National Cancer Institute

What You Need 

To Know About TM

Liver

Cancer

U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES

National Institutes of Health
For more publications

This is only one of many free booklets for

people with cancer. 

Here’s how to get other National Cancer

Institute (NCI) booklets:

• Call the NCI Contact Center

at 1–800–4–CANCER (1–800–422–6237)

• Go to the NCI Web site at 

http://www.cancer.gov/publications

For materials in Spanish

Here’s how to get NCI materials in Spanish:

• Call the NCI Contact Center 

at 1–800–422–6237

• Go to the NCI Web site at 

http://www.cancer.gov/espanol
U.S. DEPARTMENT OF

HEALTH AND HUMAN SERVICES

National Institutes of Health

National Cancer Institute

Contents

About This Booklet 1

The Liver 3

Cancer Cells 4

Risk Factors 5

Symptoms 7

Diagnosis 8

Staging 10

Treatment 12

Second Opinion 20

Supportive Care 21

Nutrition 23

Follow-up Care 24

Sources of Support 25

Taking Part in Cancer Research 26

Dictionary 28

National Cancer Institute Services 39

National Cancer Institute Publications 40
About This Booklet

This National Cancer Institute (NCI) booklet is

about cancer* that starts in the liver (primary liver

cancer). Each year in the United States, about 15,000

men and 6,000 women are told they have primary liver

cancer. Most are over 64 years old.

1

*Words in italics are in the Dictionary on page 28. The Dictionary

explains these terms. It also shows how to pronounce them.

This booklet is only about cancer that begins in

the liver. It isn’t about cancer that spreads to the

liver from somewhere else.

It’s common for cancer to spread (metastasize)

to the liver from the colon, lungs, breasts, or other

parts of the body. When this happens, the disease

is not liver cancer. Instead, the cancer in the liver

is named for the organ or the tissue in which it

began. For example, colon cancer that spreads to

the liver is metastatic colon cancer. It is not liver

cancer.

In the United States, metastatic cancer in the

liver is far more common than primary liver

cancer.

People with metastatic cancer in the liver have

different treatment options than those with

primary liver cancer. Treatment depends mainly

on where the cancer started. Instead of this

booklet, you may want to read the NCI fact sheet

Metastatic Cancer. The NCI Contact Center at

1–800–4–CANCER (1–800–422–6237) can

send you this fact sheet, as well as other

information.
Learning about medical care for liver cancer can

help you take an active part in making choices about

your care. This booklet tells about:

• Diagnosis and staging

• Treatment and supportive care

• Taking part in research studies

This booklet has lists of questions that you may

want to ask your doctor. Many people find it helpful to

take a list of questions to a doctor visit. To help

remember what your doctor says, you can take notes or

ask whether you may use a tape recorder. You may also

want to have a family member or friend go with you

when you talk with the doctor—to take notes, ask

questions, or just listen.

For the latest information about liver cancer, please

visit the NCI Web site at http://www.cancer.gov/

cancertopics/types/liver. Also, the NCI Contact

Center can answer your questions about cancer. We can

also send you NCI booklets and fact sheets. Call

1–800–4–CANCER (1–800–422–6237) or instant

message us through the LiveHelp service at

http://www.cancer.gov/help.

This booklet is mainly about adult liver cancer. It

does not deal with childhood liver cancer. Information

about childhood liver cancer is available on the NCI

Web site and from the NCI Contact Center.

2
The Liver

The liver is the largest organ inside your abdomen.

It’s found behind your ribs on the right side of your

body.

The liver does important work to keep you healthy: 

• It removes harmful substances from the blood.

• It makes enzymes and bile that help digest food.

• It also converts food into substances needed for life

and growth.

The liver gets its supply of blood from two vessels.

Most of its blood comes from the hepatic portal vein.

The rest comes from the hepatic artery.

Intestines

Gall

bladder

Portal

vein

Hepatic

artery

Liver

Stomach

Esophagus

Ribs

Spleen

3
Cancer Cells

Cancer begins in cells, the building blocks that make

up tissues. Tissues make up the organs of the body.

Normal cells grow and divide to form new cells as

the body needs them. When normal cells grow old or

get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells

form when the body doesn’t need them, and old or

damaged cells don’t die as they should. The buildup of

extra cells often forms a mass of tissue called a growth,

nodule, or tumor.

Growths in the liver can be benign (not cancer) or

malignant (cancer). Benign tumors are not as harmful

as malignant tumors:

• Benign tumors: 

—are rarely a threat to life

—can be removed and usually don’t grow back

—don’t invade the tissues around them 

—don’t spread to other parts of the body

• Malignant growths: 

—may be a threat to life 

—sometimes can be removed but can grow back 

—can invade and damage nearby tissues and organs

(such as the stomach or intestine) 

—can spread to other parts of the body 

Most primary liver cancers begin in hepatocytes

(liver cells). This type of cancer is called

hepatocellular carcinoma or malignant hepatoma.

4
Liver cancer cells can spread by breaking away

from the original tumor. They mainly spread by

entering blood vessels, but liver cancer cells can also

be found in lymph nodes. The cancer cells may attach

to other tissues and grow to form new tumors that may

damage those tissues. See the Staging section on page

10 for information about liver cancer that has spread.

Risk Factors

When you get a diagnosis of cancer, it’s natural to

wonder what may have caused the disease. Doctors

can’t always explain why one person gets liver cancer

and another doesn’t. However, we do know that people

with certain risk factors may be more likely than others

to develop liver cancer. A risk factor is something that

may increase the chance of getting a disease.

Studies have found the following risk factors for

liver cancer:

• Infection with hepatitis B virus (HBV) or hepatitis

C virus (HCV): Liver cancer can develop after

many years of infection with either of these viruses.

Around the world, infection with HBV or HCV is

the main cause of liver cancer.

HBV and HCV can be passed from person to person

through blood (such as by sharing needles) or sexual

contact. An infant may catch these viruses from an

infected mother. Although HBV and HCV infections

are contagious diseases, liver cancer is not. You

can’t catch liver cancer from another person.

HBV and HCV infections may not cause symptoms,

but blood tests can show whether either virus is

present. If so, the doctor may suggest treatment.

Also, the doctor may discuss ways to avoid

infecting other people.

5
In people who are not already infected with HBV,

hepatitis B vaccine can prevent HBV infection.

