Here [at City of Hope], there is one mission: It is treatment of cancer patients to make them no longer cancer patients but recovering individuals that are going back to their families." Yuman Fong, M.D., chair, Department of Surgery
An estimated 42,220 adults (30,610 men and 11,610 women) in the United States will be diagnosed with primary liver cancer in 2018.
Liver cancer care at City of Hope means you will get the most advanced, leading-edge treatments available, including minimally invasive robotic surgery, novel cancer-fighting drugs and highly precise radiation delivery. Our multidisciplinary team of specialized experts - many of whom are leaders and innovators in the field of liver cancer treatment and research - are solely focused on giving you the greatest chance at a lasting cure.
We will answer your questions, calm your concerns and design a personalized treatment plan to give you the best possible outcome.
- What is liver cancer?
- What are the risk factors for liver cancer?
- What are the symptoms of liver cancer?
- How is liver cancer detected?
- What the treatment options for liver cancer?
- Meet our liver cancer team
- What clinical trials are being offered for liver cancer?
- Living with liver cancer
Request a consultation
If you have been diagnosed with liver cancer, are at a high risk for developing liver cancer or are looking for a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673. Please visit Making Your First Appointment for more information.
City of Hope, located in Southern California, has been named a best hospital for cancer by U.S. News & World Report for over a decade and a National Cancer Institute comprehensive cancer center, the highest designation that recognizes our commitment to cancer treatment, research and education. As a founding member of the National Comprehensive Cancer Network, our doctors also help develop and improve evidence-based liver cancer treatment guidelines for patients throughout the country.
Highlights of our liver cancer program include:
- A patient-centered treatment approach guided by your unique needs and background, including molecular and genetic testing of your cancer to find the most effective therapies
- Our leadership, innovation and experience in minimally invasive and complex surgeries for liver cancer — with one of the best track records for safety and long-term outcomes
- Advanced technology and expertise minimally invasive, robotically assisted surgeries that can reduce discomfort, blood loss and recovery times for liver cancer patients, with some being able to go home within 24 hours after the operation
- Needle- and catheter-based therapies, such as ablation and radioembolization, that can treat liver tumors effectively without major incisions
- Experience in hepatic arterial infusion (HAI), which delivers cancer-fighting drugs directly to the tumor site for greater effectiveness
- A wide portfolio of drugs that can fight cancer better with fewer side effects, including targeted therapy and immunotherapy that attacks liver cancer cells with greater accuracy
- Targeted radiation therapy delivery that can focus on liver tumors while sparing healthy liver tissue, allowing the treatment to destroy the tumor completely or shrink it small enough for surgical removal
- Access to a wide range of clinical trials that may be more effective against liver cancer and/or less harmful to the patient; many of these promising therapies are only available to City of Hope patients
- Supportive care services to address a wide range of disease- and treatment-related concerns
NEWS & BREAKTHROUGHS
October 3, 2017
Liver cancer is a disease in which cancerous cells form in the liver, an organ that plays a major role in digestion, metabolism and detoxification in the human body. These cancerous cells do not function normally and may divide uncontrollably, crowding out healthy liver cancer cells and possibly invading other organs in the body.
The majority of primary liver cancer is hepatocellular carcinoma, which arises from the organ’s main cells, called hepatocytes. This cancer typically accompanies other liver diseases, such as hepatitis B or C infections, metabolic disorders and alcohol-related diseases such as cirrhosis.
Other, less common types of primary liver cancer include:
- Fibrolamellar carcinoma: a rare subtype of hepatocellular carcinoma that is slower growing and less aggressive than other primary liver cancers
- Angiosarcomas, hemangiosarcomas and hemangioendotheliomas: fast-growing tumors arising from blood vessels of the liver
- Hepablastomas: a highly treatable liver cancer found in young children
The liver is also a common site for secondary cancers, in which primary cancers from another organ or site (such as breast, colon or prostate) have spread to the liver and started developing a tumor there. Many secondary liver tumors are highly treatable and can even be cured with appropriate treatment.
