What Is Hepatocellular Carcinoma?

Hepatocellular carcinoma is a cancer that starts in your liver. It's different from "secondary"
liver cancers, which have spread to the liver from other organs.

If caught early, it can sometimes be cured with surgery or transplant. In more advanced cases
it can’t be cured, but treatment and support can help you live longer and better.

It's important to remember that you still have control over the decisions you make about your
treatment and your life. Make sure you have people you can talk to about your plans, your
fears, and your feelings. Ask your doctor about support groups, where you can meet people
who know what you're going through.

Your doctor can help you understand your treatment options. Surgery, radiation, and
chemotherapy are some of your choices.

Causes
Doctors aren't sure exactly what causes all cases of hepatocellular carcinoma, but they've
identified some things that may increase your risk for getting it:

Hepatitis B or hepatitis C. Hepatocellular cancer can start many years after you've had one
of these liver infections. Both are passed through blood, such as when drug users share
needles. Blood tests can show whether you have hepatitis B or C.

Cirrhosis. This serious disease happens when liver cells are damaged and replaced with scar
tissue. Many things can cause it: hepatitis B or C infection, alcohol drinking, certain drugs,
and too much iron stored in the liver.

Heavy drinking. Having more than two alcoholic drinks a day for many years raises your
risk of hepatocellular cancer. The more you drink, the higher your risk.

Obesity and diabetes. Both conditions raise your risk of liver cancer. Obesity can lead to
nonalcoholic fatty liver disease, which can lead to hepatocellular carcinoma. The higher risk
from diabetes may be due to high insulin levels in people with diabetes or from liver damage
caused by the disease.

Iron storage disease. This causes too much iron to be stored in the liver and other organs.
People who have it may develop hepatocellular carcinoma.

Aflatoxin. This harmful substance, which is made by certain types of mold on peanuts, corn,
and other nuts and grains, can cause hepatocellular carcinoma. The U.S. has safety measures
that limit aflatoxin in the food supply.

Symptoms
You might not have any symptoms when hepatocellular carcinoma is in an early stage. As the
cancer grows, you may have one or more of these:
  Pain in the upper right part of your belly
 A lump or feeling of heaviness in your upper belly
 Bloating or swelling in your belly
 Loss of appetite and feelings of fullness
 Weight loss
 Weakness or deep fatigue
 Nausea and vomiting
 Yellow skin and eyes
 Pale, chalky bowel movements and dark urine
 Fever

Getting a Diagnosis
Your doctor will give you a physical exam and may ask you questions like:

 Have you had any pain in your belly?

 Are you feeling weak or tired?
 Is your appetite down?
 Have you lost weight?

Your doctor may use tests to help diagnose hepatocellular carcinoma:

Blood test. Your doctor takes a sample of your blood and checks to see if it has a protein
called AFP. : Unborn babies have high levels of AFP, but it decreases in most people right
after birth. If your blood has a high amount of AFP, it could be a sign of liver cancer.

Imaging tests. Your doctor may ask you to get an ultrasound, CT scan, or MRI to look for
tumors in your liver. An ultrasound creates images of your liver with sound waves. A CT
scan is a powerful X-ray that makes detailed pictures inside your body. An MRI uses strong
magnets and radio waves to make an image of your liver.

Liver biopsy . Your doctor may want to remove a sample of your liver tissue and check it
under a microscope for cancer cells.

This can be done several ways. In one method, your doctor removes some liver tissue with a
needle that he places through your skin and into your liver. He numbs the area first so you
won't feel pain.

Your doctor may also do a biopsy by making a small cut in your belly and putting a needle
into the liver to pull out a sample of tissue. You'll get anesthesia first, so you won't be awake
while this is going on.

Questions for Your Doctor

 Has my liver cancer spread?
 What treatment do you recommend?
 What are the side effects?
 What can help my pain and treatment side effects?
 What kind of follow-up care will I need?
Treatment
There are many treatments for hepatocellular carcinoma. It's a big decision, so work closely
with your doctor to make the right plan for you.

Your choices may include:

Radiation. This uses high-energy rays to kill your cancer cells. Two types of radiation
therapy can treat hepatocellular carcinoma:

 External: You'll lie on a table while a large machine aims beams of radiation at
specific spots on your chest or belly.
 Internal: A doctor injects tiny radioactive particles into the artery that sends blood to
your liver. These block or destroy the blood supply to the tumor in your liver.