Researchers are working to develop a vaccine to

prevent HCV infection.

• Heavy alcohol use: Having more than two drinks of

alcohol each day for many years increases the risk

of liver cancer and certain other cancers. The risk

increases with the amount of alcohol that a person

drinks.

• Aflatoxin: Liver cancer can be caused by aflatoxin,

a harmful substance made by certain types of mold.

Aflatoxin can form on peanuts, corn, and other nuts

and grains. In parts of Asia and Africa, levels of

aflatoxin are high. However, the United States has

safety measures limiting aflatoxin in the food

supply.

• Iron storage disease: Liver cancer may develop

among people with a disease that causes the body to

store too much iron in the liver and other organs.

• Cirrhosis: Cirrhosis is a serious disease that

develops when liver cells are damaged and replaced

with scar tissue. Many exposures cause cirrhosis,

including HBV or HCV infection, heavy alcohol

use, too much iron stored in the liver, certain drugs,

and certain parasites. Almost all cases of liver

cancer in the United States occur in people who first

had cirrhosis, usually resulting from hepatitis B or C

infection, or from heavy alcohol use.

• Obesity and diabetes: Studies have shown that

obesity and diabetes may be important risk factors

for liver cancer.

The more risk factors a person has, the greater the

chance that liver cancer will develop. However, many

people with known risk factors for liver cancer don’t

develop the disease.

6
Symptoms

Early liver cancer often doesn’t cause symptoms.

When the cancer grows larger, people may notice one

or more of these common symptoms: 

• Pain in the upper abdomen on the right side

• A lump or a feeling of heaviness in the upper

abdomen

• Swollen abdomen (bloating)

• Loss of appetite and feelings of fullness

• Weight loss

• Weakness or feeling very tired

• Nausea and vomiting 

• Yellow skin and eyes, pale stools, and dark urine

from jaundice

• Fever 

These symptoms may be caused by liver cancer or

other health problems. If you have any of these

symptoms, you should tell your doctor so that

problems can be diagnosed and treated as early as

possible.

7
Diagnosis

If you have symptoms that suggest liver cancer,

your doctor will try to find out what’s causing the

problems.

You may have one or more of the following tests:

• Physical exam: Your doctor feels your abdomen to

check the liver, spleen, and other nearby organs for

any lumps or changes in their shape or size. Your

doctor also checks for ascites, an abnormal buildup

of fluid in the abdomen. Also, your skin and eyes

may be checked for signs of jaundice.

• Blood tests: Many blood tests may be used to check

for liver problems. One blood test detects alphafetoprotein (AFP). High AFP levels could be a sign

of liver cancer. Other blood tests can show how well

the liver is working.

• CT scan: An x-ray machine linked to a computer

takes a series of detailed pictures of your liver and

other organs and blood vessels in your abdomen.

You may receive an injection of contrast material so

that your liver shows up clearly in the pictures. On

the CT scan, your doctor may see tumors in the liver

or elsewhere in the abdomen.

• MRI: A large machine with a strong magnet linked

to a computer is used to make detailed pictures of

areas inside your body. Sometimes contrast material

makes abnormal areas show up more clearly on the

picture.

• Ultrasound test: The ultrasound device uses sound

waves that can’t be heard by humans. The sound

waves produce a pattern of echoes as they bounce

off internal organs. The echoes create a picture

(sonogram) of your liver and other organs in the

abdomen. Tumors may produce echoes that are

different from the echoes made by healthy tissues.

8
Biopsy

A biopsy usually is not needed to diagnose liver

cancer, but in some cases, the doctor may remove a

sample of tissue. A pathologist uses a microscope to

look for cancer cells in the tissue.

The doctor may obtain tissue in one of several ways: 

• A needle through the skin: The doctor inserts a

thin needle into the liver to remove a small amount

of tissue. CT or ultrasound may be used to guide the

needle.

• Laparoscopic surgery: The surgeon makes a few

small incisions in your abdomen. A thin, lighted

tube (laparoscope) is inserted through the incision.

The laparoscope has a tool to remove tissue from

the liver.

• Open surgery: The surgeon can remove tissue from

the liver through a large incision.

9

You may want to ask the doctor these

questions before having a biopsy:

• How will the biopsy results affect my

treatment plan?

• What kind of biopsy will I have?

• How long will it take? Will I be awake? Will it

hurt?

• Is there a risk that a needle biopsy procedure

will cause the cancer to spread? What are the

chances of infection or bleeding after the

biopsy? Are there any other risks?

• How soon will I know the results? How do I

get a copy of the pathology report?

• If I do have cancer, who will talk with me

about treatment? When?
Staging

If liver cancer is diagnosed, your doctor needs to

learn the extent (stage) of the disease to help you

choose the best treatment. Staging is an attempt to find

out whether the cancer has spread, and if so, to what

parts of the body.

When liver cancer spreads, the cancer cells may be

found in the lungs. Cancer cells also may be found in

the bones and in lymph nodes near the liver.

10
When cancer spreads from its original place to

another part of the body, the new tumor has the same

kind of abnormal cells and the same name as the

primary tumor. For example, if liver cancer spreads to

the bones, the cancer cells in the bones are actually

liver cancer cells. The disease is metastatic liver

cancer, not bone cancer. It’s treated as liver cancer, not

bone cancer. Doctors sometimes call the new tumor

“distant” or metastatic disease.

To learn whether the liver cancer has spread, your

doctor may order one or more of the following tests:

• CT scan of the chest: A CT scan often can show

whether liver cancer has spread to the lungs.

• Bone scan: The doctor injects a small amount of a

radioactive substance into your blood vessel. It

travels through the bloodstream and collects in the

bones. A machine called a scanner detects and

measures the radiation. The scanner makes pictures

of the bones. The pictures may show cancer that has

spread to the bones.

• PET scan: You receive an injection of a small

amount of radioactive sugar. The radioactive sugar

gives off signals that the PET scanner picks up. The

PET scanner makes a picture of the places in your

body where the sugar is being taken up. Cancer cells

show up brighter in the picture because they take up

sugar faster than normal cells do. A PET scan shows

whether liver cancer may have spread.

11
Treatment

Treatment options for people with liver cancer are

surgery (including a liver transplant), ablation,

embolization, targeted therapy, radiation therapy, and

chemotherapy. You may have a combination of

treatments.