Additionally, benign tumors may also form in the liver. These typically do not cause symptoms and are usually discovered in imaging tests for other conditions. They may not require treatment unless they cause bleeding or abdominal pain.
Common benign tumors include:
- Hepatic adenomas: begin in hepatocytes and occur mainly in women of childbearing age
- Focal nodular hyperplasia: a tumor-like growth comprised of several cell types, occurring mainly in women in their 20s and 30s
- Hemangiomas: abnormal mass of blood vessels in the liver
- Liver cysts: fluid-filled growths in the liver; occasionally, these cysts can rupture and cause an infection
Factors that can elevate risk liver cancer risk include:
- Alcohol: Heavy alcohol use, especially over a long time, increases liver cancer risk.
- Aflatoxin-tainted foods: Aflatoxin is a harmful compound produced by a fungus that grows in improperly stored grains and nuts — particularly in hot and humid environments. Consuming this toxin can increase one’s liver cancer risk.
Diseases and conditions that raise liver cancer risk
- Hepatitis B or C infection
- Cirrhosis: a chronic and progressive disease in which normal liver cells are replaced with scar tissues
- Hematochromatosis: a condition that causes excess iron to be stored in the liver
- Type 2 diabetes
- Non-alcoholic fatty liver disease
- Ethnicity: Asians and Pacific Islanders have the highest risk of developing liver cancer, but the risk is also elevated for African-American, American Indian and Latino populations as well, compared to non-Hispanic whites.
- Gender: Liver cancer is more common in men.
- Tobacco use
Common symptoms of liver cancer include:
- Jaundice (yellowing of the skin or the whites of the eyes)
- Discomfort or pain in the upper right side of the abdomen or the lower right side of the rib cage
- Poor appetite or feeling full after consuming small portions of food
- Swelling of the abdomen or legs
- Unexplained weight loss
Although these symptoms can be caused by other conditions, you should check with your doctor to get a definitive diagnosis.
Sources: National Cancer Institute and American Cancer Society
Precise liver cancer tests are crucial for treatment planning, and City of Hope is equipped with state-of-the-art technologies and specialized staff to ensure an accurate, comprehensive diagnosis of liver cancer.
Highlights of our screening and diagnosis services include:
- Advanced imaging technology to better identify and locate tumors
- Genomic and molecular profiling of the cancer, which can lead to more effective, less toxic treatments
How is liver cancer detected?
Your doctor may use the following tests to look for liver cancer:
- Physical exam
- Blood tests: In addition to standard tests, such as blood cell counts and chemistry, your doctor may also order tests looking for substances associated with liver cancer such as alpha-fetoprotein (AFP), hepatitis B and C, and liver enzyme levels.
- Ultrasound: This imaging test uses sound waves to identify the location and number of tumors; it may also be able to tell the difference between liver cancer and benign liver tumors.
- CT or CAT (computed tomography) scan: This test involves taking a series of X-ray images to form a computer-generated image, which determines tumor size, location and spread. Special dyes may be used to enhance this scan.
- MRI (magnetic resonance imaging) scan: This procedure uses radio waves and strong magnets to produce detailed images of the body’s tissues, including liver tumors.
- Laparoscopy: A procedure that uses a thin, lit tube equipped with a small camera. This tube is inserted through small incisions in the abdomen and the doctor can see if there are tumors in the liver and surrounding organs.
- Biopsy: Surgical removal of suspicious tissues for further examination.
- Genomic testing: The cancerous tissue is tested to see if it exhibits certain genetic mutations or molecular markers, which can be used to help determine disease progression, optimal treatments or identify risk for other cancers.
Based on the results of these tests, the liver cancer is then staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs. Generally, liver cancer caught in earlier stages will have better outcomes than those caught in advanced or metastasized stages.
What are the current screening guidelines for liver cancer?
