancer

Localized resectable liver cancer is cancer that canbe removed during surgery. There is no evidence thatthe cancer has spread to the nearby lymph nodes or toother parts of the body. Lab tests show that the liver isworking well.

Surgery to remove part of the liver is called partialhepatectomy. The extent of the surgery depends on thesize, number, and location of the tumors. It also

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depends on how well the liver is working. The doctormay remove a wedge of tissue that contains the livertumor, an entire lobe, or an even larger portion of theliver.

In a partial hepatectomy, the surgeon leaves a marginof normal liver tissue. This remaining healthy tissuetakes over the functions of the liver.

For a few patients, liver transplantation may be anoption. For this procedure, the transplant surgeonremoves the patient’s entire liver (total hepatectomy)and replaces it with a healthy liver from a donor. A livertransplant is an option only if the disease has not spreadoutside the liver and only if a suitable donated liver canbe found. While the patient waits for a donated liver tobecome available, the health care team monitors thepatient’s health and provides other treatments, asnecessary.

Localized unresectable cancer

Localized unresectable liver cancer cannot beremoved by surgery even though it has not spread tothe nearby lymph nodes or to distant parts of the body.Surgery to remove the tumor is not possible because ofcirrhosis or other conditions that cause poor liverfunction, the location of the tumor within the liver, orother health problems.

Patients with localized unresectable cancer mayreceive other treatments to control the disease andextend life:

• Radiofrequency ablation—The doctor uses a specialprobe to kill the cancer cells with heat. The probecontains tiny electrodes that destroy the cancer cells.Sometimes the doctor can insert the probe directlythrough the skin. Only local anesthesia is needed. Inother cases, the doctor may insert the probe througha small incision in the abdomen or may make a

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wider incision to open the abdomen. Theseprocedures are done in the hospital with generalanesthesia.

Other therapies that use heat to destroy liver tumorsinclude laser or microwave therapy.

• Percutaneous ethanol injection—The doctor injectsalcohol (ethanol) directly into the liver tumor to killcancer cells. The doctor uses ultrasound to guide asmall needle. The procedure may be performed onceor twice a week. Usually local anesthesia is used,but if the patient has many tumors in the liver,general anesthesia may be needed.

• Cryosurgery—The doctor makes an incision intothe abdomen and inserts a metal probe to freeze andkill cancer cells. The doctor may use ultrasound tohelp guide the probe.

• Hepatic arterial infusion—The doctor inserts a tube(catheter) into the hepatic artery, the major arterythat supplies blood to the liver. The doctor theninjects an anticancer drug into the catheter. The drugflows into the blood vessels that go to the tumor.Because only a small amount of the drug reachesother parts of the body, the drug mainly affects thecells in the liver.

Hepatic arterial infusion also can be done with asmall pump. The doctor implants the pump into thebody during surgery. The pump continuously sendsthe drug to the liver.

• Chemoembolization—The doctor inserts a tinycatheter into an artery in the leg. Using x-rays as aguide, the doctor moves the catheter into the hepaticartery. The doctor injects an anticancer drug into theartery and then uses tiny particles to block the flowof blood through the artery. Without blood flow, thedrug stays in the liver longer. Depending on the typeof particles used, the blockage may be temporary or

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permanent. Although the hepatic artery is blocked,healthy liver tissue continues to receive blood fromthe hepatic portal vein, which carries blood from thestomach and intestine. Chemoembolization requiresa hospital stay.

• Total hepatectomy with liver transplantation—Iflocalized liver cancer is uresectable because of poorliver function, some patients may be able to have aliver transplant. While the patient waits for adonated liver to become available, the health careteam monitors the patient’s health and providesother treatments, as necessary.

Advanced cancer

Advanced cancer is cancer that is found in bothlobes of the liver or that has spread to other parts of thebody. Although advanced liver cancer cannot be cured,some patients receive anticancer therapy to try to slowthe progress of the disease. Others discuss the possiblebenefits and side effects and decide they do not want tohave anticancer therapy. In either case, patients receivepalliative care to reduce their pain and control othersymptoms.

