What is Liver Cancer?
Liver cancer in 2007 is one of the most significant problems that a person with hepatitis C can develop. The medical term for the main cancer that begins in the liver is hepatocellular carcinoma (pronounced "HEP-a-toe-SEL-yoo-ler KAR-sih-NOH-muh"), or HCC for short. We will refer to HCC as "liver cancer" here.
Who gets Liver Cancer?
People with long-standing hepatitis C who develop cirrhosis are at increased risk of developing liver cancer. Those who do not develop cirrhosis usually do not develop liver cancer. Among people with both hepatitis C and cirrhosis living in the United States, about 1-4% per year will develop liver cancer.
Other groups of people also can develop liver cancer, including people with cirrhosis resulting from long-term heavy alcohol use and people with chronic hepatitis B. Those with hepatitis B have an increased risk even if cirrhosis has not developed. The risk of developing liver cancer is higher for people living in Asia and Africa than it is for people living the United States.
Experts recommend that persons with hepatitis C who have developed cirrhosis be tested regularly for signs of liver cancer, even if they have no symptoms. Testing for the presence of a disease before there are any symptoms is called "screening." Repeat testing, such as every 6 or 12 months, is called "surveillance."
How is Liver Cancer Diagnosed?
A diagnosis of liver cancer can be made if a mass is seen in the liver and a blood test reveals high levels of a substance called alpha-fetoprotein (AFP). Radiologists can take images of the liver to check for any mass. That can be done with:
- a computed tomography (CT) scan
- magnetic resonance imaging (MRI)
An extremely high level of AFP alone can indicate that liver cancer is present, but it is especially likely if a mass is seen in the liver images as well. A high level of AFP and the appearance of a mass in the liver sometimes are sufficient for making a diagnosis of liver cancer, without doing a biopsy. If not, further testing can be done by taking a small sample of the mass with a hollow needle or by removing the mass and examining the tissue for cancer.
The benefit of screening and surveillance for liver cancer is that it can be detected in its early stages, when there are more options for treatment. When liver cancer is found at a more advanced stage, involving either a large tumor or symptoms such as abdominal pain, fewer treatment options are available.
Things to Know about Liver Cancer
- Liver cancer can cause death in a person with cirrhosis.
- Patients with cirrhosis resulting from any cause, including hepatitis C, hepatitis B, and alcohol use, have a greater risk of developing liver cancer.
- Liver cancer is one of the most common cancers in the world, especially in Asia and Africa, and it is becoming increasingly common in the United States.
- Biopsy refers to extracting a small sample of tissue with a hollow needle and testing it for liver cancer. A biopsy is sometimes needed to make a diagnosis, but imaging and blood tests can usually determine whether liver cancer is present. Biopsies of liver masses can be difficult to perform and there are some risks involved.
- Liver cancer can be treated if it is detected early, but the treatment is very specialized. Patients should discuss the details thoroughly with their health care providers.
- One excellent treatment for early-stage liver cancer is a liver transplant. This is a complicated form of treatment, because a patient first needs to be a good candidate for a liver transplant, then be evaluated at a liver transplant center and placed on a waiting list, and finally, be well enough to undergo a transplant when a donated liver becomes available.
What are the Treatments for Liver Cancer?
- Alcohol injection
- Radiofrequency ablation
- Embolization or chemoembolization of arteries in the liver
- Surgical resection
- Chemotherapy or radiation therapy
- Liver Transplant
How can Liver Cancer be Avoided?
For patients with hepatitis C, the treatments against the virus are pegylated interferon and ribavirin. If the virus is cleared, that will reduce the chance of developing cirrhosis. For patients who already have cirrhosis, the treatment can sometimes reduce the risk that liver cancer will develop.
For patients who have cirrhosis resulting from hepatitis C or alcohol use, the risk of further damage to the liver can be reduced by avoiding alcohol.
Patients with advanced cirrhosis can be evaluated for a liver transplant before liver cancer develops.
Patients with hepatitis B and a high hepatitis B viral load can be treated with medications for hepatitis B. Reducing the hepatitis B viral load will reduce the chance of developing liver cancer.
Autoimmune Liver Disease
An autoimmune liver disease panel is a series of tests performed when autoimmune liver disease is suspected. An autoimmune liver disease means that the body's immune system attacks the liver.
These tests include:
- Anti-liver/kidney microsomal antibodies
- Anti-mitochondrial antibodies
- Anti-nuclear antibodies
- Anti-smooth muscle antibodies
Occasionally, the panel may also include additional tests. Certain immune protein levels in the blood are also checked.
How the Test is Performed
Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.
Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.
In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.
The blood sample is sent to the laboratory for testing.
How to Prepare for the Test
No special preparation is necessary for this test.
How the Test Will Feel
When the needle is inserted to draw blood, some people feel pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Why the Test is Performed
Autoimmune disorders, in which cells from the immune system attack tissues or organs, are one possible cause of liver disease. The most common autoimmune liver diseases are autoimmune hepatitis and primary biliary cirrhosis.
This group of tests helps your health care provider diagnose liver disease.
The normal range for protein levels in the blood will change with each laboratory. Please check with your health care provider for the normal ranges in your particular laboratory.
Negative results on all antibodies are normal.
Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
What Abnormal Results Mean
Blood tests for autoimmune diseases are not completely accurate. They can have false negative results (you have the disease, but the test is negative) and false positive results (you do not have the disease, but the test is positive).
A “weakly positive” or “low titer positive” test for autoimmune disease is often not due to any disease.
A positive test on the panel may indicate autoimmune hepatitis or other autoimmune liver disease.
If the test is positive mostly for anti-mitochondrial antibodies, there is a high probability of primary biliary cirrhosis.
If the immune proteins are high and albumin is low, you may have liver cirrhosis or chronic active hepatitis.
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
- Excessive bleeding
- Fainting or feeling light-headed
- Hematoma (blood accumulating under the skin)
- Infection (a slight risk any time the skin is broken)