Hepatic Neoplasm

Hepatic neoplasms are tumors that develop in the liver, one of the body’s largest and most vital organs. Understanding these growths, their causes, and available treatments can help patients and their families navigate this serious condition with greater confidence.

What is a Hepatic Neoplasm?
Types of Hepatic Neoplasms
The Liver and Its Function
Signs and Symptoms
Causes and Risk Factors
How Hepatic Neoplasms Are Diagnosed
Treatment Options
Living with a Hepatic Neoplasm

What is a Hepatic Neoplasm?

A hepatic neoplasm is a growth or tumor that develops in the liver. The term “hepatic” refers to the liver, while “neoplasm” means an abnormal growth of tissue. These growths can be either benign (non-cancerous) or malignant (cancerous).^[1]

Primary hepatic neoplasms are tumors that start in the liver itself. This is different from cancer that spreads to the liver from other parts of the body, which is called secondary or metastatic liver cancer. Primary neoplasms are composed of cells that resemble the normal cells found in the liver, such as liver cells called hepatocytes or cells lining the bile ducts.^[2]

It’s important to know that metastases are actually the most common type of liver tumor. In people without underlying liver disease, cancers that spread to the liver from other organs outnumber primary liver cancers by as much as 30 to 1. However, in people who have cirrhosis (scarring of the liver), primary liver cancer is much more common.^[2]

Types of Hepatic Neoplasms

There are several types of hepatic neoplasms, and understanding which type you have is important for treatment planning.^[3]

Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma, also called hepatoma or HCC, is the most common type of primary liver cancer. It develops from the main liver cells called hepatocytes. Among primary liver tumors that come to medical attention, more than three-fourths are hepatocellular carcinoma.^[2]^[4]

HCC accounts for about 85% to 90% of all primary liver cancers and is more common in people with cirrhosis. It occurs in approximately 85% of patients diagnosed with cirrhosis. Hepatocellular carcinoma is the third leading cause of cancer-related deaths worldwide.^[5]^[4]

Cholangiocarcinoma (Bile Duct Cancer)

Cholangiocarcinoma is cancer that starts in the bile ducts. Bile ducts are tubes that connect the liver and gallbladder to the small intestine and carry bile, a fluid made by the liver that helps digest fats. This type accounts for about 8% to 10% of primary liver cancers.^[2]^[6]

Cancer that starts in the ducts inside the liver is called intrahepatic cholangiocarcinoma and is considered a type of primary liver cancer. Cancer that starts in the ducts outside the liver is called extrahepatic cholangiocarcinoma.^[6]

Angiosarcoma

Angiosarcoma, also known as haemangiosarcoma, is an extremely rare type of cancer that begins in the blood vessels of the liver. It represents about 1% of all primary liver cancer cases and is most often diagnosed in older people.^[4]^[6]

Hepatoblastoma

Hepatoblastoma is a very rare type of primary liver cancer that usually affects young children. It is most often diagnosed in children under 2 years of age.^[6]

Fibrolamellar Carcinoma

Fibrolamellar carcinoma is a rare type of HCC that tends to develop in people in their 20s or 30s. Unlike other types of liver cancer, it is not usually linked with cirrhosis or infection with hepatitis B or C.^[6]

Benign Liver Tumors

Most growths in the liver are actually benign, meaning they are not cancer and usually won’t become cancerous in the future. The most common types of benign tumors in the liver include haemangioma, hepatic adenoma, and focal nodular hyperplasia. Benign tumors do not usually need treatment, though this can depend on the size of the tumor and whether it’s causing symptoms.^[6]

The Liver and Its Function

Liver
Bile ducts
Gallbladder

The liver is one of the largest organs in the body. It is a football-sized organ that sits under the right portion of your abdomen, beneath your diaphragm and beside your stomach. It fills the upper right side of the abdomen inside the rib cage.^[1]^[3]

The liver has two lobes and performs many vital functions. The liver has over 500 known functions, making it one of the most important organs in your body. No one can live without their liver.^[1]^[4]

The main functions of the liver include making bile to help digest fat that comes from food, storing glycogen (sugar) which the body uses for energy, and filtering harmful substances from the blood so they can be passed from the body. The liver also balances the chemicals in your blood, processes chemicals in food, alcohol, and medications, and regulates blood clotting.^[1]^[3]