Treatment for advanced liver cancer may involvechemotherapy, radiation therapy, or both:

• Chemotherapy uses drugs to kill cancer cells. The patient may receive one drug or a combinationof drugs. The doctor may use chemoembolization or hepatic arterial infusion. Or the doctor may givesystemic therapy, meaning that the drugs are injectedinto a vein and flow through the bloodstream tonearly every part of the body. The doctor may call this intravenous or IV chemotherapy.

Usually chemotherapy is an outpatient treatmentgiven at the hospital, clinic, or at the doctor’s office.However, depending on which drugs are given and

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the patient’s general health, the patient may need tostay in the hospital.

• Radiation therapy (also called radiotherapy) useshigh-energy rays to kill cancer cells. Radiationtherapy is local therapy, meaning that it affectscancer cells only in the treated area. A large machineoutside the body directs radiation to the tumor area.

Recurrent cancer

Recurrent cancer means the disease has come backafter the initial treatment. Even when a tumor in theliver seems to have been completely removed ordestroyed, the disease sometimes returns becauseundetected cancer cells remained somewhere in thebody after treatment. Most recurrences occur within the

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first 2 years of treatment. The patient may have surgeryor a combination of treatments for recurrent livercancer.

People do not need to ask all of their questions or

understand all of the answers at once. They will haveother chances to ask the health care team to explainthings that are not clear and to ask for moreinformation.

These are some questions a person may want toask the doctor before treatment begins:

• Is there any evidence the cancer has spread? What is the stage of the disease?

• Do I need any more tests to determine whether I can have surgery?

• What are my treatment choices? Which do yourecommend for me? Why?

• What are the expected benefits of each kind oftreatment?

• What are the risks and possible side effects of each treatment?

• Will I need to stay in the hospital?

• How will you treat my pain?

• What is the treatment likely to cost? Is this treatment covered by my insurance plan?

• How will treatment affect my normal activities?

• Would a clinical trial (research study) beappropriate for me?

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Side Effects of Treatment

ecause cancer treatment may damage healthy cellsand tissues, unwanted side effects often occur.

Side effects depend on many factors, including the typeand extent of the treatment. Side effects may not be thesame for each person, and they may even change fromone treatment session to the next. The health care teamwill explain the possible side effects of treatment andhow they will help the patient manage them.

The NCI provides helpful booklets about cancertreatments and coping with side effects, such asChemotherapy and You, Radiation Therapy and You,and Eating Hints for Cancer Patients. See the“National Cancer Institute Information Resources” and“National Cancer Institute Booklets” sections for othersources of information about side effects.

SurgeryIt takes time to heal after surgery, and the time

needed to recover is different for each person. Patientsare often uncomfortable during the first few days.However, medicine can usually control their pain.Patients should feel free to discuss pain relief with thedoctor or nurse. It is common to feel tired or weak fora while. Also, patients may have diarrhea and a feelingof fullness in the abdomen. The health care teamwatches the patient for signs of bleeding, infection,liver failure, or other problems requiring immediatetreatment.

After a liver transplant, the patient may need to stayin the hospital for several weeks. During that time, thehealth care team checks for signs of how well thepatient’s body is accepting the new liver. The patient

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takes drugs to prevent the body from rejecting the newliver. These drugs may cause puffiness in the face, highblood pressure, or an increase in body hair.

CryosurgeryBecause a smaller incision is needed for cryosurgery

than for traditional surgery, recovery after cryosurgeryis generally faster and less painful. Also, infection andbleeding are not as likely.

Percutaneous Ethanol InjectionPatients may have fever and pain after percutaneous

ethanol injection. The doctor can suggest medicines torelieve these problems.

Chemoembolization and Hepatic ArterialInfusion

Chemoembolization and hepatic arterial infusioncause fewer side effects than systemic chemotherapybecause the drugs do not flow through the entire body.Chemoembolization sometimes causes nausea,vomiting, fever, and abdominal pain. The doctor cangive medications to help lessen these problems. Somepatients may feel very tired for several weeks after thetreatment.

