Medical expert of the article
New publications
Liver cancer
Last reviewed: 12.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
According to WHO, liver cancer is one of the ten most common malignant tumors in the world.
In Russia, liver cancer is relatively rare and accounts for 3-5% of all malignant neoplasms, which is approximately the same as in Europe and America. The standardized incidence rate in Russia is 4.9 cases per 100,000 people. The incidence rate tends to decrease. Thus, the decline in the standardized rate over 10 years was 14.6%, while in some countries liver cancer occupies a leading position in the structure of oncological diseases. For example, in the countries of Southeast Asia, its share is 40%, and in the countries of southern Africa - more than 50% in the structure of all oncological diseases.
In the Russian Federation, the highest incidence rate is registered in Tobolsk and Vladivostok. The highest incidence rate of liver cancer is registered in the Republic of Sakha (Yakutia) - 11 cases per 100 thousand people.
The peak incidence occurs at the age of 50 - 60 years. Men suffer from this pathology 3 times more often than women.
Causes of liver cancer
Among the risk factors that contribute to the development of a disease such as primary liver cancer, four groups can be distinguished:
- nutritional factors;
- helminthic infestations;
- infectious lesion;
- cirrhosis.
In addition to these, trauma, biliary tract disease, hemochromatosis, and hereditary predisposition may be significant.
Nutritional factors
One of the important etiological factors is kwashiorkor. In the literature, this disease has several names: infantile pellagra, malignant malnutrition, fatty degeneration. Kwashiorkor is usually observed in children and early adolescence, if the diet contains insufficient amounts of proteins with a predominance of carbohydrates. Fatty and protein degeneration, liver tissue atrophy, and necrosis in later stages occur.
Alcoholic beverages, if consumed regularly, can contribute to the development of the disease.
In recent years, a large number of studies have appeared indicating the role of aflatoxin in the development of malignant tumors. Aflatoxin is a metabolite of the ubiquitous saprophytic fungus Aspergellus flavus. Aflatoxin enters the human body with food contaminated with the saprophytic fungus that produces this toxin. Studies have shown high levels of aflatoxin in dried oysters, soybeans, peanuts, etc.
Worm infestations
Most often, the occurrence of malignant tumors is facilitated by worms that parasitize the human body: Opistorhus felineus, Schistosomiasis, Clonorchis sinensis, etc.
Onistorchiasis is widespread in the river basins of the Dnieper, Kama, Volga, Don, Northern Dvina, Pechora, Neva and in Siberia - Ob, Irtysh, as well as on the territory of the Korean Peninsula, in Japan and China. People become infected with this helminth by eating uncooked, raw thawed or frozen fish.
Schistosomiasis is observed in Egypt, Equatorial Africa, as well as in Brazil, some parts of China, Venezuela, and Japan.
Clonorchiasis affects the pancreas in addition to the hepatobiliary system. The parasite is common in China, the countries of the Korean Peninsula, Japan and the Far East.
Among other helminthic infections, echinococcosis should be mentioned.
Infectious lesions
The risk of developing a malignant tumor is increased by diseases such as viral hepatitis, malaria, and syphilis.
Symptoms of liver cancer
Numerous variants of the clinical course are summarized into three main forms.
Hepatomegalic, "tumor" form, which is based on nodular, less often - massive cancer. This variant is relatively often recognized during life by hepatomegaly and especially by palpable tumor nodes and is accompanied by pain in the hypochondrium, jaundice, rapidly growing nodes that deform the dome of the diaphragm. Splenomegaly, signs of portal hypertension, ascites are rarely observed.
Cirrhotic form with prevalence of cirrhosis clinical features, against the background of which cancer remains unrecognized. In terms of frequency, this form is in second place and, by analogy with cirrhosis, is divided into two variants according to the course.
A form of chronic long-term cirrhosis with the appearance of clinical symptoms of cancer at a late stage of the disease. Cancer in this case has an acute course and is manifested not by hepatomegaly, but rather by complications associated with it.
