A National Cancer Institute-designated Comprehensive Cancer Center

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Liver Cancer

Liver Cancer
City of Hope’s Liver Tumor Program encompasses all aspects of care, including prevention, early diagnosis and effective treatment. Formed in the early 1980s, our program takes an aggressive, multidisciplinary approach that keeps us at the forefront of diagnosis and treatment of liver disease.

Through our active clinical trials research program – one of the most extensive in the nation – we can often provide liver cancer patients with access to promising new anticancer drugs and technologies not available elsewhere.
About Liver Cancer
Adult Primary Liver Cancer
Adult primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver. If the cancer has traveled from another organ and lodged in the liver, it is known as secondary or metastatic liver cancer. The liver is one of the largest organs in the body. It has two lobes and fills the upper right side of the abdomen inside the rib cage. The liver has many important functions, including: Filtering harmful substances from the blood so they can be passed from the body in stools and urine. Making bile to help digest fats from food. Storing glycogen (sugar), which the body uses for energy. Liver cancers are commonly referred to as hepatocellular carcinoma (HCC) which is the fifth most common solid tumor in the world.. Prevalence in the U.S. is much lower than the rest of the world. Most cases are seen in people with liver cirrhosis. More than 80 percent of HCC develops in cirrhotic livers and the remaining 20 percent arise in livers without evidence of cirrhosis.

Recurrent Adult Primary Liver Cancer

By definition, liver metastasis is cancer that has spread to the liver from somewhere else in the body. The liver is the most common site for cancers to spread to after the lymph nodes. Most of these originate from cancers of the colon, rectum, pancreas, stomach, esophagus, breast, lung, melanoma and some other less common sites. In the past, they were often considered advanced disease and frequently sent for palliative care. However, today the paradigm has shifted completely. Depending on where they originate from, aggressive surgical resection couples with chemotherapy will lead to significant improvement and long term survival in this patient population.

Benign Liver Tumors

Benign liver tumors are non-cancerous masses or lesions of the liver. These tumors affect nearly 20 perecent of the U.S. population. Benign lesions of the liver are correspondingly increasing as the use of diagnostic imaging increases. Benign lesions include cystic tumors such as simple cysts, cystadenomas and echinococcal cysts. Benign solid lesions include hepatic adenomas, focal nodular hyperplasia and hemangiomas.

Hepatic Hemangiomas (Liver Hemangioma)

Hepatic hemangiomas are the most common benign solid lesions of the liver. These lesions are usually found in middle-aged women. They are most commonly located in the subcapsular area of the right lobe and measure less than 5 cm. If larger, they may cause non-specific abdominal pain as a result of tumor expansion, hemorrhage or localized thrombosis. Although there are case reports of spontaneous and traumatic rupture of hemangiomas, hemorrhage is uncommon. Rarely, giant hemangiomas may have thrombocytopenia, disseminated intravascular coagulopathy, bleeding and abdominal pain. Hemangiomas are usually solitary but 5 to 10 percent of patients have multiple lesions. These can often be followed conservatively, i.e. no treatment. Surgical treatment should be considered only for patients who are symptomatic or to definitively rule out cancer. Enucleation or resection of the hemangioma is the operative procedure of choice.

Hepatic Adenoma

Hepatic adenomas (HA) occur mostly in 20 to 40 year old premenopausal women on oral contraceptives. These lesions have a 25 percent risk of rupture of bleeding. Patients commonly present with abdominal pain. The association with oral contraceptives was established in the 70’s and it has become well known that HA are associated with estrogen and progesterone. Understandably, HA have a tendency to grow and rupture during pregnancy, and the risks to the mother and fetus are extremely high. Surgical Resection is the preferred form of treatment for HA because of the risks of rupture, bleeding and malignant transformation. Although there have been anecdotal reports of complete resolution of small HA following the cessation of oral contraceptives, resection is still favored if they persist.

Liver Cysts

Asymptomatic simple cysts may be followed routinely and often require no treatment. Surgical treatment is recommended for cysts that are symptomatic as in causing problems with digestion, dyspepsia etc. Percutaneous aspiration has a 100 percent recurrence rate and is performed only to secure a diagnosis or as a therapeutic test. The current recommended therapy is laparoscopic unroofing of the cyst. Cystadenomas are most commonly found in the liver parenchyma and less often in the extrahepatic biliary ducts. The pathogenesis is unclear and may be congenital in origin from abnormal bile ducts or from aberrant germ cells.

