Hepatobiliary cancer is a group of serious diseases that affect organs crucial for digestion and processing what we eat and drink. These cancers form in the liver, pancreas, gallbladder, and bile ducts—parts of the body that work together to produce, store, and transport bile, a fluid that helps break down fats and remove waste from our bodies.
Understanding Hepatobiliary Cancer
The term “hepatobiliary” refers to the system responsible for bile production and movement through the body. This system includes several organs that work together to keep our digestion running smoothly and to filter toxins from our blood. When abnormal cells begin growing uncontrollably in these organs, it leads to what doctors call hepatobiliary cancer.[1]
The liver, the largest internal organ in our body, sits under the right side of our ribcage. It performs over 500 different functions, including balancing chemicals in our blood, making bile for digestion, clearing toxins, and controlling blood clotting. The gallbladder is a small, pear-shaped organ nestled under the liver that stores bile. The bile ducts are a network of tubes that carry bile from the liver and gallbladder to the small intestine. The pancreas is a gland located deep in the abdomen, between the stomach and spine, that helps with digestion and blood sugar control.[4][5]
These cancers are collectively referred to as hepatobiliary cancers because they all involve organs within this interconnected system. The main types covered under this term include hepatocellular carcinoma (HCC, which is liver cancer that starts in liver cells), gallbladder cancer, intrahepatic cholangiocarcinoma (bile duct cancer inside the liver), and extrahepatic cholangiocarcinoma (bile duct cancer outside the liver).[2]
How Common Is Hepatobiliary Cancer?
Hepatobiliary cancers are highly lethal diseases that affect thousands of people each year. According to data from 2008, approximately 21,370 people in the United States were estimated to be diagnosed with liver or intrahepatic bile duct cancer, and about 9,520 with gallbladder cancer or other biliary tract cancer. The death toll from these diseases was significant, with approximately 18,410 deaths from liver or intrahepatic bile duct cancer and 3,340 deaths from gallbladder cancer or other biliary tract cancer estimated to occur that year.[2]
Hepatocellular carcinoma, the most common type of primary liver cancer in adults, is particularly concerning on a global scale. It represents the third leading cause of cancer-related deaths worldwide. Each year in the United States, about 24,500 men and 10,000 women are diagnosed with liver cancer. This shows that men are affected more frequently than women, with about 74% of all patients diagnosed between 2011 and 2015 being male.[4][7]
The median age at diagnosis is 64 years, meaning that hepatobiliary cancers tend to affect people in their later years. Liver and bile duct cancer is the 13th most common type of cancer in the United States, and only about 1% of people will be diagnosed with it during their lifetime.[7]
What Causes Hepatobiliary Cancer?
The root causes of hepatobiliary cancer are complex and vary depending on which organ is affected. For hepatocellular carcinoma, the most common hepatobiliary cancer, infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) is a major risk factor. These viruses cause long-term inflammation and damage to the liver, which can eventually lead to cancer.[2]
Certain conditions that exist before cancer develops can also increase risk. Cirrhosis, which is scarring of the liver tissue, creates an environment where cancer is more likely to develop. Cirrhosis can be caused by hepatitis infections, excessive alcohol consumption, or other liver diseases. People with nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH), conditions where extra fat builds up in the liver not caused by alcohol, are also at higher risk.[6]
A condition called hemochromatosis, where the body absorbs and stores more iron than it needs, can damage the liver over time and increase cancer risk. Eating foods contaminated with aflatoxin, a fungus that can grow on improperly stored grains and nuts, is another known cause of liver cancer.[6]
For bile duct and gallbladder cancers, the causes can be different, though some risk factors overlap with liver cancer. Each type of hepatobiliary cancer is unique with its own set of contributing factors, signs, symptoms, and prevention strategies.[1]
Who Is at Higher Risk?