The form of acute cirrhosis without a cirrhotic anamnesis is characterized by an acute onset and rapid progression of the disease, the presence of edematous-ascitic syndrome, a reduced or slightly enlarged liver, dyspeptic disorders, moderate jaundice, and fever. All this creates a clinical picture similar to the edematous-ascitic variant of epidemic hepatitis or subacute cirrhosis. In these cases, liver cancer may be indicated by symptoms that are not characteristic of pure cirrhosis: persistent pain in the right hypochondrium and chest cavity, rapidly increasing cachexia, hemorrhagic ascites, deformation of the diaphragm dome, radiologically established metastases in the lungs, persistently recurring pleural effusion.
The latent, or masked, form has a number of course variations.
- The most acute, perforative, acute hemoperitoneal form, which is more common in cirrhosis-cancer - hepatoma and is caused by a sudden rupture of the cancerous node with subsequent hemorrhage into the abdominal cavity with signs of peritoneal irritation and anemia.
- Form with a predominance of rarer symptoms:
- febrile form, similar to liver abscess;
- cardiovascular form with edema of the lower extremities, heart failure, portal stasis;
- cerebral, pulmonary, cardiac and other forms with a predominance of corresponding metastases that simulate encephalomyelitis, lung cancer, etc.;
- mechanical jaundice syndrome;
- endocrine masks.
Where does it hurt?
Stages of liver cancer
Histological classification
- Hepatocellular carcinoma (liver cell carcinoma).
- Cholangiocarcinoma (cancer of the intrahepatic bile ducts).
- Cystadenocarcinoma of the bile ducts.
- Mixed hepatocellular cholangiocellular carcinoma.
- Hepatoblastoma.
- Undifferentiated cancer.
Liver cancer stages according to TNM (IPRS, 2003)
This classification is applicable only to primary hepatocellular carcinoma and cholangiocarcinoma.
- T - primary tumor:
- Tx - insufficient data to assess the primary tumor;
- T0 - the primary tumor is not determined;
- T1 - solitary tumor without vascular invasion;
- T2 - solitary tumor with vascular invasion or multiple tumors less than 5 cm in greatest dimension;
- T3 - multiple tumors greater than 5 cm or a tumor involving a major branch of the portal or hepatic vein;
- T4 - tumor with direct extension to adjacent organs (not gallbladder) or with perforation of the visceral peritoneum. N - regional metastases
- Nx - insufficient data to assess regional lymph nodes;
- N0 - no signs of metastatic lesions of regional lymph nodes;
- N1 - there are metastases in the regional lymph nodes. M - distant metastases:
- Mx - insufficient data to determine distant metastases;
- M0 - no signs of distant metastases;
- M1 - there are distant metastases.
Grouping by stages:
- Stage I - T1 N0 M0
- Stage II - T2 N0 M0
- Stage III A - T3 N0 M0
- Stage III B - T4 N0 M0
- Stage II 1C - Any T N1 M0
- Stage IV - Any T Any NM
Macroscopic forms
Primary liver cancer is represented by three forms: nodular, massive, and diffuse.
Nodular (knotty) form
The organ usually contains two or more tumor nodes of the same size, located mainly in the right lobe. Around the main 2-3 nodes, there may be small metastatic nodules over the entire surface. Sometimes several small tumor nodules of the same size are found in the liver, scattered throughout the organ.
Massive form
This form has two variants: the first is one large node with metastases on the periphery; the second is a single large tumor node without metastases. The first variant is more common. The main node is usually located in the right lobe of the liver or its gates, has a rounded shape, sometimes with scalloped edges.
Diffuse form
This form is less common than the previous forms and in most cases occurs against the background of liver cirrhosis. Tumor foci are the same size as the remnants of the parenchyma preserved in cirrhosis, which presents significant difficulties for diagnosis without microscopic confirmation.
[ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ]
Liver cancer metastases
The spread of a primary malignant tumor, like other neoplasms, occurs in two ways: lymphogenously and hematogenously. Conventionally, metastases in liver cancer are divided into intra- and extrahepatic. Intrahepatic metastasis is more common. Extrahepatic metastases of cancer are mainly found in the lymph nodes of the hilum and lungs. Sometimes metastases to bones were noted. Rarely - to the skin, testicle, penis, spleen.
Diagnosis of liver cancer
Diagnosis is very difficult.
Laboratory diagnostics involve detection of the fetal protein alpha-fetoprotein in the blood serum.
A positive reaction to alpha-fetoprotein is observed in 70-90% of patients with hepatocellular liver cancer. The detection of alpha-fetoprotein is of particular importance in the prognosis of the disease - an increase in the concentration of alpha-fetoprotein is a bad prognostic sign.