Intrahepatic bile ducts are a network of small tubes that carry bile inside the liver. These ducts connect to form larger ducts that eventually carry bile to the gallbladder and small intestine.^[3]

Signs and Symptoms

In its early stages, liver cancer may not have symptoms that can be seen or felt. Unfortunately, you can have very early liver cancer without any symptoms. However, as the cancer grows larger, people may notice one or more common symptoms.^[4]^[7]

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. Common symptoms may include:^[3]^[4]

A hard lump on the right side just below the rib cage
Discomfort in the upper abdomen on the right side or swollen abdomen
Pain near the right shoulder blade or in the back
Jaundice (yellowing of the skin and whites of the eyes)
Easy bruising or bleeding
Unusual tiredness or weakness
Nausea and vomiting
Loss of appetite or feelings of fullness after eating a small meal
Weight loss for no known reason
Pale, chalky bowel movements and dark urine
Fever
Itchy skin

Many people with liver cancer also experience extreme fatigue. This tiredness and feeling lethargic a lot of the time are common during treatment and for some months afterwards.^[4]

Causes and Risk Factors

Liver cancer happens when something affects healthy liver cells’ DNA. DNA carries the genes that tell our cells how to function. When our DNA mutates, or changes, our cells get new instructions. Certain medical conditions and other issues can affect your liver’s DNA and increase your risk of developing liver cancer.^[4]

Cirrhosis

The most common risk factor for liver cancer is long-term liver damage leading to cirrhosis, which means scarring of the liver. Most people who have cancer in the liver (approximately 80%) have cirrhosis, although some have conditions that can lead to cirrhosis. With these conditions, unmanaged long-term liver inflammation can lead to severe scarring and, eventually, hepatic neoplasms.^[4]^[5]

HCC occurs in 80% to 90% of patients with cirrhosis. The annual incidence of HCC in patients with cirrhosis is 2% to 4%.^[5]

Viral Hepatitis

Chronic hepatitis B virus and chronic hepatitis C virus are associated with more than 70% of cases of hepatocellular carcinoma. Infection with hepatitis B or hepatitis C is a major risk factor for developing liver cancer.^[5]^[7]

The hepatitis B virus and the hepatitis C virus infection account for 56% and 20% of HCC cases diagnosed worldwide, respectively. Hepatitis B affects more than 250 million individuals worldwide and is the most common cause of chronic hepatitis worldwide. HCC can occur in the absence of cirrhosis in patients infected with the hepatitis B virus infection, though more than 80% of HBV-related HCC have underlying cirrhosis.^[5]

Yet like liver cancer itself, these hepatitis conditions often have no symptoms. That’s why universal screening is so important—because people living with chronic hepatitis may not even be aware they are at risk. The Centers for Disease Control and Prevention (CDC) now recommends that every adult over the age of 18 get tested for both conditions at least once in their lifetime.^[7]

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, is a condition that causes excess fat to build up in your liver. You’re more likely to have MASLD if you have obesity, an inherited metabolic syndrome, or Type 2 diabetes. Increasingly, people diagnosed with HCC have MASLD, a liver condition that sometimes leads to cirrhosis.^[4]^[5]

Alcohol Use

Heavy drinking of beverages containing alcohol is a significant risk factor. Alcohol is difficult for your liver to process. Drinking too much of it can eventually lead to cirrhosis and liver cancer.^[4]^[7]

Other Risk Factors

Additional conditions and behaviors that increase your risk of hepatic neoplasms include:^[4]^[7]

Being overweight or having obesity
Type 2 diabetes
Tobacco smoking
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)

Increasing age is also the most important risk factor for most cancers. HCC is two to three times more common in men, and most people diagnosed are 60 or older.^[4]

Prevention

The good news is that hepatic neoplasm’s main risk factors are treatable—or even reversed. Hepatitis B can be prevented with a vaccine, and hepatitis C can now be cured in almost all cases. Alcohol-related liver disease can improve when drinking is controlled, and fatty liver disease can regress with weight loss, better nutrition, and control of metabolic conditions like diabetes.^[7]

You can lower your risk of getting liver cancer in the following ways:^[7]