There are currently no screening guidelines for liver cancer, since no screenings have been shown to lower risk of dying from liver cancer for people of average risk. However, your physician may recommend more vigorous monitoring if you are at a high risk of developing this disease, which includes:
- Hepatitis B or C infection
- Chronic liver diseases such as cirrhosis and fatty liver
- Genetic conditions such as hematochromatosis
When you are able to provide patients a disease-free advantage ... it is extremely gratifying." Gagandeep Singh, M.D., Head of Liver and Pancreatic Surgery
City of Hope has one of the most renowned liver cancer programs in the United States, with a multidisciplinary team of medical experts across different fields — including surgery, radiation oncology, medical oncology and supportive care medicine.
Members of our liver cancer team meet twice weekly to review patient cases, bringing a variety of clinical perspectives and experience to the development of an individualized treatment plan. The team also participates in a weekly meeting to share clinical trial results, review information from surgical pathology reports and plan future research studies.
Our physicians are also active members in many collaborations and cooperative groups, and have led or participated in most national clinical trials for detecting, treating and preventing liver cancer. This dedication to research also ensures our patients have access to the most promising and leading-edge liver cancer therapies.
Learn more about our liver cancer treatment options below:
Surgery is the primary treatment for liver cancer. It can be curative for early stage liver cancer patients and can also improve survival outcomes and reduce discomfort for advanced liver cancer patients.
- The procedure can involve removing the tumor from the body or destroying the tumor while it’s still in the body (ablation) or halt its growth by cutting off its blood supply (embolization).
- The liver is one of two organs in the human body that has the capacity to regenerate. Up to 80 percent of the liver can be surgically removed and, within several weeks, it will entirely rebuild itself. If one lobe - and its associated blood vessels - is surgically removed, the remaining lobe will compensate for the loss.
- Our surgeons routinely use a new technique called preoperative portal vein embolization, which redirects the blood supply to the healthy portion of the liver to stimulate cell growth before surgery.
- Our doctors also use liver-sparing surgical techniques that leave more of the healthy liver intact, reducing the need for regeneration and the possibility of complications.
- The expertise of City of Hope’s surgeons also means that they can treat liver tumors that are considered inoperable elsewhere. This is done through advanced procedures that can navigate around sensitive areas (such as major blood vessels) and working with radiation and medical oncologists, who can shrink the tumor to down to an operable size and shape with radiation and drug therapies.
Our liver surgeons have performed thousands of liver tumor operations and we have one of the most experienced liver surgery teams in the nation. Our experience and leadership in this field has been demonstrated with published findings showing the following benefits compared to hospitals that do not perform a high number of liver surgeries.
- Lower rate of complications
- Better clinical and survival outcomes
- Enhanced quality of life
Our experience also means we can surgically treat a greater range of liver cancer patients, including patients who may be deemed inoperable elsewhere due to advanced disease, older age or other health conditions.
Additional highlights of our liver cancer surgery program
- When possible, minimally invasive and robotically assisted tumor removals, which reduces discomfort, blood loss, hospital stay and recovery time compared to traditional open procedures.
- Therapies to stimulate liver regeneration that allow our surgeons to remove a greater portion of suspicious liver tissue to prevent cancer recurrence.
- For patients with secondary liver cancers (e.g., cancer originating elsewhere but have spread to the liver), our surgery teams can coordinate so that we can remove both the primary tumor and the liver metastases in a single operation. This simultaneous removal results in less blood loss and shorter hospital stays compared to staging the removal in two separate operations.
- Liver transplant - patients with liver tumors that are small in size and number, have not spread to nearby blood vessels, and have cirrhosis or other liver conditions, may be eligible for liver transplantation at another medical center. Our liver cancer team can identify which patients may benefit from transplantation and routinely coordinates liver transplantation at other area hospitals.
- Made in City of Hope: Pushing the limits of liver cancer surgery
- Minimally Invasive Therapies for Liver Cancer
Ablation and Embolization
Ablation and embolization are minimally invasive procedures using small tubes and needles to deliver cancer therapy directly to the tumor. These needles and probes are inserted through the skin or a blood vessel and carefully guided to the cancer site using detailed imaging technology.
