• Cirrhosis
• Viral Hepatitis
• Portal Hypertension
• Liver Tumors
• Endocrine Tumors
• Liver Transplant
• Mediastinal Lesions/Masses
• Bile Duct Cancer
• Bile Duct Disorders (Noncancerous)
• Gallstones
• Obstructive Jaundice
• Ampullary Lesions and Cancers

Tumors are abnormal masses of tissue that form when cells begin to reproduce at an increased rate. The liver can grow both non-cancerous (benign) and cancerous (malignant) tumors.

Cancerous tumors in the liver either have originated in the liver (primary liver cancer) or spread from cancer sites elsewhere in the body (metastatic liver cancer).

Primary Liver Cancer

Hepatocellular carcinoma (HCC), previously called Hepatoma, is the most common form of primary liver cancer. Most patients with this tumor have underlying chronic liver disease, usually at the stage of cirrhosis. The most common causes of liver disease leading to cancer are chronic infection with hepatitis B and C viruses, excessive alcohol consumption and fatty liver disease.

For more information on liver tumors, including symptoms and risk factors, visit our Health Library.

Diagnosis

Blood Tests

If liver cancer is suspected, blood tests will measure amounts of certain substances, called tumor markers, which are linked to liver cancer. The presence of one marker, alpha-fetoprotein (AFP), may indicate liver cancer, cirrhosis, or hepatitis if levels are elevated. The status of the underlying liver is also assessed by blood tests called liver function tests. Coagulation profile and levels of red and white cells and platelets are also tested. In metastatic liver cancer other markers may be elevated including carcinoembryonic antigen (CEA) and CA 19-9.

Other tests

• abdominal ultrasound (also called sonography)
• computed tomography scan (CT or CAT scan)
• magnetic resonance imaging (MRI)
• positron emission tomography (PET Scan)
• liver biopsy in selected cases

Treatment

Treatment of primary malignant liver tumors depends on the extent of the disease both within and outside the liver and the overall health of the patient.

Surgery

Surgery is the preferred treatment for liver cancer and the one with the best prospect of long-term cure. It should be offered whenever possible. In early stages of HCC, liver transplantation is the best option, however its use is limited by organ availability. In non- transplant candidates, partial liver resection is an option. It should take into account the underlying liver disease and it may be offered to selected patients. Our surgeons use minimally invasive laparoscopic techniques for major liver resection whenever possible. For large tumors, liver resection is the method of choice and requires an open approach.

Chemotherapy

Chemoembolization, may be used for larger tumors. With this technique, chemotherapy is injected into the hepatic artery via a catheter (narrow tube). The chemotherapy is combined with a substance that blocks off this artery (usually temporarily), cutting off blood flow to the tumor and "starving" it. Much of the chemotherapy is trapped near the tumor, which works directly on the cancer, while limiting the drug's contact with the rest of the body, and causing fewer side effects than chemotherapies given systemically. The embolization is selectively applied to the area of the liver bearing the tumor and is made possible by the dual blood supply to the liver through the hepatic artery and the portal vein.

Other treatment methods include:

• Radiofrequency Ablation (RFA) is a minimally invasive, innovative treatment for small tumors. It is an image-guided technique that heats and destroys cancer cells. Imaging techniques such as ultrasound or computed tomography (CT) are used to help guide a needle electrode into a cancerous tumor. High-frequency electrical currents are then passed through the electrode, creating heat that destroys the abnormal cells. In general, radiofrequency ablation is most effective treating tumors that are less than one and a half inches in diameter (4 cm).
• Targeted Therapies, also called Biologic Therapies, contain agents that aim to specifically target cancer cells or cut off a tumor's blood supply, while generally leaving healthy cells alone. The most commonly used in primary liver cancer is Nexavar® (Sorafenib)
• Radiation Rherapy. IMRT (Intensity Modulated Radiation Therapy) delivers precisely targeted radiation directly to the tumor, which spares healthy tissue. SBRT (Stereotactic Body Radiotherapy) delivers pencil-thin beams of radiation to target the diseased area. Such treatments are currently under investigation in selected patients with Hepatocellular Carcinoma (HCC.)
• Brachytherapy is used to treat cancer that has metastasized to the liver, brachytherapy, places temporary or permanent radioactive seeds near the tumor to deliver pinpointed radiation to the cancer.
• Molecularly Targeted Oral Drugs. Investigations of new molecularly targeted oral drugs and combination therapies are showing some survival benefits. The most commonly oral drug used in primary liver cancer is Nexavar® (Sorafenib)

Clinical Trials

NewYork-Presbyterian Hospital/Weill Cornell Medical Center has an extremely active research program in liver cancer. Our medical center has pioneered many new biologic treatments for liver cancers.