The disease tends to occur in females 30 to 50 years old. These cystic tumors are often large and symptomatic, causing abdominal pain and/or an abdominal mass. Ten percent of cystadenomas are malignant and there is a 25 percent chance of malignant degeneration. Diagnosis is usually made on an ultrasound and/ or a CT scan and appear as multiloculated cystic lesions with papillary projections. Cystadenomas carry the risk of malignant degeneration, enlargement and infection and should undergo complete resection.
Liver Cancer Risk Factors and Symptoms
Primary Tumors: Risk Factors
Hepatocellular carcinoma is not common in the United States; however, it ranks as the fourth most common cancer worldwide. These primary liver tumors arise much more often in Africa, the Middle East and Asia.

While the exact cause of primary liver cancer is unknown, major risk factors include:

•Chronic viral hepatitis B and/or hepatitis C infection
•Chronic alcohol abuse
•Cirrhosis (buildup of scar tissue in the liver)
•Exposure to toxins
•Anabolic steroid usage
•Family history of both hepatitis and liver cancer
•Certain metabolic disorders such as hemochromatosis

Secondary (Metastatic) Liver Tumors: Risk Factors
•Secondary, or metastatic, liver tumors begin as primary cancers in other organs such as the colon, rectum, pancreas, stomach, lung or breast. Because the liver is supplied with nutrient-rich blood from the intestines, cancers affecting the gastrointestinal tract may spread to the liver.
•Liver metastases may already be present at the time that a primary cancer is diagnosed in another part of the body. Or, they may arise months or even years after a person has been treated for a primary tumor.
Liver Cancer Signs and Symptoms
Liver cancer is sometimes called a "silent disease" because in an early stage it often does not cause symptoms. But, as the cancer grows, symptoms may include:

•Pain in the upper abdomen on the right side; the pain 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

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


A variety of different tests and procedures may be used to detect and diagnose liver tumors, including:
  • Physical exam and history
  • Complete blood count
    Blood samples are drawn and analyzed for the different cell types as well as hemoglobin (the component in the red blood cell that carries oxygen from the lungs to the tissues).
  • Serum tumor marker tests
    These blood tests can determine whether certain substances are being released into the blood by organs, tissues or tumor cells.
  • CT or CAT (computerized axial tomography) scan
    This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
  • MRI (magnetic resonance imaging)
    MRI creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves and computer imaging.
  • PET (positron emission tomography) scan
    This scan is used to identify malignant cells even before an actual “lump or bump” can be detected in a physical exam, or on CAT or MRI scans. Prior to the scan, a small amount of radionuclide glucose (sugar) is injected into a vein. Because cancer cells divide more frequently than normal cells, they take up more glucose than normal cells and appear brighter in the scan.
  • Ultrasound
    High-energy sound waves (ultrasound) are bounced off internal tissues or organs to create an image called a sonogram that provides an image of the liver, spleen and other organs.
  • Laparoscopy
    A surgical procedure used to examine internal organs by direct visualization. Small incisions are made in the abdominal wall, and a thin, lighted tube called laparoscope is inserted. During the procedure, the surgeon can inspect the abdominal organs and insert other instruments to take tissue samples for a biopsy  (examination of cells under a microscope).
  • Biopsy
    Tissue samples may be obtained in other ways beside laparoscopy. One method, called fine-needle aspiration or needle biopsy, involves inserting a thin needle into the liver during an X-ray or ultrasound procedure, and taking samples of cells.