Side effects from hepatic arterial infusion includeinfection and problems with the pump device.Sometimes the device may have to be removed.

Systemic Chemotherapy The side effects of chemotherapy depend mainly on

the drugs and the doses the patient receives. As withother types of treatment, side effects are different foreach patient.

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Systemic chemotherapy affects rapidly dividingcells throughout the body, including blood cells. Bloodcells fight infection, help the blood to clot, and carryoxygen to all parts of the body. When anticancer drugsdamage blood cells, patients are more likely to getinfections, may bruise or bleed easily, and may haveless energy. Cells in hair roots and cells that line thedigestive tract also divide rapidly. As a result, patientsmay lose their hair and may have other side effectssuch as poor appetite, nausea and vomiting, or mouthsores. Usually, these side effects go away graduallyduring the recovery periods between treatments or aftertreatment is complete. The health care team cansuggest ways to relieve side effects.

Radiation TherapyThe side effects of radiation therapy depend mainly

on the treatment dose and the part of the body that istreated. Patients are likely to become very tired duringradiation therapy, especially in the later weeks oftreatment. Resting is important, but doctors usuallyadvise patients to try to stay as active as they can.

Radiation therapy to the chest and abdomen maycause nausea, vomiting, diarrhea, or urinarydiscomfort. Radiation therapy also may cause adecrease in the number of healthy white blood cells,cells that help protect the body against infection.Although the side effects of radiation therapy can bedistressing, the doctor can usually treat or control them.

Pain Control

ain is a common problem for people with livercancer. The tumor can cause pain by pressing

against nerves and other organs. Also, therapies forliver cancer may cause discomfort.

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The patient’s doctor or a specialist in pain controlcan relieve or reduce pain in several ways:

• Pain medicine—Medicines often can relieve pain.(These medicines may make people drowsy andconstipated, but resting and taking laxatives canhelp.)

• Radiation—High-energy rays can help relieve painby shrinking the tumor.

• Nerve block—The doctor may inject alcohol intothe area around certain nerves in the abdomen toblock the pain.

The health care team may suggest other ways torelieve or reduce pain. For example, massage,acupuncture, or acupressure may be used along withother approaches. Also, the patient may learn to relievepain through relaxation techniques such as listening toslow music or breathing slowly and comfortably.

More information about pain control can be found inthe NCI publications called Pain Control: A Guide forPeople with Cancer and Their Families, Get Relieffrom Cancer Pain, and Understanding Cancer Pain.The Cancer Information Service can send thesebooklets.

Nutrition

eople with liver cancer may not feel like eating,especially if they are uncomfortable or tired. Also,

the side effects of treatment can make eating difficult.Foods may smell or taste different. Nevertheless,patients should try to eat enough calories and protein tocontrol weight loss, maintain strength, and promotehealing. Also, eating well often helps people withcancer feel better and have more energy.

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Careful planning and checkups are important. Livercancer and its treatment may make it hard for patientsto digest food and maintain their weight. The doctorwill check the patient for weight loss, weakness, andlack of energy.

The doctor, dietitian, or other health care providercan advise patients about ways to have a healthy dietduring treatment. Patients and their families may wantto read the National Cancer Institute booklet EatingHints for Cancer Patients, which contains many usefulsuggestions and recipes. The section “National CancerInstitute Booklets” tells how to get this publication.

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Continuing Care

ontinuing care for patients with liver cancerdepends on the stage of their disease and the

treatments they have received. Followup is veryimportant after surgery to remove cancer from the liver.This is because the cancer can return in the liver or inanother part of the body. People who have had livercancer surgery may wish to discuss the chance ofrecurrence with the doctor. Followup care may includeblood tests, x-rays, ultrasound tests, CT scans,angiograms, or other tests.

For people who have had a liver transplant, thedoctor will test how well the new liver is working. Thedoctor also will watch the patient closely to make surethe new liver is not being rejected. People who havehad a liver transplant may want to discuss with thedoctor the type and schedule of followup tests that willbe needed.