A clinical blood test of a patient with primary liver cancer is not very specific: increased ESR, neutrophilic leukocytosis, and rarely erythrocytosis.
Radioisotope scanning with I-131, Au-198 reveals "cold spots" corresponding to the tumor localization. The method is safe, diagnostic efficiency is 98%.
Ultrasound examination allows visualization of tumor focus, enlarged lymph nodes, detection of ascites and metastatic liver damage. This method is harmless and does not require special preparation. In this case, focal formations with a diameter of more than 2 cm are detected.
Computer tomography is one of the methods of topical diagnostics of neoplasms. The resolution of this method is visualization of formations from 5 mm and more. Computer tomography, due to its high resolution, allows not only to identify focal lesions, but also to establish their nature, determine intraorgan localization, obtain information about neighboring organs in which the primary lesion may be located, if liver cancer is secondary.
The vascular nature of the tumor can be revealed by emission computed tomography using labeled red blood cells.
Magnetic resonance imaging (MRI) is used to diagnose primary liver cancer. This study makes it possible to obtain an image of the organ in various sections, which increases the informativeness of the method in specifying the localization of the tumor and its intra- and extrahepatic spread.
Selective celiacography is a special method of examination that allows to establish the exact localization of the tumor. In the image, the tumor appears as a focus of hypervascularization.
Morphological verification is performed by the method of fine-needle puncture biopsy, which is performed under ultrasound or laparoscopy control. Laparoscopy with tumor biopsy is preferable in this regard.
Diagnostic laparotomy is performed in complex diagnostic cases to verify the process and determine the possibility and scope of surgical intervention.
[ 16 ]
What do need to examine?
Who to contact?
Liver cancer treatment
The main method of treating primary liver cancer is surgical. Despite the high regenerative capacity of the organ, the difficulties of resection are due to the need for careful hemostasis due to the rich blood supply of the tissues. In this case, it is necessary to observe the principle of radicality and ablastics: resection must be performed within healthy tissues.
To perform a resection at the modern level, a number of technical means are required that allow determining the functional reserves of the organ, clarifying the prevalence of the tumor process and reducing the risk of developing intra- and postoperative complications. Such means include:
- radioisotope study of liver function using the radiopharmaceutical Brom MESIDA;
- intraoperative ultrasound examination of the organ, which allows to clarify the extent of the tumor process and determine the boundaries of the tumor node, which are necessary to decide on the extent of surgical intervention;
- an ultrasonic surgical aspirator that makes it possible to destroy and remove the liver parenchyma without affecting the tubular structures, which leads to a significant reduction in intraoperative blood loss, eliminating the need for hemostatic sutures on the liver parenchyma. This reduces the necrosis zone and ultimately reduces the trauma of the operation;
- water jet scalpel for parenchyma dissection;
- argon coagulator from Valleylab (USA), used to stop capillary bleeding from the resected surface of the organ;
- adhesive preparations "Tachocomb" and "Tissukol" to stop capillary bleeding and reduce the risk of biliary fistula formation.
Extensive resections are not advisable for patients with liver cirrhosis, severe functional disorders of the kidneys and heart.
Radiation therapy is not used for primary liver cancer.
Polychemotherapy is used for adjuvant purposes. This method has no independent value in the treatment of primary liver cancer.
It is very important to follow a diet for liver cancer.
Treatment of metastatic liver cancer
Secondary liver cancer is observed 60 times more often than primary cancer and accounts for 90% of all malignant neoplasms.
In terms of localization of metastatic cancer, the liver ranks first among all organs. Metastasis to the liver occurs through the hepatic artery and portal vein. Most often, pancreatic cancer (50% of cases), colorectal cancer (20 to 50% of cases), stomach cancer (35% of cases), breast cancer (30%), and esophageal cancer (25%) metastasize to the liver.
The clinical picture of secondary liver cancer is determined by the symptoms of the primary lesion and the degree of metastatic damage to the liver parenchyma.
Diagnosis of liver cancer metastases is not very difficult. Ultrasound, computed tomography, laparoscopy with biopsy are used.
Treatment is difficult. The presence of liver metastases is an indicator of the incurability of the tumor process. If there is a single marginal metastatic focus, its surgical removal is possible.