Understanding risk factors helps identify who might be more vulnerable to developing hepatobiliary cancer. Being overweight or having obesity significantly increases the risk. Extra body weight, particularly around the abdomen, can lead to fatty liver disease, which over time may progress to more serious conditions including cancer.[6]
Having a long-term infection with hepatitis B or hepatitis C virus is one of the strongest risk factors. These viral infections can persist for years, causing ongoing liver damage. Smoking cigarettes and drinking alcohol excessively are harmful behaviors that damage the liver and increase cancer risk. Alcohol causes cirrhosis, and smoking introduces toxins that the liver must process.[6]
People with diabetes are at higher risk, as this condition is often linked with fatty liver disease. The connection between metabolic health and liver health is strong, and managing blood sugar levels is important for liver protection.[6]
Those who already have cirrhosis from any cause are at elevated risk for hepatocellular carcinoma. The scarred liver tissue provides a setting where cancer cells can more easily develop and grow.[6]
Recognizing the Symptoms
One of the challenges with hepatobiliary cancers is that in the early stages, they often do not cause symptoms that can be felt or noticed. This is why many cases are discovered only after the cancer has grown larger or spread. However, as the disease progresses, certain warning signs may appear.[6]
One of the most noticeable symptoms is jaundice, which is yellowing of the skin and the whites of the eyes. This happens when bile ducts become blocked, preventing bile from flowing normally. The buildup of bile pigments in the blood causes the yellow color. Jaundice is often one of the first signs that something is wrong with the liver or bile ducts.[1][13]
Abdominal pain, particularly in the upper right quadrant of the belly just below the ribcage, is another common symptom. Some people may feel a hard lump on the right side of their abdomen. Pain near the right shoulder blade or in the back can also occur as the cancer grows.[1][6]
Unintended and significant weight loss is a red flag. When the body is fighting cancer, metabolism changes and appetite decreases, leading to weight loss without trying. Along with this, many people experience a loss of appetite and decreased desire to eat. Persistent and unexplained tiredness, or fatigue, affects daily activities and doesn’t improve with rest.[1][6]
Digestive disturbances such as nausea and vomiting are common as the cancer affects organs involved in digestion. A swollen abdomen may develop due to fluid buildup, a condition called ascites. Easy bruising or bleeding can occur because the liver’s ability to produce clotting factors becomes impaired.[1][6]
It’s important to remember that these symptoms can also be caused by other, less serious health conditions. However, if you experience any of these signs, especially if they persist or worsen, it’s crucial to talk to your doctor for proper evaluation.[6]
How Can Hepatobiliary Cancer Be Prevented?
While not all cases of hepatobiliary cancer can be prevented, there are several steps you can take to significantly lower your risk. Maintaining a healthy weight through balanced eating and regular physical activity is one of the most effective preventive measures. Avoiding obesity helps prevent fatty liver disease and reduces strain on the liver.[6]
Getting vaccinated against hepatitis B is a powerful preventive tool. The hepatitis B vaccine is safe and effective, and it protects against a virus that is a major cause of liver cancer. Unfortunately, there is currently no vaccine for hepatitis C, but getting tested for hepatitis C is important. If you test positive, medical treatments are available that can cure the infection and reduce your risk of liver cancer.[6]
Avoiding excessive alcohol consumption protects the liver from damage that can lead to cirrhosis and cancer. Doctors and healthcare providers agree that people with existing liver conditions should avoid alcoholic drinks entirely. If you don’t smoke, don’t start, and if you do smoke, quitting is one of the best things you can do for your liver and overall health.[6]
Managing chronic conditions like diabetes through medication, diet, and lifestyle changes helps protect liver health. Eating a balanced diet rich in vegetables, whole grains, fish, poultry, low-fat dairy products, certain nuts, and soy is beneficial for people concerned about liver health. These foods provide nutrients that support liver function and overall health.[18]
Ensuring that grains and nuts are stored properly helps prevent contamination with aflatoxin. This is particularly important in regions where food storage conditions may not be ideal.[6]
Screening and Early Detection
Screening for hepatobiliary cancers aims to detect the disease at an early stage when treatment is more likely to be effective. For people at higher risk—such as those with hepatitis infections, cirrhosis, or family history of liver disease—regular screening can be life-saving.[1]
Screening generally involves a combination of different approaches. Imaging techniques such as ultrasound, CT scans (computed tomography), and MRI (magnetic resonance imaging) can create detailed pictures of the liver and surrounding organs, helping doctors spot abnormal growths. Blood tests that measure tumor markers (substances produced by cancer cells) and check liver function can provide additional clues about the presence of cancer.[1]