For patients with advanced disease, the health careteam will focus on keeping the patient as comfortableas possible. Medicines and other measures can helpwith digestion, reduce pain, or relieve other symptoms.

Support for People with Liver Cancer

aving a serious disease such as liver cancer is noteasy. Some people find they need help coping

with the emotional and practical aspects of theirdisease. Support groups can help. In these groups,patients or their family members get together to sharewhat they have learned about coping with the diseaseand the effects of treatment. Patients may want to talkwith a member of their health care team about finding asupport group. Groups may offer support in person,over the telephone, or on the Internet.

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Patients may worry about caring for their families,holding on to their jobs, or keeping up with dailyactivities. Concerns about treatments and managingside effects, hospital stays, and medical bills are alsocommon. Doctors, nurses, and other members of thehealth care team will answer questions about treatment,working, or other activities. Meeting with a socialworker, counselor, or member of the clergy can behelpful to those who want to talk about their feelings ordiscuss their concerns. Often, a social worker cansuggest resources for emotional support, financial aid,transportation, or home care.

Printed materials on coping are available from theCancer Information Service (1–800–4–CANCER) andthrough other sources listed in the “National CancerInstitute Information Resources” section. The CancerInformation Service can also provide information tohelp patients and their families locate the programs andservices they need.

The Promise of Cancer Research

aboratory scientists are studying the liver to learnmore about what may cause liver cancer and how

liver cancer cells work. They are looking for newtherapies to kill cancer cells.

Doctors in hospitals and clinics are conducting manytypes of clinical trials. These are research studies inwhich people take part voluntarily. In these trials,researchers are studying ways to treat liver cancer thathave shown promise in laboratory studies. Research hasled to advances in treatment methods, but controllingliver cancer remains a challenge. Scientists continue tosearch for more effective ways to treat this disease.

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Patients who join clinical trials have the first chanceto benefit from new treatments. They also make animportant contribution to medical science. Althoughclinical trials may pose some risks, researchers takevery careful steps to protect people.

Currently, clinical trials involve chemotherapy,chemoembolization, and radiofrequency ablation for thetreatment of liver cancer. Another approach under studyis biological therapy, which uses the body’s naturalability (immune system) to fight cancer. Biologicaltherapy is being studied in combination withchemotherapy.

Patients who are interested in joining a clinical studyshould talk with their doctor. They may want to readTaking Part in Clinical Trials: What Cancer PatientsNeed To Know. This NCI booklet describes howtreatment studies are carried out and explains theirpossible benefits and risks. NCI’s cancerTrials™ Website at http://cancertrials.nci.nih.gov provides generalinformation about clinical trials. It also offers detailedinformation about specific ongoing studies of livercancer by linking to PDQ®, NCI’s cancer informationdatabase. The Cancer Information Service at1–800–4–CANCER can answer questions about cancerclinical trials and can provide information from thePDQ database.

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Dictionary

Abdomen (AB-do-men): The area of the body thatcontains the pancreas, stomach, intestine, liver,gallbladder, and other organs.

Acupressure: The application of pressure or localizedmassage to specific sites on the body to controlsymptoms such as pain or nausea. Also used to stopbleeding.

Acupuncture: The technique of inserting thin needlesthrough the skin at specific points on the body tocontrol pain and other symptoms.

Aflatoxins (AF-la-TOK-sins): Harmful substancesmade by certain types of mold (Aspergillus flavus andAspergillus parasiticus) that are often found on poorlystored grains and nuts. Consumption of foodscontaminated with aflatoxins is a risk factor forprimary liver cancer.

Alpha-fetoprotein (AL-fa-FEE-toe-PRO-teen): AFP. Aprotein normally produced by a fetus. AFP levels areusually undetectable in the blood of healthy adult menor women (who are not pregnant). An elevated level ofAFP suggests the presence of either a primary livercancer or germ cell tumor.