The treatment that’s right for you depends mainly on

the following:

• the number, size, and location of tumors in your

liver 

• how well your liver is working and whether you

have cirrhosis 

• whether the cancer has spread outside your liver

Other factors to consider include your age, general

health, and concerns about the treatments and their

possible side effects.

At this time, liver cancer can be cured only when

it’s found at an early stage (before it has spread) and

only if people are healthy enough to have surgery. For

people who can’t have surgery, other treatments may

be able to help them live longer and feel better. Many

doctors encourage people with liver cancer to consider

taking part in a clinical trial. Clinical trials are research

studies testing new treatments. They are an important

option for people with all stages of liver cancer. See

the Taking Part in Cancer Research section on page 26.

Your doctor may refer you to a specialist, or you

may ask for a referral. Specialists who treat liver

cancer include surgeons (especially hepatobiliary

surgeons, surgical oncologists, and transplant

surgeons), gastroenterologists, medical oncologists,

and radiation oncologists. Your health care team may

also include an oncology nurse and a registered

dietitian.

12
Your health care team can describe your treatment

choices, the expected results of each, and the possible

side effects. Because cancer therapy often damages

healthy cells and tissues, side effects are common.

Before treatment starts, ask your health care team

about possible side effects and how treatment may

change your normal activities. You and your health

care team can work together to develop a treatment

plan that meets your needs.

Surgery

Surgery is an option for people with an early stage

of liver cancer. The surgeon may remove the whole

liver or only the part that has cancer. If the whole liver

is removed, it’s replaced with healthy liver tissue from

a donor.

You and your surgeon can talk about the types of

surgery and which may be right for you.

Removal of part of the liver

Surgery to remove part of the liver is called partial

hepatectomy. A person with liver cancer may have part

of the liver removed if lab tests show that the liver is

working well and if there is no evidence that the cancer

has spread to nearby lymph nodes or to other parts of

the body.

The surgeon removes the tumor along with a margin

of normal liver tissue around the tumor. The extent of

the surgery depends on the size, number, and location

of the tumors. It also depends on how well the liver is

working.

As much as 80 percent of the liver may be removed.

The surgeon leaves behind normal liver tissue. The

remaining healthy tissue takes over the work of the

liver. Also, the liver can regrow the missing part. The

new cells grow over several weeks.

13
It takes time to heal after surgery, and the time

needed to recover is different for each person. You may

have pain or discomfort for the first few days.

Medicine can help control your pain. Before surgery,

you should discuss the plan for pain relief with your

doctor or nurse. After surgery, your doctor can adjust

the plan if you need more pain control.

It’s common to feel tired or weak for a while. Also,

you may have diarrhea and a feeling of fullness in the

abdomen.

The health care team will watch you for signs of

bleeding, infection, liver failure, or other problems.

Liver transplant

A liver transplant is an option if the tumors are

small, the disease has not spread outside the liver, and

suitable donated liver tissue can be found.

Donated liver tissue comes from a deceased person

or a live donor. If the donor is living, the tissue is part

of a liver, rather than a whole liver.

While you wait for donated liver tissue to become

available, the health care team monitors your health

and provides other treatments.

When healthy liver tissue from a donor is available,

the transplant surgeon removes your entire liver (total

hepatectomy) and replaces it with the donated tissue.

After surgery, your health care team will give you

medicine to help control your pain. You may need to

stay in the hospital for several weeks. During that time,

your health care team monitors how well your body is

accepting the new liver tissue. You’ll take medicine to

prevent your body’s immune system from rejecting the

new liver. These drugs may cause puffiness in your

face, high blood pressure, or an increase in body hair.

14
Ablation

Methods of ablation destroy the cancer in the liver.

They are treatments to control liver cancer and extend

life. They may be used for people waiting for a liver

transplant. Or they may be used for people who can’t

have surgery or a liver transplant. Surgery to remove

the tumor may not be possible because of cirrhosis or

other conditions that cause poor liver function, the

location of the tumor within the liver, or other health

problems.

Methods of ablation include the following: 

• Radiofrequency ablation: The doctor uses a special

probe that contains tiny electrodes to kill the cancer

cells with heat. Ultrasound, CT, or MRI may be

used to guide the probe to the tumor. Usually, the

doctor can insert the probe directly through your

skin, and only local anesthesia is needed.

Sometimes, surgery under general anesthesia is

needed. The doctor inserts the probe through a small

incision in your abdomen (using a laparoscope) or

through a wider incision that opens your abdomen.

Some people have pain or a slight fever after this

procedure. Staying overnight in the hospital is not

usually needed.

Radiofrequency ablation is a type of hyperthermia

therapy. Other therapies that use heat to destroy

liver tumors include laser or microwave therapy.

They are used less often than radiofrequency

ablation.

• Percutaneous ethanol injection: The doctor uses

ultrasound to guide a thin needle into the liver

tumor. Alcohol (ethanol) is injected directly into the

tumor and kills cancer cells. The procedure may be

performed once or twice a week. Usually local

anesthesia is used, but if you have many tumors in

the liver, general anesthesia may be needed.

15
You may have fever and pain after the injection.

Your doctor can suggest medicines to relieve these

problems.

Embolization

For those who can’t have surgery or a liver

transplant, embolization or chemoembolization may be

an option. The doctor inserts a tiny catheter into an

artery in your leg and moves the catheter into the

hepatic artery. For embolization, the doctor injects tiny

sponges or other particles into the catheter. The

particles block the flow of blood through the artery.

Depending on the type of particles used, the blockage

may be temporary or permanent.

Without blood flow from the hepatic artery, the

tumor dies. Although the hepatic artery is blocked,

healthy liver tissue continues to receive blood from the

hepatic portal vein.

For chemoembolization, the doctor injects an

anticancer drug (chemotherapy) into the artery before

injecting the tiny particles that block blood flow.

Without blood flow, the drug stays in the liver longer.

You’ll need to be sedated for this procedure, but

general anesthesia is not usually needed. You’ll

probably stay in the hospital for 2 to 3 days after the

treatment.

Embolization often causes abdominal pain, nausea,

vomiting, and fever. Your doctor can give you

medicine to help lessen these problems. Some people

may feel very tired for several weeks after the

treatment.

16
Targeted Therapy 

People with liver cancer who can’t have surgery or a

liver transplant may receive a drug called targeted

therapy. Sorafenib (Nexavar) tablets were the first

targeted therapy approved for liver cancer.