Patients have access to some of the most important and advanced clinical trials in the country for liver cancer. These trials include investigations related to:

• Ablative therapies for liver tumors and hepatic pumps for chemotherapy
• Use of a new drug to prevent immune system suppression following surgery

Research is also underway aimed at developing ways to use gene vectors to deliver chemotherapy to liver metastases.

Metastatic Liver Cancers

Metastatic liver cancers most commonly originate in the lungs, breast, colon, small intestine, pancreas, or stomach. Leukemia and lymphoma may also involve the liver. These cancers spread to the liver because when cancer cells break away from a primary cancer, they often travel through the bloodstream. The liver filters most of the blood from the rest of the body and has two blood supplies, which facilitates the spread of cancer from other organs. In these cases, the other organ is considered the primary site of the cancer.

Treatment

Treatment of metastatic liver cancer depends on how far the cancer has spread, the size and number of tumors and what the primary cancer is.

Chemotherapy. The goal of chemotherapy is to shrink tumors, slow their growth and prolong life. But at the moment, chemotherapy is not able to cure the cancer. Major advances have occurred in recent years with development of new drugs that are both more potent against cancer cells and better tolerated with less adverse effects on the rest of the body. Drugs delivered intravenously are the most commonly used, but direct infusion into the main artery of the liver may also be used.

Radiation Therapy. Radiation to the liver is used to relieve pain, but will not cure the disease. IMRT (Intensity Modulated Radiation Therapy) and SBRT (Stereotactic Body Radiotherapy) are also under investigation.

Surgery. When localized in one part of the liver, metastases can be removed surgically with the possibility of achieving a cure.

The most frequent metastatic liver cancers are those from colorectal cancer. About 20% to 30% of these cancers are amenable to liver resection. Advances in surgical tools and techniques, better imagining, and a better understanding of liver anatomy now make it possible for surgeons to remove up to 75% of a diseased liver while leaving the remaining liver to regenerate itself. Whenever possible, these tumors are resected using minimally invasive laparoscopy. We offer open abdominal surgery for patients with tumors that cannot be removed laparoscopically

Resection of colorectal liver metastases has been shown to significantly improve survival and offers a real chance for cure. In conjunction with newer chemotherapy regimens and enhanced interventional radiology techniques, the limits of surgery have been pushed and a growing number of patients, once declared inoperable, can now undergo surgery.

Non-Cancerous (Benign) Tumors

Non-cancerous (benign) tumors of the liver are quite common and usually do not produce symptoms. Therefore, many of these tumors remain undetected. When diagnosed, they are often an incidental finding when an ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) scan is performed for another reason. The vast majority of these lesions do not require treatment. However, state-of-the-art imaging and expert opinion are essential to avoid unnecessary surgery and diagnose the rare cases that require treatment. Due to the benign nature of the lesions, when surgery is indicated, the laparoscopic approach is an excellent option when possible. There are several types of benign liver tumors, including:

Hemangioma is a benign mass of abnormal blood vessels. Up to five percent of adults have small liver hemangiomas that cause no symptoms. The vast majority of hemangiomas require no treatment and only giant hemangiomas causing symptoms or complications require surgery.

Hepatocellular Adenoma occurs most often in women of childbearing age and may be favored by the use of oral contraception. Sometimes, an adenoma will rupture and bleed into the abdominal cavity, requiring surgery. While adenomas rarely become cancerous, the risk of bleeding usually leads to surgical excision of proven adenomas. Continuing oral contraception is contraindicated in women with a history of liver adenoma.

Focal Nodular Hyperplasia also occurs primarily in women of childbearing age but is probably unrelated to oral contraception. After hemangiomas, these tumors are the second most common tumors of the liver. Like hemangiomas, they are often easily characterized by MRI. They usually present as a single mass and have no malignant potential. Surgery is only indicated in the rare cases that are symptomatic.