Anesthesia (an-es-THEE-zha): Drugs or substancesthat cause loss of feeling or awareness. Localanesthetics cause loss of feeling in a part of the body.General anesthetics put the person to sleep.

Angiogram (AN-jee-o-gram): An x-ray of bloodvessels; the person receives an injection of dye tooutline the vessels on the x-ray.

Ascites (ah-SYE-teez): Abnormal buildup of fluid inthe abdomen.

Benign (beh-NINE): Not cancerous; does not invadenearby tissue or spread to other parts of the body.

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Bile: A fluid made by the liver and stored in thegallbladder. Bile is excreted into the small intestine,where it helps digest fat.

Biological therapy (by-o-LAHJ-i-kul): Treatment tostimulate or restore the ability of the immune system tofight infection and disease. Also used to lessen sideeffects that may be caused by some cancer treatments.Also known as immunotherapy, biotherapy, orbiological response modifier (BRM) therapy.

Biopsy (BY-ahp-see): The removal of cells or tissuesfor examination under a microscope. When only asample of tissue is removed, the procedure is called anincisional biopsy or core biopsy. When an entire tumoror lesion is removed, the procedure is called anexcisional biopsy. When a sample of tissue or fluid isremoved with a needle, the procedure is called a needlebiopsy or fine-needle aspiration.

Cancer: A term for diseases in which abnormal cellsdivide without control. Cancer cells can invade nearbytissues and can spread through the bloodstream andlymphatic system to other parts of the body.

Catheter (KATH-i-ter): A flexible tube used to deliverfluids into or withdraw fluids from the body.

Cell: The individual unit that makes up all of the tissuesof the body. All living things are made up of one ormore cells.

Chemoembolization: A procedure in which the bloodsupply to the tumor is blocked surgically ormechanically, and anticancer drugs are administereddirectly into the tumor. This permits a higherconcentration of drug to be in contact with the tumorfor a longer period of time.

Chemotherapy (kee-mo-THER-a-pee): Treatment withanticancer drugs.

Chronic: A disease or condition that persists orprogresses over a long period of time.

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Cirrhosis: A type of chronic, progressive liver diseasein which liver cells are replaced by scar tissue.

Clinical trial: A research study that tests how well newmedical treatments or other interventions work inpeople. The study tests new methods of screening,prevention, diagnosis, or treatment of a disease.

Core biopsy: The removal of a tissue sample with aneedle for examination under a microscope.

Cryosurgery (KRY-o-SIR-jer-ee): Treatment performedwith an instrument that freezes and destroys abnormaltissues.

CT scan: Computed tomography scan. A series ofdetailed pictures of areas inside the body taken fromdifferent angles; the pictures are created by a computerlinked to an x-ray machine. Also called computerizedtomography and computerized axial tomography(CAT) scan.

Enzyme: A protein that speeds up chemical reactions inthe body.

Fine-needle aspiration: The removal of tissue or fluidwith a needle for examination under a microscope.Also called needle biopsy.

Gastroenterologist (GAS-tro-en-ter-AHL-o-jist): Adoctor who specializes in diagnosing and treatingdisorders of the digestive system.

General anesthesia (an-es-THEE-zha): Drugs thatcause loss of feeling or awareness and put the personto sleep.

Hepatectomy: Surgery to remove all or part of theliver.

Hepatic: Refers to the liver.

Hepatic arterial infusion: Putting drugs by catheterinto the hepatic artery, the major vessel that suppliesthe liver with blood.

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Hepatic artery: The artery that carries blood to theliver.

Hepatic portal vein: A short blood vessel that carriesblood to the liver from the stomach and intestine.

Hepatitis (hep-a-TYE-tis): Disease of the liver causinginflammation. Symptoms include an enlarged liver,fever, nausea, vomiting, abdominal pain, and darkurine.

Hepatitis B virus: A virus that causes hepatitis. It iscarried and passed to others through blood or sexualcontact. Also, infants born to infected mothers maybecome infected with the virus.

Hepatitis C virus: A virus that causes hepatitis. It iscarried and passed to others through blood or sexualcontact. Also, infants born to infected mothers maybecome infected with the virus.