At City of Hope, our goal is to ensure that treatments are effective and comprehensive, and provided in a setting of care and compassion. Our surgeons, medical oncologists, radiation oncologists and interventional radiologists work together as a team to provide combined treatments with maximum benefits.
Department of Surgery
Patients with liver tumors often require some form of surgery to remove the affected tissue. When appropriate, minimally invasive surgical techniques may be possible. These require only small incisions to accommodate thin, flexible laparoscopic instruments, similar to performing a biopsy. Laparoscopic surgery offers results comparable to open surgery, but with less pain, reduced loss of blood, faster recovery, shorter hospital stays and a lower risk of post-operative complications.
City of Hope surgeons are also highly skilled in robotic-assisted surgery, using the most advanced da Vinci S Surgical System. This system provides excellent results in complex and delicate operations. A surgeon directs and controls the movements of a specially designed robot, equipped with a camera and miniature surgical tools. A sophisticated computerized imaging system provides real-time, three-dimensional views of the surgical area, with better visualization than can be achieved with the surgeon’s eye alone.
Types of surgery used to treat liver cancer include:
  • Partial hepatectomy Removing the area of the liver where a tumor exists, along with a margin of the healthy tissue around it. The remaining liver tissue can regenerate, restoring liver function.
  • Total hepatectomy and liver transplant In certain cases, the entire liver may be removed, and then replaced with a healthy donated liver.
Radiation Therapy
Radiation therapy uses high-energy X-rays and other types of radiation to kill cancer cells. City of Hope was the first in the western U.S. to provide treatment for liver cancer using helical TomoTherapy. This advanced radiation therapy system combines two technologies, precision spiral CT scanning and intensity modulated radiation therapy, which allows doctors to match the highest dose of radiation to fit the exact shape of the tumor. The system not only provides more effective and potentially curative treatment, it reduces the unwanted exposure of normal tissues and reduces potential complications.
In cases where liver cancer cannot be removed by surgery, patients may receive localized internal radiation treatment using radioactive Yttrium-90 labeled microspheres. These are infused into the affected area, destroying the tumor but leaving most of the healthy tissue relatively unaffected.
Chemotherapy drugs destroy cancer cells by interfering with their growth and multiplication. There are several methods by which these cancer-fighting medicines are delivered. Some involve an infusion of drugs into a vein or central line. Others utilize interventional radiology, in which substances are injected directly into the liver through a thin tube (catheter) or needle, guided into the correct area by the use of X-ray imaging.
This type of local chemotherapy is used to treat tumors that have spread to the liver. An anticancer drug mixed with a substance that embolizes (blocks) blood vessels is injected into the hepatic artery. As the artery is blocked off, the drug is trapped near the tumor, for maximum effect.


All of our patients have access to the  Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
Additional Resources
American Cancer Society
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
National Comprehensive Cancer Network (NCCN)
888-909-NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
National Cancer Institute (NCI)
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
The American Liver Foundation
800-GO-Liver (465-4834)
The American Liver Foundation (ALF) is the nation's leading nonprofit organization promoting liver health and disease prevention. ALF provides research, education and advocacy for those affected by liver-related diseases, including hepatitis.
Hepatitis Foundation International (HFI)
Hepatitis Foundation International is a gateway to liver care and hepatitis information.
U.S. Dept. of Health & Human Services National Institutes of Health (NIH)
301-402-9612 for TYY
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health & Human Services.

Research/Clinical Trials

City of Hope conducts multiple clinical trials of new drugs and advanced treatment strategies aimed at improving treatments and outcomes for patients with liver tumors. As a patient at City of Hope, you may qualify to participate in a test of these promising new investigational therapies.

To learn more about our clinical trials program and specifically about clinical trials for liver cancer,  click here.



Liver Cancer Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Joe Komsky
Senior Director
Phone: 213-241-7293
Email: jkomsky@coh.org

Liver Cancer/Tumors Care
City of Hope specializes in research designed to improve the care of patients with many kinds of cancer. Our Liver Tumor Clinic, active since the early 1980s, takes a multidisciplinary approach that keeps us at the forefront of diagnosis and treatment of liver disease.

Treatments and Clinics
A national leader in cancer treatment and prevention, City of Hope is steadfast in its drive to offer more positive outcomes to patients everywhere. Our research innovations become advances in patient care without delay, because people fighting cancer need better options – now.

To make an appointment for yourself, a family member or a friend, please complete and submit our Become a Patient Request Form, or call City of Hope at
800-826-HOPE (4673).
The Sheri & Les Biller Patient and Family Resource Center embodies the heart and soul of City of Hope’s mission to care for the whole person.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
Situated just northeast of Los Angeles, City of Hope combines the best science and the most innovative and highly compassionate patient care. Stretched across more than 100 acres in the City of Duarte, lushly landscaped gardens surround state-of-the-art facilities.
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