Radiation therapy can cause side effects, including nausea, vomiting, or tiredness, but these
symptoms go away when treatment is done.

Chemotherapy. To treat cancer, doctors often place chemotherapy drugs directly into your
liver. It's a process called "chemoembolization."

Your doctor puts a thin, flexible tube into the artery that supplies blood to your liver. The
tube delivers a chemo drug combined with another drug that helps to block the artery. The
goal is to kill the tumor by starving it of blood. Your liver still gets the blood it needs through
another blood vessel.

You usually get chemotherapy on an outpatient basis, which means you don't need to stay
overnight in a hospital. It can cause side effects, such as nausea and vomiting, loss of
appetite, fever and chills, headache, and weakness. You may also be more likely to get
infections, bruising, bleeding, and fatigue. Medicine can ease some of these side effects.

Alcohol injection. This is also called "percutaneous ethanol injection." An ultrasound, which
uses sound waves to see structures in your body, helps your doctor guide a thin needle into
the tumor. Then he injects ethanol (alcohol) to destroy the cancer.

You usually have this procedure under local anesthesia, which means you won't feel pain but
you're awake while this is going on.

Cryoablation and radiofrequency ablation. In cryoablation, your doctor destroys your

tumor by freezing it with a thin metal probe. While you're under anesthesia, your doctor puts
the probe into the tumor and delivers a cold gas that kills the cancer cells. A similar method,
called radiofrequency ablation, uses an electric current to kill the cancer with heat.

Surgery to remove part of your liver. Your surgeon may take out the part of your liver that
has the cancer, an operation called "partial hepatectomy." Healing time varies, but you might
have pain and discomfort for the first few days. Medicine can help control it. You may also
feel weak or tired for a while. Some people also have diarrhea and a sense of fullness in the
stomach.
Liver transplant . If your doctor can't remove your cancer through a partial hepatectomy, he
may suggest a liver transplant.

A liver transplant is major surgery. First, you'll need to get on a waiting list for a donor. Your
new liver will come from someone who recently died and has the same blood type and a
similar body size as yours. When donor livers are available, they go to the sickest people on
the waiting list. Since you may have to wait a long time for a new liver, your doctor may
suggest that you keep up with other treatments in the meantime.

You may need to stay in the hospital for up to 3 weeks after your surgery. It could take you 6
months to a year before you can return to your regular lifestyle. After your transplant, you'll
need to take drugs that prevent your body from rejecting the new liver.

If you're considering a transplant, you'll need a lot of emotional support. Ask your doctor
about support groups that have people facing the same concerns as you. Also ask about
educational workshops that can explain what to expect before and after a transplant.

Taking Care of Yourself

While you're getting treatment, there are lots of things you can do to manage side effects and
stay healthy.

Since chemotherapy can sometimes upset your stomach, you can try changing some of your
eating habits. For instance, stay away from fried or spicy foods. You can also try eating five
or six small meals a day rather than the traditional three meals.

If your treatment makes you tired, you can try to take short naps. You also might find that
short walks can help boost your energy.

If you're stressed about your treatment, sometimes deep breathing and meditation might help
you relax.

Reach out to family and friends who can give you emotional support when you need it.

What to Expect
For some people, treatment makes the cancer go away. For others, the cancer may not go
away completely or may return. If that's the case, you may need regular treatment to keep it
in check for as long as possible.

Your treatment to fight liver cancer may stop working. If that happens, you may want to
focus on making sure you're as comfortable as possible, known as palliative care. You may
not be able to control your cancer, but you control choices about how you'll live your life.

You don't have to face things alone. Consider joining a support group, where you can you
share your feelings with others who understand what it's like.
Getting Support
For more information on hepatocellular cancer, go to the web site of the American Cancer
Society. You can find out how to join support groups in your area.

You can also learn how to take part in a clinical trial, which tests new drugs to see if they are
safe and if they work. It's often a way for people to try new medicine that isn't available to
everyone.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on November 01, 2016

http://www.webmd.com/cancer/hepatocellular-carcinoma#4