Hepatoblastoma (HEP-a-toe-blas-TOE-ma): A type ofliver tumor that occurs in infants and children.

Hepatocellular carcinoma (HEP-a-toe-SEL-yoo-lerkar-sin-O-ma): A type of adenocarcinoma, the mostcommon type of liver tumor.

Hepatocyte (HEP-a-toe-site): A liver cell.

Hepatoma (hep-a-TOE-ma): A liver tumor.

Imaging: Tests that produce pictures of areas inside thebody.

Immune system (im-YOON): The complex group oforgans and cells that defends the body against infectionor disease.

Incision (in-SIH-zhun): A cut made in the body toperform surgery.

Intestine (in-TES-tin): A long, tube-shaped organ inthe abdomen that completes the process of digestion.There is both a large intestine and a small intestine.Also called the bowel.

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Intravenous (in-tra-VEE-nus): IV. Within a bloodvessel.

Jaundice (JAWN-dis): A condition in which the skinand the whites of the eyes become yellow, urinedarkens, and stool becomes lighter in color. Jaundiceoccurs when the liver is not working properly or whena bile duct is blocked.

Laparoscope: A thin, lighted tube used to look attissues and organs inside the abdomen.

Laser (LAY-zer): A device that concentrates light intoan intense, narrow beam used to cut or destroy tissue. Itis used in microsurgery, photodynamic therapy, and fora variety of diagnostic purposes.

Liver: A large organ located in the upper abdomen. Theliver cleanses the blood and aids in digestion bysecreting bile.

Lobe: A portion of an organ such as the liver, lung,breast, or brain.

Local anesthesia (an-es-THEE-zha): Drugs that cause atemporary loss of feeling in one part of the body. Thepatient remains awake but cannot feel the part of thebody treated with the anesthetic.

Local therapy: Treatment that affects cells in the tumorand the area close to it.

Lymphatic system (lim-FAT-ik): The tissues and organsthat produce, store, and carry white blood cells thatfight infection and other diseases. This system includesthe bone marrow, spleen, thymus, lymph nodes, and anetwork of thin tubes that carry lymph and white bloodcells. These tubes branch, like blood vessels, into all thetissues of the body.

Malignant (ma-LIG-nant): Cancerous; a growth with atendency to invade and destroy nearby tissue andspread to other parts of the body.

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Medical oncologist (on-KOL-o-jist): A doctor whospecializes in diagnosing and treating cancer usingchemotherapy, hormonal therapy, and biologicaltherapy. A medical oncologist often serves as the maincaretaker of someone who has cancer and coordinatestreatment provided by other specialists.

Metastasis (meh-TAS-ta-sis): The spread of cancerfrom one part of the body to another. Tumors formedfrom cells that have spread are called “secondarytumors” and contain cells that are like those in theoriginal (primary) tumor. The plural is metastases.

Metastasize (meh-TAS-ta-size): To spread from onepart of the body to another. When cancer cellsmetastasize and form secondary tumors, the cells in themetastatic tumor are like those in the original (primary)tumor.

Microwave therapy: Treatment that destroys tissue withheat.

Mold: A form of fungus. Some molds can cause diseasein humans.

MRI: Magnetic resonance imaging (mag-NET-ik REZ-o-nans IM-a-jing). A procedure in which a magnetlinked to a computer is used to create detailed picturesof areas inside the body.

Outpatient: A patient who visits a clinic or hospital fordiagnosis or treatment but who does not spend thenight.

Palliative therapy: Treatment given to relievesymptoms caused by advanced cancer. Palliativetherapy does not alter the course of a disease but canimprove the quality of life.

Parasite: An animal or a plant that lives on or in anorganism of another species and gets at least some ofits nutrition from that other organism.

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Pathologist (pa-THOL-o-jist): A doctor who identifiesdiseases by studying cells and tissues under amicroscope.

Percutaneous ethanol injection (per-kyoo-TAN-ee-us):An injection of ethanol (alcohol) directly into the tumorto kill cancer cells.