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

How Hepatic Neoplasms Are Diagnosed

Your healthcare provider will do a physical examination and ask about your symptoms. They may do several tests to diagnose hepatic neoplasms.^[4]

Blood Tests

Healthcare providers may do blood tests for cancer. They may do liver function tests to check how well your liver is working. Blood tests can also check for alpha-fetoprotein (AFP), which can mark the presence of cancer cells.^[4]

Imaging Tests

Several imaging tests can help diagnose hepatic neoplasms:^[4]

Liver ultrasound takes pictures of the inside of your liver using sound waves. This test may be used for screening people at high risk for liver cancer.^[4]

CT scan (computed tomography) takes detailed images of your liver. It gives providers information about liver tumor size and location. A triple-phase, contrast-enhanced CT scan can be used to diagnose HCC in patients with cirrhosis or other risk factors.^[4]

MRI (magnetic resonance imaging) uses a large magnet, radio waves, and a computer. It produces very clear images of your liver’s insides. Like CT scans, triple-phase MRI studies can help diagnose HCC.^[4]

Other imaging tests may include angiograms to examine your liver’s blood vessels.^[4]

Biopsy

Your provider may do a liver biopsy, which involves taking a small sample of liver tissue to examine under a microscope. However, 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. It’s important to talk to your doctor and your medical team to determine what is best for you.^[4]

Screening and Surveillance

If you belong to a high-risk group, your healthcare provider may suggest regular screenings to catch hepatic neoplasms early, when they are treatable. People with cirrhosis should have a liver ultrasound and a blood test for alpha-fetoprotein every six months. Lesions smaller than 1 cm that are detected during screening in patients at high risk do not require further diagnostic evaluation but should be followed closely at 3-month intervals.^[4]

Treatment Options

Liver cancer is often treatable, but it can be difficult to treat. The treatment you have will depend on whether the cancer started in the liver or spread from somewhere else, the size and type of liver cancer you have, where it is, if it has spread, and your general health.^[4]

The specialist care team looking after you will explain the treatments, benefits and side effects, work with you to create a treatment plan that is best for you, and help you manage any side effects.^[4]

Surgery

If liver cancer is found early, is small, and has not spread, you may be able to have surgery to remove it. Surgery will remove part or all of your liver. A partial hepatectomy removes the part of the liver where cancer is found. 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.^[4]^[10]

If the entire liver is removed, you will need a liver transplant to replace your liver with a donated one. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If you have to wait for a donated liver, other treatment is given as needed.^[10]

Recovery from surgery to treat liver cancer can take a long time. The specialist team looking after you will discuss all the benefits and side effects.^[4]

Ablation Therapy

Ablation therapy removes or destroys tissue. Different types are used for liver cancer:^[10]

Radiofrequency ablation uses special needles inserted directly through the skin or through an incision in the abdomen to reach the tumor. High-energy radio waves heat the needles and tumor which kills cancer cells.^[10]

Microwave therapy exposes the tumor to high temperatures created by microwaves. This can damage and kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs.^[10]

Percutaneous ethanol injection uses a small needle to inject ethanol (pure alcohol) directly into a tumor to kill cancer cells. Several treatments may be needed.^[10]

You may have thermal ablation to treat liver cancer if you’re not able to have surgery because you are very unwell, or the cancer cannot be removed by surgery.^[4]

Embolization Therapy

Embolization therapy uses substances to block or decrease the flow of blood through the hepatic artery to the tumor. When the tumor doesn’t get the oxygen and nutrients it needs, it will not continue to grow. This is used for people who cannot have surgery to remove the tumor or ablation therapy and whose tumor has not spread outside the liver.^[10]

Transarterial embolization (TAE) involves inserting a catheter (thin, flexible tube) through a small incision in the inner thigh and threading it up into the hepatic artery. Once the catheter is in place, a substance that blocks the hepatic artery and stops blood flow to the tumor is injected.^[10]

Transarterial chemoembolisation (TACE) is similar to TAE except an anticancer drug is also given. For liver cancer, the chemotherapy medicine is usually given into the blood vessels of the cancer. It aims to stop the cancer growing.^[4]^[10]

Targeted Medicines

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.^[4]