Targeted therapy slows the growth of liver tumors. It

also reduces their blood supply. The drug is taken by

mouth.

Side effects include nausea, vomiting, mouth sores,

and loss of appetite. Sometimes, a person may have

chest pain, bleeding problems, or blisters on the hands

or feet. The drug can also cause high blood pressure.

The health care team will check your blood pressure

often during the first 6 weeks of treatment.

You may want to read the NCI fact sheet Targeted

Cancer Therapies.

Radiation Therapy

Radiation therapy uses high-energy rays to kill

cancer cells. It may be an option for a few people who

can’t have surgery. Sometimes it’s used with other

approaches. Radiation therapy also may be used to

help relieve pain from liver cancer that has spread to

the bones.

Doctors use two types of radiation therapy to treat

liver cancer:

• External radiation therapy: The radiation comes

from a large machine. The machine aims beams of

radiation at the chest and abdomen.

• Internal radiation therapy: The radiation comes

from tiny radioactive spheres. A doctor uses a

catheter to inject the tiny spheres into your hepatic

artery. The spheres destroy the blood supply to the

liver tumor.

17
The side effects from radiation therapy include

nausea, vomiting, or diarrhea. Your health care team

can suggest ways to treat or control the side effects.

You may find it helpful to read the NCI booklet

Radiation Therapy and You. 

Chemotherapy

Chemotherapy, the use of drugs to kill cancer cells,

is sometimes used to treat liver cancer. Drugs are

usually given by vein (intravenous). The drugs enter

the bloodstream and travel throughout your body.

Chemotherapy may be given in an outpatient part of

the hospital, at the doctor’s office, or at home. Rarely,

you may need to stay in the hospital.

The side effects of chemotherapy depend mainly on

which drugs are given and how much. Common side

effects include nausea and vomiting, loss of appetite,

headache, fever and chills, and weakness.

Some drugs lower the levels of healthy blood cells,

and you’re more likely to get infections, bruise or

bleed easily, and feel very weak and tired. Your health

care team will check for low levels of blood cells.

Some side effects may be relieved with medicine.

You may wish to read the NCI booklet

Chemotherapy and You.

18
19

You may want to ask your doctor these

questions before your treatment begins:

• What is the stage of the disease? Has the liver

cancer spread? 

• Do I have cirrhosis?

• Do I need any more tests to determine whether

I can have surgery?

• What is the goal of treatment? What are my

treatment choices? Which do you recommend

for me? Why?

• What are the expected benefits of each kind of

treatment?

• What are the risks and possible side effects of

each treatment? How can side effects be

managed?

• Will I need to stay in the hospital? If so, for

how long?

• How will you treat my pain?

• What will the treatment cost? Will my

insurance cover it?

• How will treatment affect my normal

activities? 

• Would a clinical trial (research study) be

appropriate for me?

• How often will I need checkups?

• Can you recommend other doctors who could

give me a second opinion about my treatment

options?
Second Opinion

Before starting treatment, you may want a second

opinion about your diagnosis, the stage of cancer, and

the treatment plan. You may also want to find a

medical center that has a lot of experience with treating

people with liver cancer. You may even want to talk to

several different doctors about all of the treatment

options, their side effects, and the expected results. For

example, you could discuss your treatment plan with a

hepatobiliary surgeon, radiation oncologist, and

medical oncologist.

Some people worry that the doctor will be offended

if they ask for a second opinion. Usually the opposite

is true. Most doctors welcome a second opinion. And

many health insurance companies will pay for a second

opinion if you or your doctor requests it. Some

companies require a second opinion.

If you get a second opinion, the second doctor may

agree with your first doctor’s diagnosis and treatment

plan. Or the second doctor may suggest another

approach. Either way, you have more information and

perhaps a greater sense of control. You can feel more

confident about the decisions you make, knowing that

you’ve looked at your options.

It may take some time and effort to gather your

medical records and see another doctor. In most cases,

it’s not a problem to take several weeks to get a second

opinion. The delay in starting treatment usually will

not make treatment less effective. To make sure, you

should discuss this delay with your doctor.

20
There are many ways to find a doctor for a second

opinion. You can ask your doctor, a local or state

medical society, a nearby hospital, or a medical school

for names of specialists.

Also, you can request a consultation with specialists

at the National Institutes of Health Clinical Center in

Bethesda, Maryland. Specialists in the NCI Surgery

Branch provide consultations and surgical care for

people with liver cancer. The telephone number is

301–496–4164. The Web site is located at

http://ccr.cancer.gov/labs/lab.asp?labid=93.

The NCI Contact Center at 1–800–4–CANCER

(1–800–422–6237) can tell you about nearby

treatment centers. Other sources can be found in the

NCI fact sheet How To Find a Doctor or Treatment

Facility If You Have Cancer.

Supportive Care

Liver cancer and its treatment can lead to other

health problems. You can have supportive care before,

during, and after cancer treatment.

Supportive care is treatment to control pain and

other symptoms, to relieve the side effects of therapy,

and to help you cope with the feelings that a diagnosis

of cancer can bring. You may receive supportive care

to prevent or control these problems and to improve

your comfort and quality of life during treatment.

You can get information about supportive care 

at http://www.cancer.gov/cancerinfo/coping on the

NCI Web site and from the NCI Contact Center at

1–800–4–CANCER (1–800–422–6237) or LiveHelp

(http://www.cancer.gov/help).

21
Pain Control

Liver cancer and its treatment may lead to pain.

Your doctor or a specialist in pain control can suggest

several ways to relieve or reduce pain:

• Pain medicine: Medicines often can relieve pain.

(These medicines may make people drowsy and

constipated, but resting and taking laxatives can

help.)

• Radiation therapy: Radiation therapy can help

relieve pain by shrinking the cancer.

• Nerve block: The doctor may inject alcohol into the

area around certain nerves in the abdomen to block

the pain.

The health care team may suggest other ways to

relieve or reduce pain. For example, massage,

acupuncture, or acupressure may be used along with

other approaches. Also, you may learn to relieve pain

through relaxation techniques such as listening to slow

music or breathing slowly and comfortably.

More information about pain control can be found in

the NCI booklet Pain Control.

Sadness and Other Feelings

It’s normal to feel sad, anxious, or confused after a

diagnosis of a serious illness. Some people find it

helpful to talk about their feelings. See the Sources of

Support section on page 25.