This therapy can either kill the liver tumor outright (ablation) or block its blood supply (embolization). The specific therapies offered at City of Hope include:
- Chemical ablation (using ethanol or acetic acid to kill tumor cells)
- Thermoablation (using extreme heat or cold to kill tumor cells)
- Chemoembolization (blocking a blood vessel with chemotherapy-coated beads)
- Radioembolzation (blocking a blood vessel with radioactive beads)
Ablation and embolization are viable options for patients who are current ineligible for surgery. In some cases, these therapies can shrink the tumor enough to make them operable.
Drug therapy may be given to patients to fight liver cancer cells throughout the body by killing the cancer cells or stopping their growth and spread. These drugs include:
- Chemotherapy, which targets rapidly dividing cells, including liver cancer cells
- Targeted therapy, which selectively attacks liver cancer cells based on specific characteristics
- Biologic therapy, which refers to a host of new drugs that stop tumor cells from replicating and/or disrupt a tumor’s blood supply. Sorafenib is a new biologic therapy that was recently approved by the US Food and Drug Administration for the treatment of patients with primary liver cancer who are not eligible for surgery
- Immunotherapy, which stimulates the patient’s own immune system to recognize and attack liver cancer cells
The drug or drug combination used depends on the type and stage of liver cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.
In addition to standard drug therapy regimens, City of Hope is also experienced in hepatic arterial infusion — which delivers cancer-fighting drugs to the major blood vessel from the heart to the liver. This direct delivery method can enhance the therapy’s effectiveness in shrinking or killing liver tumors.
City of Hope patients may also be eligible for new, promising drugs through our clinical trials program.
Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may be delivered externally using focused beams of energy, or internally, placing an energy emitting substance in or near the tumor site.
Radiation can treat tumors that cannot be removed by surgery (sometimes shrinking them enough to be operable) and can be used to relieve pain and other liver cancer symptoms.
City of Hope is a leader in image-driven radiation planning, using computed tomography and magnetic resonance imaging scans to determine tumor size and location. This ensures radiation is accurately delivered to the tumor site, while minimizing exposure to nearby normal tissues.
Because cancer of the liver is difficult to control, regular follow-up care after the initial course of treatment — including periodic imaging, liver function, and blood tests — is very important. You should also never hesitate to let members of your care team know about pain or any symptoms, changes, or problems that occur after treatment. Follow-up care can be arranged to be ongoing at City of Hope or arranged in partnership with you primary care physicians.
There is a high incidence of recurrent liver cancer, even after successful treatment. Patients who have been treated for liver cancer should see their surgeon, oncologist, or other doctors for regular surveillance with imaging tests such as ultrasound, CT or MRI to determine whether the cancer has returned.
Hepatitis treatment and liver cancer surveillance
Some patients with liver cancer have chronic hepatitis B or C. These viruses cause chronic inflammation and scarring in the liver, which can lead to cirrhosis and liver cancer. Chronic hepatitis B and C can be controlled with antiviral medications. Treatment with antiviral medications is often recommended in combination with treatment for liver cancer.
Patients with liver cancer often have cirrhosis or associated diabetes. Dietary counseling can often help prevent other metabolic problems or symptoms of liver insufficiency. Patients should minimize or eliminate alcohol use and avoid intensive treatment with herbal remedies. City of Hope’s Supportive Care Medicine Program provides ongoing access to nutritional information and other quality-of-life support.
At City of Hope, patients with liver cancer are treated by a multidisciplinary team including surgeons, medical oncologists, gastroenterologists, diagnostic radiologists, interventional radiologists, pathologists and radiation oncologists who work together to determine the most appropriate treatment for each patient.
Because our doctors are also leaders in their field, patients under our care have access to the newest treatment approaches. Our clinicians are also noted clinical researchers, who lead some of the most innovative clinical trials in this area.
Select from the list below to learn more about our primary liver cancer specialists, their education, training, board certifications, current publications and specific areas of clinical expertise.