For advanced HCC, the standard of care is the immunotherapy combination of the checkpoint inhibitor atezolizumab and the targeted antibody bevacizumab. There are currently several FDA-approved immunotherapy options for liver cancer, including checkpoint inhibitors that target different pathways.^[16]

Radiotherapy

Radiotherapy is where radiation is used to kill cancer cells. A type of radiotherapy called selective internal radiation therapy (SIRT) is sometimes used to treat liver cancer. This is where radioactive beads are injected into your liver’s blood supply to stop the cancer growing. You may have SIRT for liver cancer if you’re an adult and your liver has not been too badly damaged and the cancer cannot be removed by surgery.^[4]

Treatment by Stage

Treatment approaches vary depending on the stage of the cancer. For early stage liver cancer, surgery or liver transplant may be possible. For intermediate stages, embolization therapies are often used. For advanced or metastatic liver cancer, targeted medicines and immunotherapy are the main treatment options. If cancer comes back (recurs) after treatment, additional treatments may be considered based on the location and extent of recurrence.^[10]

Advanced Cancer Care

If you have advanced liver cancer, it might be very hard to treat. It may not be possible to cure the cancer. If this is the case, the aim of your treatment will be to limit the cancer and its symptoms, and help you live longer. You will be referred to a special team of doctors and nurses called the palliative care team or symptom control team. They will work with you to help manage your symptoms and make you feel more comfortable.^[4]

Living with a Hepatic Neoplasm

Diet and Nutrition

Liver cancer and its treatment can cause physical problems that affect your ability to eat and drink. You may have jaundice, feel sick, or experience fatigue. An enlarged liver can make you feel full, as it takes up space in your abdomen which can squash your stomach.^[19]

A balanced diet is good for your health and can be an important factor as you move forward with liver cancer. 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.^[19]

If you have jaundice, the flow of bile into your digestive system is blocked. Bile helps your body digest fat, so it’s best not to eat too many fatty foods. If you are recovering from surgery, you need protein to help your body repair itself.^[19]

Some helpful tips include eating several small meals a day instead of fewer larger ones, having whatever you feel like rather than forcing yourself to eat things you don’t fancy, and keeping cold foods and drinks available if you feel sick. Do ask for advice at your treatment centre. You may be able to see a dietician, who can help to work out a diet programme that suits you.^[19]

Once you’ve been diagnosed with liver cancer, try to avoid things that might further damage the liver, including alcohol and smoking. Otherwise, try to be as healthy as possible by maintaining a healthy diet and regular exercise.^[4]

Physical Activity and Exercise

Getting some exercise is important. Walking, swimming, and biking are low-impact activities that can help maintain your strength and energy. Resting but also doing some gentle physical activity can help manage tiredness and fatigue. It’s important to balance activity with rest.^[19]

Emotional Support

Coping with cancer can be difficult. You may feel a range of powerful emotions such as feeling shocked and upset, numb, frightened and uncertain, confused, angry and resentful, guilty, or sad. You may have some or all of these feelings, or you might feel totally different. Everyone reacts in their own way.^[22]

Talking to your friends and relatives about your cancer can help and support you. But some people are scared of the emotions this could bring up and won’t want to talk. Help your family and friends by letting them know if you would like to talk about what’s happening and how you feel.^[22]

You might find it easier to talk to someone other than your own friends and family. You may prefer to see a counsellor. Support groups can also help you connect with others going through similar experiences.^[22]

Managing Physical Changes

Liver cancer and its treatment may cause physical changes in your body. You might have jaundice which can cause very dry itchy skin. You might lose weight. You might have a swollen abdomen (ascites) that is uncomfortable. You might feel sick or have pain. These changes can be difficult to cope with and may affect the way you feel about yourself.^[22]

Community cancer nurses or symptom control nurses can help to support you at home if you have advanced cancer. Your local hospice may be able to help you with complementary therapies, counselling, or short stays to give you a break or to help with symptoms.^[22]

Follow-up Care

You’ll have regular check-ups during and after any treatments. You may also have tests and scans. If you have any symptoms or side effects that you are worried about, talk to your specialists. You do not need to wait for your next check-up.^[4]

Financial and Practical Support

Dealing with cancer can bring extra costs and financial concerns. There may be financial assistance available to help with treatment costs, travel expenses, and other practical needs. Ask your healthcare team about resources that might be available to you.^[22]