22
Nutrition 

It’s important to meet your nutrition needs before,

during, and after cancer treatment. You need the right

amount of calories, protein, vitamins, and minerals.

Getting the right nutrition can help you feel better and

have more energy.

However, you may be uncomfortable or tired, and

you may not feel like eating. You also may have side

effects of treatment such as poor appetite, nausea,

vomiting, or diarrhea. Your doctor, a registered

dietitian, or another health care provider can advise

you about ways to have a healthy diet.

23
Careful planning and checkups are important. Liver

cancer and its treatment may make it hard for you to

digest food and maintain your weight. Your doctor will

check you for weight loss, weakness, and lack of

energy.

You may want to read the NCI booklet Eating Hints.

It contains many useful ideas and recipes.

Follow-up Care

You’ll need regular checkups (such as every 3

months) after treatment for liver cancer. Checkups help

ensure that any changes in your health are noted and

treated if needed. If you have any health problems

between checkups, you should contact your doctor.

Sometimes liver cancer comes back after treatment.

Your doctor will check for return of cancer. Checkups

may include a physical exam, blood tests, ultrasound,

CT scans, or other tests.

For people who have had a liver transplant, the

doctor will test how well the new liver is working. The

doctor also will watch you closely to make sure the

new liver isn’t being rejected. People who have had a

liver transplant may want to discuss with the doctor the

type and schedule of follow-up tests that will be

needed.

The NCI has publications to help answer questions

about follow-up care and other concerns. You may find

it helpful to read the NCI booklet Facing Forward:

Life After Cancer Treatment. You may also want to

read the NCI fact sheet Follow-up Care After Cancer

Treatment.

24
Sources of Support 

Learning that you have liver cancer can change your

life and the lives of those close to you. These changes

can be hard to handle. It’s normal for you, your family,

and your friends to need help coping with the feelings

that a diagnosis of cancer can bring.

Concerns about treatments and managing side

effects, hospital stays, and medical bills are common.

You may also worry about caring for your family,

keeping your job, or continuing daily activities.

Here’s where you can go for support:

• Doctors, nurses, and other members of your health

care team can answer questions about treatment,

working, or other activities.

• Social workers, counselors, or members of the

clergy can be helpful if you want to talk about your

feelings or concerns. Often, social workers can

suggest resources for financial aid, transportation,

home care, or emotional support.

• Support groups also can help. In these groups,

patients or their family members meet with other

patients or their families to share what they have

learned about coping with the disease and the effects

of treatment. Groups may offer support in person,

over the telephone, or on the Internet. You may want

to talk with a member of your health care team

about finding a support group.

• Information specialists at 1–800–4–CANCER

(1–800–422–6237) and at LiveHelp

(http://www.cancer.gov/help) can help you locate

programs, services, and publications. They can send

you a list of organizations that offer services to

people with cancer.

For tips on coping, you may want to read the NCI

booklet Taking Time: Support for People With Cancer.

25
Taking Part in Cancer Research

Cancer research has led to real progress in liver

cancer detection and treatment. Because of research,

people with liver cancer can look forward to a better

quality of life. Continuing research offers hope that, in

the future, even more people with this disease will be

treated successfully.

Doctors all over the world are conducting many

types of clinical trials (research studies in which people

volunteer to take part). Clinical trials are designed to

find out whether new approaches are safe and

effective.

Doctors are studying many types of treatment and

their combinations: 

• Liver transplant: The National Institute of Diabetes

and Digestive and Kidney Diseases, an agency of

the National Institutes of Health, is sponsoring the

Adult to Adult Living Donor Liver Transplantation

Cohort Study. This trial will study whether it’s better

to transplant a whole liver from a deceased donor or

a part of a liver from a living donor.

• Radiofrequency ablation and chemotherapy:

Doctors are studying the combination of

radiofrequency ablation with an anticancer drug.

• Targeted therapy: Doctors are studying new

targeted therapies with people who have liver

cancer.

Even if the people in a trial do not benefit directly,

they may still make an important contribution by

helping doctors learn more about liver cancer and how

to control it. Although clinical trials may pose some

risks, doctors do all they can to protect their patients.

26
If you’re interested in being part of a clinical trial,

talk with your doctor. You may want to read the NCI

booklet Taking Part in Cancer Treatment Research

Studies. It describes how treatment studies are carried

out and explains their possible benefits and risks.

The NCI Web site includes a section on clinical

trials at http://www.cancer.gov/clinicaltrials. It

has general information about clinical trials as

well as detailed information about specific ongoing

studies of liver cancer. The NCI Contact Center

at 1–800–4–CANCER (1–800–422–6237) and at

LiveHelp at http://www.cancer.gov/help can answer

questions and provide information about clinical trials.

27
Dictionary 

Definitions of thousands of terms are on the NCI

Web site in the NCI Dictionary of Cancer Terms. You

can access it at http://www.cancer.gov/dictionary.

Abdomen (AB-doh-men): The area of the body that

contains the pancreas, stomach, intestines, liver,

gallbladder, and other organs.

Ablation (a-BLAY-shun): In medicine, the removal or

destruction of a body part or tissue or its function.

Ablation may be performed by surgery, hormones,

drugs, radiofrequency, heat, or other methods.

Acupressure (AK-yoo-PREH-sher): The application of

pressure or localized massage to specific sites on the

body to control symptoms such as pain or nausea. It is

a type of complementary and alternative medicine.

Acupuncture (AK-yoo-PUNK-cher): The technique of

inserting thin needles through the skin at specific

points on the body to control pain and other symptoms.

It is a type of complementary and alternative medicine.

Aflatoxin (A-fluh-TOK-sin): A harmful substance

made by certain types of mold (Aspergillus flavus and

Aspergillus parasiticus) that is often found on poorly

stored grains and nuts. Consumption of foods

contaminated with aflatoxin is a risk factor for primary

liver cancer.

Alpha-fetoprotein (AL-fuh-FEE-toh-PROH-teen):

AFP. A protein normally produced by a fetus. AFP

levels are usually undetectable in the blood of healthy

adult men or women (who are not pregnant). An

elevated level of AFP suggests the presence of either a

primary liver cancer or germ cell tumor.

28
Ascites (uh-SY-teez): Abnormal buildup of fluid in the

abdomen that may cause swelling. In late-stage cancer,

tumor cells may be found in the fluid in the abdomen.