Primary tumor: The original tumor.

Radiation oncologist (ray-dee-AY-shun on-KOL-o-jist): A doctor who specializes in using radiation to treatcancer.

Radiation therapy (ray-dee-AY-shun): The use of high-energy radiation from x-rays, gamma rays, neutrons,and other sources to kill cancer cells and shrink tumors.Radiation may come from a machine outside the body(external-beam radiation therapy), or it may come fromradioactive material that is placed in the body in thearea near cancer cells (internal radiation therapy,implant radiation, or brachytherapy). Systemic radiationtherapy uses a radioactive substance, such as aradiolabeled monoclonal antibody, that circulatesthroughout the body. Also called radiotherapy.

Radiofrequency ablation: The use of electrodes to heatand destroy abnormal tissue.

Resectable (ree-SEK-tuh-bull): Able to be removedwith surgery.

Risk factor: A substance, agent, genetic alteration, trait,habit, or condition that increases a person’s chance ofdeveloping a disease.

Secondary tumor: Cancer that has spread from theorgan in which it first appeared to another organ. Forexample, breast cancer cells may spread (metastasize)to the lungs and cause the growth of a new tumor.When this happens, the disease is called metastaticbreast cancer, and the tumor in the lungs is called asecondary tumor. Also called secondary cancer.

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Side effects: Problems that occur when treatmentaffects healthy cells. Common side effects of cancertreatment are fatigue, nausea, vomiting, decreasedblood cell counts, hair loss, and mouth sores.

Sonogram (SON-o-gram): A computer picture of areasinside the body created when sound waves bounce offorgans and other tissues. Also called ultrasonogram orultrasound.

Spleen: An organ that is part of the lymphatic system.The spleen produces lymphocytes, filters the blood,stores blood cells, and destroys old blood cells. It islocated on the left side of the abdomen near thestomach.

Stage: The extent of a cancer within the body,especially whether the disease has spread from theoriginal site to other parts of the body.

Staging: Performing exams and tests to learn the extentof the cancer within the body, especially whether thedisease has spread from the original site to other partsof the body.

Surgeon: A doctor who removes or repairs a part of thebody by operating on the patient.

Surgery: A procedure to remove or repair a part of thebody or to find out whether disease is present. Anoperation.

Symptom: An indication that a person has a conditionor disease. Some examples of symptoms are headache,fever, fatigue, nausea, vomiting, and pain.

Systemic therapy (sis-TEM-ik): Treatment usingsubstances that travel through the bloodstream,reaching and affecting cells all over the body.

Tissue (TISH-oo): A group or layer of cells that arealike and that work together to perform a specificfunction.

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Transplant surgeon: A doctor who specializes intransplantation surgery. The surgeon replaces a patient’sorgan with one from another person.

Transplantation: The replacement of an organ with onefrom another person.

Tumor (TOO-mer): An abnormal mass of tissue thatresults from excessive cell division. Tumors perform nouseful body function. They may be benign (notcancerous) or malignant (cancerous).

Ultrasound test: A test that bounces sound waves offtissues and internal organs and changes the echoes intopictures (sonograms).

Unresectable (un-ree-SEK-tuh-bull): Not able to beremoved with surgery.

Vaccine: A substance or group of substances meant tocause the immune system to respond to a tumor or tomicroorganisms, such as bacteria or viruses. A vaccinecan help the body recognize and destroy cancer cells ormicroorganisms.

Virus (VYE-rus): A microorganism that can infect cellsand cause disease. In cancer therapy, some viruses maybe made into vaccines that help the body build animmune response to, and kill, tumor cells.

X-ray: A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making picturesof the inside of the body. In high doses, x-rays are usedto treat cancer.

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National Cancer Institute InformationResources

ou may want more information for yourself, your family, and your doctor. The following

National Cancer Institute (NCI) services are availableto help you.

TelephoneCancer Information Service (CIS)

Provides accurate, up-to-date information on cancerto patients and their families, health professionals, andthe general public. Information specialists translate the latest scientific information into understandablelanguage and respond in English, Spanish, or on TTYequipment.

