Hepatobiliary Cancer

Hepatobiliary cancers are serious conditions that affect the liver, pancreas, gallbladder, and bile ducts—organs responsible for producing, storing, and transporting bile, a fluid essential for digestion.

Table of contents

• What is hepatobiliary cancer?
• Types of hepatobiliary cancer
• Symptoms
• Risk factors
• Screening and diagnosis
• Treatment options
• Living with hepatobiliary cancer

What is hepatobiliary cancer?

Hepatobiliary cancers are growths of abnormal cells that form in the liver, pancreas, gallbladder, and bile ducts^[1]. These cancers are called “hepatobiliary” because they involve the hepatobiliary system, which includes organs that work together to produce, store, and move bile through your body^[1]. Bile is a fluid that plays a crucial role in helping you digest food.

These cancers are highly lethal. In 2008, approximately 21,370 persons in the United States were estimated to be diagnosed with liver or intrahepatic bile duct cancer and 9,520 with gallbladder cancer or other biliary tract cancer. Furthermore, approximately 18,410 deaths from liver or intrahepatic bile duct cancer and 3,340 deaths from gallbladder cancer or other biliary tract cancer were estimated to occur^[2].

• Liver
• Pancreas
• Gallbladder
• Bile ducts

Types of hepatobiliary cancer

Hepatobiliary cancer includes several distinct types, each affecting different organs within the hepatobiliary system. The main types include hepatocellular carcinoma (HCC), gallbladder cancer, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma^[2].

Hepatocellular carcinoma is the most common type of hepatobiliary cancer. It is cancer that starts in the liver cells. The liver is a football-sized organ that sits under the right portion of your abdomen, beneath your diaphragm and beside your stomach^[4]. The liver performs over 500 known functions, including balancing chemicals in your blood, making bile, clearing toxins from the blood, and regulating blood clotting^[4].

Gallbladder cancer is a type of cancer that begins in the gallbladder, a small, pear-shaped organ found under the liver^[1].

Cholangiocarcinoma, also called bile duct cancer, is cancer that starts in the bile ducts. These are tubes that connect the liver and gallbladder to the small intestine^[5]. Cancer that forms in the bile ducts inside the liver is called intrahepatic bile duct cancer. If it forms in the bile ducts outside of the liver, it is called extrahepatic bile duct cancer^[5].

Pancreatic cancer is a type of cancer that begins in your pancreas, a gland located deep in the abdomen, between the stomach and the spine^[1].

Symptoms

In its early stages, hepatobiliary cancer may not have symptoms that can be seen or felt^[6]. However, as the cancer grows larger, people may notice certain signs.

Symptoms of hepatobiliary cancers can vary but often include^[1][6]:

• Jaundice: Yellowing of the skin and eyes, often due to bile duct obstruction
• Abdominal pain: Particularly in the upper right quadrant or near the right shoulder blade
• Weight loss: Unintended and significant weight loss
• Fatigue: Persistent and unexplained tiredness
• Loss of appetite: Decreased desire to eat
• Nausea and vomiting: Digestive disturbances
• A swollen abdomen
• A hard lump on the right side just below the rib cage
• Easy bruising or bleeding
• Unusual tiredness

It’s important to remember that these symptoms could also be caused by other health conditions. If you have any of these symptoms, talk to your doctor^[6].

Risk factors

Risk factors for the development of hepatocellular carcinoma, the most common hepatobiliary cancer, include infection with the hepatitis B virus (HBV) and/or hepatitis C virus (HCV), particular comorbidities or conditions, and certain behaviors^[2].

Behaviors and conditions that increase risk for getting liver cancer include^[6]:

• Being overweight or having obesity
• Having a long-term hepatitis B virus or hepatitis C virus infection
• Smoking cigarettes
• Drinking alcohol
• Having cirrhosis (scarring of the liver, which can also be caused by hepatitis and alcohol use)
• Having nonalcoholic fatty liver disease (extra fat in the liver that is not caused by alcohol)
• Having diabetes
• Having hemochromatosis, a condition in which the body takes up and stores more iron than it needs
• Eating foods that have aflatoxin (a fungus that can grow on foods, such as grains and nuts that have not been stored properly)

You can lower your risk of getting liver cancer in the following ways^[6]:

• Keep a healthy weight and get enough physical activity
• Get vaccinated against hepatitis B
• Get tested for hepatitis C, and get medical care if you have it
• Don’t smoke, or quit if you do
• Avoid drinking too much alcohol

Screening and diagnosis

Screenings for hepatobiliary cancers aim to detect the disease at an early stage when treatment is more likely to be effective^[1]. Screening for these cancers generally involves a combination of imaging techniques (ultrasound, CT, MRI), blood tests (tumor markers and liver function tests), and endoscopic procedures when necessary^[1]. The choice of screening tools and the frequency of screening depend on the individual’s risk factors and the specific type of hepatobiliary cancer being monitored.