Ascites also occurs in patients with liver disease.

Benign (beh-NINE): Not cancerous. Benign tumors

may grow larger but do not spread to other parts of the

body.

Bile: A fluid made by the liver and stored in the

gallbladder. Bile is excreted into the small intestine,

where it helps digest fat.

Biopsy (BY-op-see): The removal of cells or tissues for

examination by a pathologist. The pathologist may

study the tissue under a microscope or perform other

tests on the cells or tissue.

Bone scan: A technique to create images of bones on a

computer screen or on film. A small amount of

radioactive material is injected into a blood vessel and

travels through the bloodstream; it collects in the bones

and is detected by a scanner.

Cancer (KAN-ser): A term for diseases in which

abnormal cells divide without control. Cancer cells can

invade nearby tissues and can spread to other parts of

the body through the blood and lymph systems.

Cell: The individual unit that makes up the tissues of

the body. All living things are made up of one or more

cells.

Chemoembolization (KEE-moh-EM-boh-lih-ZAYshun): A procedure in which the blood supply to the

tumor is blocked surgically or mechanically and

anticancer drugs are administered directly into the

tumor. This permits a higher concentration of drug to

be in contact with the tumor for a longer period of

time.

29
Chemotherapy (KEE-moh-THAYR-uh-pee):

Treatment with drugs that kill cancer cells.

Cirrhosis (seh-ROH-sis): A type of chronic,

progressive liver disease in which liver cells are

replaced by scar tissue.

Clinical trial: A type of research study that tests how

well new medical approaches work in people. These

studies test new methods of screening, prevention,

diagnosis, or treatment of a disease.

Contrast material: A dye or other substance that helps

to show abnormal areas inside the body. It is given by

injection into a vein, by enema, or by mouth. Contrast

material may be used with x-rays, CT scans, MRI, or

other imaging tests.

CT scan: A series of detailed pictures of areas inside

the body taken from different angles. The pictures are

created by a computer linked to an x-ray machine. Also

called CAT scan, computed tomography scan,

computerized axial tomography scan, and

computerized tomography.

Diabetes (dy-uh-BEE-teez): Any of several diseases in

which the kidneys make a large amount of urine.

Diabetes usually refers to diabetes mellitus in which

there is also a high level of glucose (a type of sugar) in

the blood because the body does not make enough

insulin or use it the way it should.

Embolization (EM-boh-lih-ZAY-shun): The blocking

of an artery by a clot or foreign material. Embolization

can be done as treatment to block the flow of blood to

a tumor.

Enzyme: A protein that speeds up chemical reactions

in the body.

External radiation therapy (RAY-dee-AY-shun

THAYR-uh-pee): A type of radiation therapy that uses

a machine to aim high-energy rays at the cancer from

30
outside of the body. Also called external beam

radiation therapy.

Gastroenterologist (GAS-troh-EN-teh-RAH-loh-jist):

A doctor who specializes in diagnosing and treating

disorders of the digestive system.

General anesthesia (A-nes-THEE-zhuh): Drugs that

cause loss of feeling or awareness and put the person

to sleep.

Hepatectomy (HEH-puh-TEK-toh-mee): Surgery to

remove all or part of the liver.

Hepatic artery (heh-PA-tik AR-tuh-ree): The major

blood vessel that carries blood to the liver.

Hepatic portal vein (heh-PA-tik POR-tul VAYN): A

blood vessel that carries blood to the liver from the

stomach, small and large intestines, spleen, pancreas,

and gallbladder. Also called portal vein.

Hepatitis B virus (HEH-puh-TY-tis VY-rus): A virus

that causes hepatitis (inflammation of the liver). It is

carried and passed to others through blood or sexual

contact. Also, infants born to infected mothers may

become infected with the virus.

Hepatitis C virus (HEH-puh-TY-tis VY-rus): A virus

that causes hepatitis (inflammation of the liver). It is

carried and passed to others through blood or sexual

contact. Also, infants born to infected mothers may

become infected with the virus.

Hepatobiliary (heh-PA-toh-BIH-lee-AYR-ee): Having

to do with the liver, bile ducts, and/or gallbladder.

Hepatocellular carcinoma (heh-PA-toh-SEL-yoo-ler

KAR-sih-NOH-muh): A type of adenocarcinoma, the

most common type of liver tumor.

Hepatocyte (heh-PA-toh-site): A liver cell.

Hepatoma (HEH-puh-TOH-ma): A liver tumor.

31
Hyperthermia therapy (HY-per-THER-mee-uh

THAYR-uh-pee): A type of treatment in which body

tissue is exposed to high temperatures to damage and

kill cancer cells or to make cancer cells more sensitive

to the effects of radiation and certain anticancer drugs.

Immune system (ih-MYOON SIS-tem): The complex

group of organs and cells that defends the body against

infections and other diseases.

Incision (in-SIH-zhun): A cut made in the body to

perform surgery.

Internal radiation therapy (in-TER-nul RAY-dee-AYshun THAYR-uh-pee): A type of radiation therapy in

which radioactive material sealed in needles, seeds,

wires, or catheters is placed directly into or near a

tumor. Also called brachytherapy, radiation

brachytherapy, and implant radiation therapy.

Intestine (in-TES-tin): The long, tube-shaped organ in

the abdomen that completes the process of digestion.

The intestine has two parts, the small intestine and the

large intestine. Also called bowel.

Intravenous (IN-truh-VEE-nus): IV. Into or within a

vein. Intravenous usually refers to a way of giving a

drug or other substance through a needle or tube

inserted into a vein.

Jaundice (JAWN-dis): A condition in which the skin

and the whites of the eyes become yellow, urine

darkens, and the color of stool becomes lighter than

normal. Jaundice occurs when the liver is not working

properly or when a bile duct is blocked.

Laparoscope (LA-puh-ruh-SKOPE): A thin, tube-like

instrument used to look at tissues and organs inside the

abdomen. A laparoscope has a light and a lens for

viewing and may have a tool to remove tissue.

32
Laparoscopic surgery (LA-puh-ruh-SKAH-pik SERjuh-ree): Surgery done with the aid of a laparoscope. A

laparoscope is a thin, tube-like instrument with a light

and a lens for viewing. It may also have a tool to

remove tissue to be checked under a microscope for

signs of disease.

Laser (LAY-zer): A device that concentrates light into

an intense, narrow beam used to cut or destroy tissue.

