Primary liver cancer in adults is a disease in which malignant (cancerous) cells form in the liver tissue.
The liver is one of the largest organs in the body.It has two lobes and is located on the inside of the right upper abdominal rib cage.The three important functions of the liver are:
Filtering harmful substances from the blood so they can be excreted in the stool and urine.
Produce bile to help digest fats from food.
Storing glycogen (sugar) to meet the body’s energy needs. 
The anatomy of the liver.The liver is located in the upper abdomen, adjacent to the stomach, intestine, gallbladder, and pancreas.The liver is divided into a right lobe and a left lobe.Each liver lobe is further divided into two parts (not shown).
There are two types of primary liver cancer in adults.
The two types of adult primary hepatocellular carcinoma are:
Hepatocellular carcinoma.
Cholangiocellular carcinoma (bile duct cancer).(See the PDQ summary on bile duct cancer for more information.)
The most common type of primary liver cancer in adults is hepatocellular carcinoma.This type of liver cancer is the third leading cause of malignancy-related death worldwide.
This article is a summary of the treatment of primary liver cancer (cancer that starts in the liver). This summary does not include treatment for malignancies that originate elsewhere and spread to the liver.
Primary liver cancer can occur in both adults and children.However, the treatment options for liver cancer in children are different from those for adults.(For more information, see the PDQ summary on the treatment of liver cancer in children)
Hepatitis or cirrhosis can affect the risk of primary liver cancer in adults.
Any factor that increases the chance of developing the disease is called a risk factor.The presence of a risk factor does not necessarily mean that you will develop cancer; and the absence of a risk factor does not necessarily mean that you will not develop it. If you think you are at risk for liver cancer, talk to your doctor.
The main risk factors for liver cancer include:
Infection with hepatitis B or C. Co-infection with hepatitis B and C can put you at higher risk for liver cancer.
Hepatocirrhosis.
Alcohol abuse.Alcohol abuse combined with hepatitis B infection may increase the risk of liver cancer.
Eating food contaminated with aflatoxin (a toxin produced by a fungus that grows on foods such as grains or nuts when stored improperly).
Developing nonalcoholic steatohepatitis (NASH), a disease in which fat builds up in the liver and can progress to liver inflammation and liver cell damage.
Use tobacco, such as smoking.
Having certain genetic or rare diseases that can damage the liver, including the following.
Hereditary hemochromatosis, a genetic disorder in which the body stores more iron than it needs.Most of the excess iron is stored in the liver, heart, pancreas, skin, and joints.
α-1 antitrypsin deficiency syndrome, a genetic disorder that causes lesions in the liver or lungs.
glycogen storage disease, a genetic disorder in which the body has a disorder in the storage and utilization of glycogen, a form of glucose (sugar).
Late onset cutaneous porphyria, a rare disease that can involve the skin and cause painful blisters on sun-exposed body parts, such as the hands, arms, and face. Liver problems can also occur.
Wilson disease, a rare genetic disorder that causes the body to store more copper than it needs.The excess copper is stored in the liver, brain, eyes, and other organs.
Age is a major risk factor for most malignancies.As we age, the chance of developing cancer increases.
Signs and symptoms of primary liver cancer in adults include a lump or pain on the right side.
Appeal or other signs and symptoms can be caused by adult primary liver cancer or by other diseases.Consult your doctor if any of the following occur:
A hard mass on the right side of the lower thorax.
Discomfort in the right upper abdomen.
Abdominal swelling.
Pain near the right scapula or in the back.
Jaundice (yellowing of the skin and whites of the eyes).
Easy bruising or bleeding.
Abnormal fatigue or weakness.
Nausea and vomiting.
Loss of appetite or feeling of fullness with small amounts of food.
Unexplained weight loss.
Pale complexion, clay-like stools and darkened urine.
Fever.
Examination of the liver and blood can be used to detect (find) and diagnose primary liver cancer in adults.
The following tests and procedures may be used:
Physical examination and history: A physical examination of general physical status, including examination for signs of disease, such as a mass or any other condition that appears abnormal.The patient’s past health habits, past medical history and treatment history.
Serum tumor marker testing: A blood sample test for the amount of certain specific substances released into the bloodstream by organs, tissues, or tumor cells in the body.Increased levels of certain specific substances in the blood can be associated with specific types of malignancies.These specific substances are called tumor markers.An increased level of alpha-fetoprotein (AFP) in the blood may be a sign of liver cancer.Other cancers and certain non-cancerous diseases may also cause increased AFP levels, including cirrhosis and hepatitis.Even in liver cancer, AFP levels are sometimes normal.
Liver function test: A blood sample test that measures the amount of certain substances released into the blood by the liver.Higher than normal amounts of a specific substance may be a sign of liver cancer.
CT scan: A test that produces a series of detailed images of parts of the body, such as the abdomen, from different angles.These images are generated by a computer that is connected to an X-ray machine.A dye may be given intravenously or orally to help organs or tissues appear more clearly.This test is also known as computed tomography, computerized tomography, or computed axial tomography.It can be taken in three different time periods after the intravenous injection of the dye to get the best picture of the liver in the abdomen.This is known as three-stage CT. Spiral CT can be performed in a spiral trajectory using an X-ray machine, which can produce a very detailed series of pictures of areas of the body.
Magnetic resonance imaging: A test that uses electromagnetism, radio waves, and a computer to produce a series of detailed images of an area of the body, such as the liver.This test is also known as magnetic resonance imaging (MRI).An intravenous dye is injected into the liver to give a clearer image of the blood vessels in or around the liver.This test is called MRA (magnetic resonance angiography).It can be performed in three different time periods after the intravenous stain is injected to generate the best images of the abnormal areas within the liver.This test is known as a three-stage MRI.
Ultrasound: A test that causes high-energy sound waves (ultrasound) to be reflected by tissues or organs in the body and produce echoes.The echoes form an image of the body’s tissues called a sonogram.These images can be printed out for later viewing.
Biopsy: Excision of cells or tissue used by a pathologist to look under a microscope for the presence of cancerous features.Cell or tissue sample sampling includes the following modalities.
Fine needle aspiration biopsy: Sampling of cells, tissue, and fluid is performed with a fine needle.
Core needle biopsy : Cell or tissue sampling with a slightly wider needle.
Laparoscopy : A surgical procedure used to explore organ disease within the abdomen.Small incisions are made in the abdominal wall, and a laparoscope (a small, tubular body with a light source) is placed in one of the incisions.Another device is disposed of through the same or another incision for tissue sampling.
Tissue biopsy is not a necessary test for primary liver cancer in adults.
Some factors can affect the prognosis (chance of recovery) and choice of treatment options for hepatocellular carcinoma.
Prognosis (chance of recovery) and choice of treatment options depend on the following:
The stage of the cancer (how large the tumor is, whether it is confined or diffuse, or whether it has spread to other parts of the body).
Whether the liver function is good.
The patient’s general health, including the presence or absence of cirrhosis.