Your liver is your largest internal organ. It’s on your right side under your rib cage. It helps you digest food and breaks down aging red blood cells. The liver turns these cells into bile, which helps you process fatty foods.

The liver is quite literally a factory, creating proteins that you need to live. These include proteins to help your blood clot and albumin, the most abundant protein in the body.

Cancer starts when cells in your liver grow out of control, growing into clumps of cells called tumors. Tumors disrupt liver function and can spread to other tissues and organs.

Chronic liver conditions, including fatty liver and viral hepatitis, can cause cirrhosis. This liver scarring raises your risk of liver cancer. If you have cirrhosis, your doctors will keep a close eye on you for signs of cancer. The best “cure” for liver cancer is developing healthy habits to prevent it before it starts.

Many liver cancer risk factors are at least partially under your control. Overeating and type 2 diabetes can cause fatty deposits in the liver. Unprotected sex and sharing needles can spread viral hepatitis, which causes chronic liver damage. Excessive alcohol consumption leads to cirrhosis.

At Carilion, we treat all types of cancer that affect the liver. 

Primary liver cancers include: 

• Hepatocellular carcinoma (HCC): This is the most common type of liver cancer in adults. It starts in the most common liver cells.
• HCC fibrolamellar subtype: A rare liver cancer, it most often affects women under age 35 and has a better outlook than other HCCs.
• Intrahepatic cholangiocarcinoma: This is the second most common primary liver cancer. It starts in cells that line the bile ducts, which carry bile through the liver to the gall bladder.
• Sarcoma: This is a rare liver cancer that starts in the blood vessels.
• Mixed-type tumor: This cancer has some cells that look like HCC and some that look like ICH. It’s also rare.

Cancers that spread to the liver

Cancer that starts in other organs and spreads to the liver is secondary liver cancer. They’re also called liver metastases. These aren’t liver cancer. While many people call metastases “liver cancer,” oncologists do not. 

Cancer doctors reserve the term liver cancer for the tumors that start in the liver. Almost any cancer that gets into the bloodstream can find its way to the liver. The liver is a rich source of blood and nutrients, so cancer cells often stop in this large organ and grow.

Regardless of what we call it, we treat metastatic cancer in the liver based on where it started. The common types of cancer that may spread to your liver include:

• Colorectal
• Breast
• Esophageal
• Pancreatic
• Stomach
• Lung
• Kidney 
• Melanoma

How we treat your liver cancer depends on the cancer type and how many parts of the liver have cancer. Another key factor is if blood vessels or bile ducts were in its destructive path. We’ll craft a tailored treatment plan that’s right for you and your liver cancer.

Cancer surgery

Surgery can help diagnose your cancer, see how far it has spread, and remove tumors. 

Whenever possible, our surgeons use minimally invasive techniques to reach and remove your cancer. They may use da Vinci robotic surgery, using tiny, pencil-shaped tools that fit through small incisions. During the surgery, we may also use imaging tools to help us pinpoint the tumor for removal.

Surgery to remove liver cancer and nearby parts of your liver is a partial hepatectomy. This surgery is an option if:

• You're in good health
• You have good liver function
• You have only one tumor that hasn't grown into blood vessels

Liver transplant 

Sometimes, you’ll need your entire liver removed and will need a liver transplant. We work closely with regional transplant teams to assess whether a new liver is an option for you. Our local experts meet virtually with the Massey Cancer Center team to look at biopsies and images. Together, they assess if you need a transplant. 

If the best option for liver cancer is a transplant, we can work with the transplant care center of your choice. We can also manage your pretransplant and posttransplant care.

Cancer-killing procedures

There are several less-invasive procedures we can use to damage liver cancers. They use image guidance, with the help of our interventional radiologists, to find and kill tumor cells. It typically doesn't require sutures or staples. You don’t usually need to stay in the hospital overnight.

Ablation uses a needle and image guidance to damage the cancer cells directly. 

• Cryoablation: A special probe freezes tumor cells to destroy cancer and shrink the tumor over time
• Microwave ablation: Microwaves heat and destroy the cancer cells
• Radiofrequency ablation: High-frequency energy heats and kills cancer cells

Another image-guided procedure is transarterial embolization. This treats liver tumors by cutting off their blood supply, which helps shrink the cancer.

Doctors use imaging to guide a thin tube through an artery into the liver. Then, they send tiny beads that block the blood flow to the tumor. Sometimes these beads also carry chemotherapy or radiation to help destroy the cancer cells.

Radiation therapy

We use high-energy rays to target and kill cancer cells. We aim the radiation at the cancer cells to stop their growth and potentially destroy the tumor. Advanced machines, scanners, and molding devices target the cancer, not the surrounding healthy cells.

External beam radiation therapy is a common approach. For this treatment, a machine outside your body delivers a beam focused on your tumor and nearby lymph nodes.

Cancer medicines

Compared to other cancers, liver cancer has fewer cancer medicines that work well to kill cancer cells or stop them from growing. 

Medicines for liver cancer include:

• Targeted therapy: Some cancer cells have an “Achilles’ heel” that we can use to kill the cancer cells. This approach leaves healthy cells relatively untouched. If your cancer has these targets, targeted therapies may be an option. 
• Immunotherapy: These medicines help boost your immune system to attack cancer cells.
• Non-targeted therapy: Medicines like chemotherapy kill rapidly growing cells. Most chemotherapy drugs don’t work well on liver cancer, so we don’t use these as often.

Clinical trails

Researchers continue to study new drug therapies that may work better. At Carilion, we can access some of these treatments through clinical trials. They're often part of liver cancer care, sometimes from the start.

Clinical trials compare a new medicine or protocol to the current best therapy in a trial. These studies are voluntary; you'll talk to your care team before enrolling.