It is used in microsurgery, photodynamic therapy, and

for a variety of diagnostic purposes.

Liver: A large organ located in the upper abdomen.

The liver cleanses the blood and aids in digestion by

secreting bile.

Local anesthesia (A-nes-THEE-zhuh): Drugs that

cause a temporary loss of feeling in one part of the

body. The patient remains awake but cannot feel the

part of the body treated with the anesthetic.

Lymph node (limf node): A rounded mass of

lymphatic tissue that is surrounded by a capsule of

connective tissue. Lymph nodes filter lymph

(lymphatic fluid), and they store lymphocytes (white

blood cells). They are located along lymphatic vessels.

Also called a lymph gland.

Malignant (muh-LIG-nunt): Cancerous. Malignant

tumors can invade and destroy nearby tissue and

spread to other parts of the body.

Medical oncologist (MEH-dih-kul on-KAH-loh-jist):

A doctor who specializes in diagnosing and treating

cancer using chemotherapy, hormonal therapy, and

biological therapy. A medical oncologist often is the

main health care provider for someone who has cancer.

A medical oncologist also gives supportive care and

may coordinate treatment given by other specialists.

33
Metastasize (meh-TAS-tuh-size): To spread from one

part of the body to another. When cancer cells

metastasize and form secondary tumors, the cells in the

metastatic tumor are like those in the original (primary)

tumor.

Metastatic (meh-tuh-STA-tik): Having to do with

metastasis, which is the spread of cancer from one part

of the body to another.

Microwave therapy (MY-kroh-WAYV THAYR-uhpee): A type of treatment in which body tissue is

exposed to high temperatures to damage and kill

cancer cells or to make cancer cells more sensitive to

the effects of radiation and certain anticancer drugs.

Also called microwave thermotherapy.

Mold: A form of fungus. Some molds can cause

disease in humans.

MRI: Magnetic resonance imaging (mag-NEH-tik

REH-zuh-nunts IH-muh-jing). A procedure in which

radio waves and a powerful magnet linked to a

computer are used to create detailed pictures of areas

inside the body. These pictures can show the difference

between normal and diseased tissue. MRI makes better

images of organs and soft tissue than other scanning

techniques, such as computed tomography (CT) or

x-ray. MRI is especially useful for imaging the brain,

the spine, the soft tissue of joints, and the inside of

bones. Also called NMRI and nuclear magnetic

resonance imaging.

Nodule (NOD-yool): A growth or lump that may be

cancerous or noncancerous.

Obesity (oh-BEE-sih-tee): A condition marked by an

abnormally high, unhealthy amount of body fat.

34
Oncology nurse (on-KAH-loh-jee): A nurse who

specializes in treating and caring for people who have

cancer.

Organ: A part of the body that performs a specific

function. For example, the heart is an organ.

Parasite (PAYR-uh-SITE): An animal or plant that

gets nutrients by living on or in an organism of another

species.

Pathologist (puh-THAH-loh-jist): A doctor who

identifies diseases by studying cells and tissues under a

microscope.

Percutaneous ethanol injection (per-kyoo-TAY-neeus EH-thuh-nol in-JEK-shun): An injection of ethanol

(alcohol) through the skin directly into the tumor to kill

cancer cells.

PET scan: A procedure in which a small amount of

radioactive glucose (sugar) is injected into a vein, and

a scanner is used to make detailed, computerized

pictures of areas inside the body where the glucose is

used. Because cancer cells often use more glucose than

normal cells, the pictures can be used to find cancer

cells in the body. Also called positron emission

tomography scan.

Radiation (RAY-dee-AY-shun): Energy released in the

form of particles or electromagnetic waves. Common

sources of radiation include radon gas, cosmic rays

from outer space, and medical x-rays.

Radiation oncologist (RAY-dee-AY-shun on-KAHloh-jist): A doctor who specializes in using radiation to

treat cancer.

35
Radiation therapy (RAY-dee-AY-shun THAYR-uhpee): The use of high-energy radiation from x-rays,

gamma rays, neutrons, protons, and other sources to

kill cancer cells and shrink tumors. Radiation may

come from a machine outside the body (external-beam

radiation therapy), or it may come from radioactive

material placed in the body near cancer cells (internal

radiation therapy). Systemic radiation therapy uses a

radioactive substance, such as a radiolabeled

monoclonal antibody, that travels in the blood to

tissues throughout the body. Also called irradiation and

radiotherapy.

Radioactive (RAY-dee-oh-AK-tiv): Giving off

radiation.

Radiofrequency ablation (RAY-dee-oh-FREE-kwensee uh-BLAY-shun): A procedure that uses radio waves

to heat and destroy abnormal cells. The radio waves

travel through electrodes (small devices that carry

electricity). Radiofrequency ablation may be used to

treat cancer and other conditions.

Registered dietitian (dy-eh-TIH-shun): A health

professional with special training in the use of diet and

nutrition to keep the body healthy. A registered

dietitian may help the medical team improve the

nutritional health of a patient.

Risk factor: Something that may increase the chance

of developing a disease. Some examples of risk factors

for cancer include age, a family history of certain

cancers, use of tobacco products, certain eating habits,

obesity, lack of exercise, exposure to radiation or other

cancer-causing agents, and certain genetic changes.

Side effect: A problem that occurs when treatment

affects healthy tissues or organs. Some common side

effects of cancer treatment are fatigue, pain, nausea,

vomiting, decreased blood cell counts, hair loss, and

mouth sores.

36
Sonogram (SON-o-gram): A computer picture of areas

inside the body created by bouncing high-energy sound

waves (ultrasound) off internal tissues or organs. Also

called ultrasonogram.

Sorafenib (soh-RAF-eh-nib): A drug used to treat

advanced kidney cancer and a type of liver cancer that

cannot be removed by surgery. Also called Nexavar.

Spleen: An organ that is part of the lymphatic system.

The spleen makes lymphocytes, filters the blood, stores

blood cells, and destroys old blood cells. It is located

on the left side of the abdomen near the stomach.

Supportive care: Care given to improve the quality of

life of patients who have a serious or life-threatening

disease. The goal of supportive care is to prevent or

treat as early as possible the symptoms of a disease,

side effects caused by treatment of a disease, and

psychological, social, and spiritual problems related to

a disease or its treatment. Also called comfort care,

palliative care, and symptom management.