Tests that examine the liver and the blood are used to detect and diagnose liver cancer^[5]. Certain medical tests are used to screen for liver cancer. Not all screening tests are helpful, and many have risks^[5].

Liver cancer is one of the cancers where you may not need a biopsy to make decisions about your care. Sometimes, liver cancer can be reliably diagnosed on imaging studies such as CT scans or MRIs^[8]. It’s important to talk to your doctor and your medical team to determine whether a biopsy is needed.

Treatment options

Treatment for hepatobiliary cancers depends on several factors, such as the tumor’s grade and stage and the patient’s preference^[1]. Since each type of hepatobiliary cancer is unique, with different signs, symptoms, risk factors and prevention strategies, healthcare professionals combine the latest technology with a comprehensive course of cancer treatment options^[1].

Common treatment options include^[1][9]:

Surgery: If liver cancer is found early, is small and has not spread, you may be able to have surgery to remove it^[11]. A partial hepatectomy (surgery to remove the part of the liver where cancer is found) may be done. A wedge of tissue, an entire lobe, or a larger part of the liver, along with some of the healthy tissue around it, is removed. The remaining liver tissue takes over the functions of the liver and may regrow^[9].

Liver transplantation: In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the person has to wait for a donated liver, other treatment is given as needed^[9].

Radiation therapy: Radiation therapy uses high energy waves similar to x-rays to kill cancer cells. Different types of internal and external radiotherapy might be used to treat liver cancer^[14].

Chemotherapy: Chemotherapy uses medicines to kill cancer cells. For liver cancer, the chemotherapy medicine is usually given into the blood vessels of the cancer. It aims to stop the cancer growing. This is called chemoembolisation^[11]. You’ll usually have chemoembolisation to help make the cancer smaller, or to control and improve the symptoms.

Targeted therapy: Targeted cancer medicines aim to stop the cancer from growing. You may have treatment with targeted medicines for liver cancer if you cannot have surgery because you are very unwell, or the cancer cannot be removed by surgery, or if the cancer has spread to another part of the body^[14].

Ablation therapy: Ablation therapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer, including radiofrequency ablation, microwave therapy, and cryoablation^[9]. Ablation uses heat to destroy cancers. There are 2 types of thermal ablation: radiofrequency ablation (RFA) and microwave ablation (MWA)^[14].

Embolization therapy: Embolization therapy is used for people who cannot have surgery to remove the tumor or ablation therapy and whose tumor has not spread outside the liver. Embolization therapy is the use of substances to block or decrease the flow of blood through the hepatic artery to the tumor^[9]. Embolisation is a treatment that blocks or reduces the blood supply to the cancer. You might have it with chemotherapy (TACE) or without chemotherapy (TAE)^[14].

Living with hepatobiliary cancer

Living with hepatobiliary cancer involves making adjustments to your daily routines that may help you feel better. Small changes to your diet, nutrition, and daily activities may help make a difference in how you feel^[18].

Once you’ve been diagnosed with liver cancer, it’s important to try and avoid things that might further damage the liver. These can include alcohol and smoking. Otherwise, try to be as healthy as possible by maintaining a healthy diet and regular exercise^[8].

A balanced diet is good for your health and can be an important factor as you move forward with liver cancer^[18]. Foods that are good for you—like vegetables, whole grains, fish, poultry, low-fat dairy products, certain nuts, and soy—are also good for people with liver cancer^[18].

Physicians and other healthcare providers agree that people with liver conditions should avoid alcoholic drinks. Be sure to drink plenty of fluids to keep your body well hydrated. If you are receiving cancer treatment, you may be at higher risk for dehydration due to side effects^[18].

After treatment for liver cancer, you have regular follow-up appointments and might need to have some tests^[14]. You are likely to feel a range of powerful emotions if you are diagnosed with advanced hepatobiliary cancer. You might feel confused and find it difficult to take in what people say. You might feel angry, fearful, or sad, which can make you feel exhausted^[19].

One of the best ways to partner with your care team is to be engaged. Ask questions. Ask them about the treatment options available. Discuss the pros and cons and benefits of any proposed treatments. And together make a decision on what’s best for you. Being informed makes all the difference^[8].