Endoscopic procedures, where a thin tube with a camera is inserted into the body, may be used when necessary to directly visualize the bile ducts and collect tissue samples. The choice of screening tools and how often screening should be done depend on the individual’s specific risk factors and the type of hepatobiliary cancer being monitored.[1]
Not all screening tests are helpful for everyone, and many have risks. It’s important to discuss with your doctor whether screening is appropriate for your situation and what the potential benefits and drawbacks might be.[5]
What Happens Inside the Body
To understand hepatobiliary cancer, it helps to know what changes occur in the body when these diseases develop. Normally, the liver performs hundreds of functions that keep us healthy. It stores nutrients, removes waste products and worn-out cells from the blood, filters and processes chemicals from food, alcohol, and medications, and produces bile to aid digestion.[6]
When cancer develops, abnormal cells grow out of control and disrupt these normal processes. In hepatocellular carcinoma, cancer cells arise from hepatocytes, the main functional cells of the liver. These cancer cells don’t perform the liver’s normal functions and instead form tumors that take up space and interfere with healthy tissue.[5]
As tumors grow, they can block blood vessels, reducing the blood supply to healthy liver tissue. They can also compress or block bile ducts, preventing bile from flowing to the small intestine. When bile can’t drain properly, it backs up into the bloodstream, causing jaundice. The blockage also interferes with digestion, as bile is needed to break down fats.[1]
Chronic inflammation from hepatitis infections or alcohol damage causes liver cells to be repeatedly injured and repaired. Over many years, this cycle of damage and repair can lead to cirrhosis, where normal liver tissue is replaced by scar tissue. Scarred liver tissue is stiff and doesn’t function properly. In this environment, genetic changes can occur in liver cells, increasing the chance that some cells will become cancerous.[2]
In bile duct cancers, abnormal cells form in the lining of the bile ducts, either inside or outside the liver. As these tumors grow, they narrow or block the ducts, preventing bile from reaching the intestine. In gallbladder cancer, abnormal cells grow in the wall of the gallbladder, which can spread to nearby organs.[5]
Cancer can also spread beyond its original location. When liver cancer cells break away from the primary tumor, they can travel through the bloodstream or lymphatic system to other parts of the body, forming new tumors. This process is called metastasis. Common sites for liver cancer to spread include the lungs and bones.[4]
Treatment Options
Treatment for hepatobiliary cancers depends on several factors, including the tumor’s size, location, grade, and stage, how well the liver is functioning, and the patient’s overall health and preferences. Because each type of hepatobiliary cancer is unique, healthcare professionals combine the latest technology with a comprehensive course of treatment options tailored to each person’s specific situation.[1][13]
Surgery is one of the main treatments for early-stage cancer that started in the liver. A partial hepatectomy involves removing the part of the liver where cancer is found, along with some healthy tissue around it. The liver has a remarkable ability to regenerate, so the remaining healthy tissue can take over the liver’s functions and may even grow back.[9]
In some cases, a liver transplant may be performed. This involves removing the entire diseased liver and replacing it with a healthy donated liver. Liver transplantation may be an option when the cancer is confined to the liver and a suitable donor liver can be found. If a person must wait for a donated liver, other treatments are given as needed to control the cancer during the waiting period.[9][13]
Ablation therapy uses heat or other methods to remove or destroy cancer tissue. Radiofrequency ablation involves inserting special needles directly into the tumor, which are then heated using radio waves to kill cancer cells. Microwave therapy exposes the tumor to high temperatures created by microwaves. Cryoablation uses extreme cold to freeze and destroy cancer cells. These treatments are often used for people who cannot have surgery because of their health status or because the cancer cannot be safely removed.[9]
Embolization therapy blocks or reduces blood flow to the tumor through the hepatic artery. Since tumors rely heavily on blood from this artery for oxygen and nutrients, cutting off this supply can stop the tumor from growing. Transarterial chemoembolization (TACE) combines blocking the artery with delivering chemotherapy drugs directly to the tumor.[9]
Chemotherapy uses medicines to kill cancer cells. For liver cancer, chemotherapy may be given directly into the blood vessels feeding the tumor. Targeted therapy drugs aim to stop cancer from growing by interfering with specific molecules involved in tumor growth. Immunotherapy drugs help the body’s immune system recognize and attack cancer cells.[1][13]
Radiation therapy uses high-energy waves similar to x-rays to kill cancer cells. A specialized type called selective internal radiation therapy (SIRT) involves injecting radioactive beads into the liver’s blood supply to deliver radiation directly to the tumor.[1]
The healthcare team looking after you will explain all available treatments, their benefits, and possible side effects. Together with your medical team, you can create a treatment plan that is best for your individual situation. Being informed and engaged in your care decisions makes all the difference.[8]