Surgeon: A doctor who removes or repairs a part of

the body by operating on the patient.

Surgery (SER-juh-ree): A procedure to remove or

repair a part of the body or to find out whether disease

is present. An operation.

Surgical oncologist (SER-jih-kul on-KAH-loh-jist): A

doctor who performs biopsies and other surgical

procedures in cancer patients.

Targeted therapy (TAR-geh-ted THAYR-uh-pee): A

type of treatment that uses drugs or other substances,

such as monoclonal antibodies, to identify and attack

specific cancer cells. Targeted therapy may have fewer

side effects than other types of cancer treatments.

Tissue (TISH-oo): A group or layer of cells that work

together to perform a specific function.

37
Transplant (TRANZ-PLANT): A surgical procedure

in which tissue or an organ is transferred from one area

of a person’s body to another area, or from one person

(the donor) to another person (the recipient).

Transplant surgeon (TRANZ-PLANT SER-jun): A

doctor who specializes in transplantation surgery. The

surgeon replaces a patient’s organ with an organ from

another person.

Tumor (TOO-mer): An abnormal mass of tissue that

results when cells divide more than they should or do

not die when they should. Tumors may be benign (not

cancerous), or malignant (cancerous). Also called

neoplasm.

Ultrasound (UL-truh-SOWND): A procedure in which

high-energy sound waves (ultrasound) are bounced off

internal tissues or organs and make echoes. The echo

patterns are shown on the screen of an ultrasound

machine, forming a picture of body tissues called a

sonogram. Also called ultrasonography.

Vaccine: A substance or group of substances meant to

cause the immune system to respond to a tumor or to

microorganisms, such as bacteria or viruses. A vaccine

can help the body recognize and destroy cancer cells or

microorganisms.

X-ray: A type of high-energy radiation. In low doses,

x-rays are used to diagnose diseases by making

pictures of the inside of the body. In high doses, x-rays

are used to treat cancer.

38
National Cancer Institute Services

You may want more information for yourself, your

family, and your doctor. The NCI offers comprehensive

research-based information for patients and their

families, health professionals, cancer researchers,

advocates, and the public.

• Call the NCI Contact Center at

1–800–4–CANCER (1–800–422–6237)

• Visit us at http://www.cancer.gov or

http://www.cancer.gov/espanol

• Chat using LiveHelp, NCI's instant messaging

service, at http://www.cancer.gov/livehelp

• E-mail us at cancergovstaff@mail.nih.gov

• Order publications at http://www.cancer.gov/

publications or by calling 1–800–4–CANCER

• Get help with quitting smoking at

1–877–44U–QUIT (1–877–448–7848)

39
National Cancer Institute Publications

NCI provides publications about cancer, including

the booklets and fact sheets mentioned in this booklet.

Many are available in both English and Spanish.

You may order these publications by telephone, on

the Internet, or by mail. You may also read them online

and print your own copy.

• By telephone: People in the United States and its

territories may order these and other NCI

publications by calling the NCI Contact Center at

1–800–4–CANCER (1–800–422–6237).

• On the Internet: Many NCI publications may be

viewed, downloaded, and ordered from

http://www.cancer.gov/publications on the

Internet. People in the United States and its

territories may use this Web site to order printed

copies. This Web site also explains how people

outside the United States can mail or fax their

requests for NCI booklets.

• By mail: NCI publications may be ordered by

writing to the address below: 

Publications Ordering Service

National Cancer Institute

P.O. Box 24128

Baltimore, MD 21227

Clinical Trials

• Taking Part in Cancer Treatment Research Studies

40
Finding a Doctor, Support Groups, or Other

Organizations

• How To Find a Doctor or Treatment Facility If You

Have Cancer (also in Spanish)

• Cancer Support Groups

• National Organizations That Offer Services to

People With Cancer and Their Families (also in

Spanish) 

Cancer Treatment and Supportive Care

• Radiation Therapy and You (also in Spanish)

• Understanding Radiation Therapy: What To Know

About External Beam Radiation Therapy (also in

Spanish)

• Chemotherapy and You (also in Spanish)

• Eating Hints for Cancer Patients (also in Spanish)

• Pain Control (also in Spanish)

Coping with Cancer

• Taking Time: Support for People with Cancer 

• Managing Radiation Therapy Side Effects: What To

Do When You Feel Weak or Tired (Fatigue) (also in

Spanish)

Life After Cancer Treatment

• Facing Forward: Life After Cancer Treatment (also

in Spanish)

• Follow-up Care After Cancer Treatment

• Facing Forward: Ways You Can Make a Difference

in Cancer

41
Advanced or Recurrent Cancer

• Coping With Advanced Cancer

• When Cancer Returns

Complementary Medicine

• Thinking about Complementary & Alternative

Medicine: A guide for people with cancer

• Complementary and Alternative Medicine in Cancer

Treatment (also in Spanish)

Caregivers

• When Someone You Love Is Being Treated for

Cancer: Support for Caregivers

• When Someone You Love Has Advanced Cancer:

Support for Caregivers

• Facing Forward: When Someone You Love Has

Completed Cancer Treatment

• Caring for the Caregiver: Support for Cancer

Caregivers

42
The National Cancer Institute 

The National Cancer Institute (NCI), part of the

National Institutes of Health, is the Federal

Government’s principal agency for cancer research

and training. NCI conducts and supports basic and

clinical research to find better ways to prevent,

diagnose, and treat cancer. The Institute also supports

education and training for cancer research and

treatment programs. In addition, NCI is responsible

for communicating its research findings to the

medical community and the public.

Copyright permission

You must have permission to use or reproduce the

artwork in this booklet for other purposes. The

artwork was created by private sector illustrators,

designers, and/or photographers, and they retain the

copyrights to artwork they develop under contract to

NCI. In many cases, artists will grant you permission,

but they may require a credit line and/or usage fees.

To inquire about permission to reproduce NCI

artwork, please write to: 

Office of Communications and Education

National Cancer Institute

6116 Executive Boulevard, Room 3066 

MSC 8323

Rockville, MD 20892–8323

You do not need our permission to reproduce or

translate NCI written text. The written text of this

NCI booklet is in the public domain, and it is not

subject to copyright restrictions. However, we would

appreciate a credit line and a copy of your translation

of this NCI booklet.
NIH Publication No.09-5009

Revised February 2009

Printed May 2009