- Surgical Oncology
- Surgical Oncology
- Liver and Pancreatic Surgery
- Liver Cancers and Metastases
- Bile Duct Cancers
- Gallbladder Cancer
- Pancreas Cancer
- Surgical Oncology
- Surgical Oncology
- Liver Cancer and Metastases
- Pancreas Cancer
- Gallbladder Cancer and Bile Duct Cancer
- Robotic Minimally Invasive Surgery
- Surgical Oncology
- Liver Surgery
- Pancreatic Surgery
- Gallbladder and Bile Duct Surgery
- Minimally Invasive Surgery
- Robotic Surgery
- General Surgery
Diagnostic Radiology and Interventional Radiology
- Diagnostic Radiology
- Diagnostic Radiology
- Interventional Radiology
- Diagnostic Radiology
At City of Hope, we have a dedicated team of nurses who specialize in caring for patients with liver cancer during outpatient visits and inpatient hospital stays. Each nurse works in collaboration with one primary physician to oversee every patient’s care. This allows our nurses to assess a patient’s needs, triage symptoms, and, if necessary, make referrals to other departments within City of Hope, such as supportive care medicine, nutrition, and social work. Nurses also help patients understand the details of the treatment plan and what to expect throughout the course of treatment. They are actively involved with teaching both patients and their families, and provide educational materials as needed.
As the liaison between patients and physicians, nurses play an important role in the team approach to care offered at City of Hope.
At City of Hope, liver cancer clinicians and researchers collaborate extensively to develop and evaluate new therapies for better survival and quality-of-life outcomes. Our patients have access to a wide variety of clinical trials including new chemotherapy and targeted therapies, hormone therapies, novel surgical techniques, innovative radiation approaches and new prevention strategies.
These trials give current patients access to promising, leading-edge therapies and improve overall care for future patients worldwide. Visit our clinical trials page to learn more about current studies and their eligibility criteria.
Here are some of our current liver cancer research projects:
- We have developed a Chinese herb combination called PHY906 that can interfere with liver tumor cell growth. It's being tested in a phase I clinical trial with the targeted therapy drug sorafenib to see if it is effective in advanced liver cancer.
- City of Hope is part of a phase II trial to see if the targeted therapy drug trametinib can stop tumor development by removing enzymes necessary for liver cancer cells to grow. This trial will also evaluate whether trametinib is more effective and less toxic than combination therapy for patients with advanced or recurrent liver cancer.
- We are also part of a phase II trial testing the anti-cancer drug SGI-110, which has shown promise against blood cancers and can potentially treat liver cancer as well by suppressing genes that drive cancer growth.
- Our researchers are participating in a phase II trial combining two cancer drugs, temsirolimus and bevacizumab, which fight cancer using different mechanisms.
- Researchers are investigating whether linking the breast cancer drug Herceptin to an imaging agent can produce more accurate PET (positron emission tomography) scans, because some liver cancers will take in more Herceptin than normal tissue.
- We are currently developing a virus that can either directly kill liver tumor cells or enhance the patient’s immune reaction against the cancer.
While our primary goal is to cure or control the disease, another top priority is relieving suffering and discomfort for liver cancer patients undergoing cancer treatments.
In addition to curative treatments, City of Hope liver cancer patients and their caregivers have access to the broad range of services offered by our Department of Supportive Care Medicine. The department’s staff of professionals, including registered dieticians, rehabilitation specialists, supportive medicine physicians and clinical social workers, can help patients and loved ones with a variety of care and wellness issues including:
- Managing symptoms and side effects, such as pain, nausea and fatigue
- Adjusting to dietary changes after liver cancer therapy
- Handling emotional, social and spiritual issues
- Coping with stress
- Navigating the health care system
- Maintaining a healthy lifestyle with expert nutrition and physical activity guidance
- Building caregiver skills
- Improving communication with family, partners and loved ones
- Restoring normalcy in your family, job or school routine
- Returning to wellness after active treatment
For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE) or the Women’s Center at 800-934-5555.