Toll-free: 1–800–4–CANCER (1–800–422–6237)

TTY: 1–800–332–8615

Internethttp://cancer.gov

NCI’s Web site contains comprehensive informationabout cancer cause and prevention, screening anddiagnosis, treatment and survivorship; clinical trials;statistics; funding, training, and employmentopportunities; and the Institute and its programs.

FaxCancerFax®

Includes NCI information about cancer treatment,screening, prevention, and supportive care. To obtain acontents list, dial 1–800–624–2511 or 301–402–5874from your touch-tone phone or fax machine hand setand follow the recorded instructions.

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National Cancer Institute Booklets

ational Cancer Institute (NCI) publications can beordered by writing to the address below, and

some can be viewed and downloaded fromhttp://cancer.gov/publications on the Internet.

Publications Ordering ServiceNational Cancer InstituteBuilding 31, Room 10A3131 Center Drive, MSC 2580Bethesda, MD 20892–2580

In addition, people in the United States and itsterritories may order these and other NCI booklets bycalling the Cancer Information Service at1–800–4–CANCER. They may also order many NCIpublications on-line at http://cancer.gov/publications.

Booklets About Cancer Treatment• Chemotherapy and You: A Guide to Self-Help

During Treatment

• Help Yourself During Chemotherapy: 4 Steps forPatients

• Radiation Therapy and You: A Guide to Self-HelpDuring Treatment

• Eating Hints for Cancer Patients

• Understanding Cancer Pain

• Pain Control: A Guide for People with Cancer andTheir Families

• Get Relief from Cancer Pain

• Taking Part in Clinical Trials: What CancerPatients Need To Know

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• La quimioterapia y usted: Una guía de autoayudadurante el tratamiento del cáncer (Chemotherapyand You: A Guide to Self-Help During Treatment forCancer)

• El tratamiento de radioterapia: Guía para elpaciente durante el tratamiento (Radiation Therapyand You: A Guide to Self-Help During Treatment)

• El dolor relacionado con el cáncer (UnderstandingCancer Pain)

• ¿En qué consisten los estudios clínicos? Un folletopara los pacientes de cáncer (What Are Clinical Trials All About? A Guide for CancerPatients)

Booklets About Living With Cancer• Taking Time: Support for People With Cancer and

the People Who Care About Them

• When Cancer Recurs: Meeting the Challenge

• Advanced Cancer: Living Each Day

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This booklet was written and published by the NationalCancer Institute (NCI), 31 Center Drive, MSC 2580,Bethesda, MD 20892–2580. The NCI, the largestcomponent of the National Institutes of Health,coordinates a national research program on cancercauses and prevention, detection and diagnosis, andtreatment. In addition, NCI’s mission includesdissemination of information about cancer to patients,the public, and health professionals.

The National Cancer Act, passed by Congress in 1971,made research a National priority. Since that time, theNCI, the lead Federal agency for cancer research, hascollaborated with top researchers and facilities acrossthe country to conduct innovative research leading toprogress in cancer prevention, detection, diagnosis, andtreatment. These efforts have resulted in a decrease inthe overall cancer death rate, and have helped improveand extend the lives of millions of Americans.

The written text of NCI material is in the publicdomain and is not subject to copyright restrictions. Onedoes not need special permission to reproduce ortranslate NCI written text. However, we wouldappreciate a credit line and a copy of any translatedmaterial.

The copyright for artwork developed for NCI byprivate sector designers, photographers, and illustratorsunder contract to the Government remains in the handsof the originators. One must have permission to use orreproduce these materials. In many cases, permissionwill be granted, but a credit line and/or fees for usagemay be required. To learn if permission is required, orto obtain permission to reproduce NCI artwork, writeto: Communication Services Branch, Office ofCommunications, National Cancer Institute, Room10A28, 31 Center Drive, MSC 2580, Bethesda, MD20892–2580.

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NIH Publication No. 01-5009September 2001

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