Both benign (non-cancerous) and malignant (cancerous) tumors can develop in the liver. There are different types of liver tumors:
Primary liver cancer (hepatocellular carcinoma) originates in the liver.
Metastatic liver cancer, also called secondary liver cancer, has spread to the liver from other sites (such as cancer that started in the colon).
Benign liver tumors are not cancerous, and may or may not cause symptoms or require treatment.
At the Center for Advanced Digestive Care (CADC) of NewYork-Presbyterian/Weill Cornell Medical Center, patients benefit from a team of healthcare professionals with exceptional experience diagnosing and treating benign and malignant liver tumors. Gastroenterologists, surgeons, medical oncologists, radiation oncologists, radiologists, interventional radiologists, and other specialists collaborate to develop a plan of care for each patient, tailored to their individual needs. The CADC also offers clinical trials of promising new treatment approaches in an effort to advance the field, improve liver cancer prognosis, and raise the survival rate of patients with liver cancer and liver metastases.
Large mass that can be felt in upper, right part of abdomen
Jaundice (yellowing of the skin and eyes)
Because these symptoms may have other causes, it is important to have them evaluated by a physician.
Diagnosis of Liver Tumors
If a liver tumor is suspected, doctors in the CADC order tests to measure the amounts of certain substances, called "tumor markers," which are associated with liver cancer. Elevated levels of one marker, alpha-fetoprotein (AFP), may indicate the presence of liver cancer, cirrhosis, or hepatitis. Our doctors may also order liver function tests to assess the status of the liver, as well as tests to assess blood clotting and the levels of red blood cells, white blood cells, and platelets. Patients with metastatic liver cancer may have high blood levels of the markers carcinoembryonic antigen (CEA) and CA 19-9.
Other tests that we may perform to diagnose liver tumors include:
Abdominal ultrasound (also called sonography)
Computed tomography scan (CT or CAT scan)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET scan)
Liver biopsy to remove and analyze liver tissue
Primary Liver Cancer
Hepatocellular carcinoma, previously called hepatoma, is the most common form of primary liver cancer. Most patients with this tumor have underlying chronic liver disease, which has usually progressed to cirrhosis. The most common causes of primary liver cancer are chronic infection with the hepatitis B and C viruses, excessive alcohol consumption, and fatty liver disease. The CADC has a strong surveillance program for people at risk for liver cancer, particularly those with chronic hepatitis B or hepatitis C, with the hope of detecting the disease in its early, more curable stages.
Treatment of primary liver cancer depends on the stage of the disease and the patient's overall health. Therapy at the CADC may include one or more of the following approaches:
Surgery is the preferred treatment for liver cancer and offers the best chance for long-term cure. Patients with early-stage liver cancer may be candidates for liver transplantation, which is available through NewYork-Presbyterian's Center for Liver Disease and Transplantation. Patients who cannot undergo transplantation may be candidates for partial removal of liver tissue.
CADC surgeons use minimally invasive laparoscopic techniques for liver surgery whenever possible. Patients with large tumors may need an open abdominal approach.
The CADC offers chemoembolization, which may be used to treat patients with larger liver 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, resulting in fewer side effects than chemotherapies that are given systemically (throughout the whole body).
Radiofrequency ablation (RFA) is a minimally invasive treatment for small liver tumors (less than one and a half inches in diameter). This image-guided technique heats and destroys cancer cells. Imaging techniques such as ultrasound or computed tomography are used to help guide a needle electrode into the tumor. High-frequency electrical currents are then passed through the electrode, creating heat that destroys the abnormal cells.
Radiation therapy for liver cancer may be given through several approaches at the CADC. Intensity modulated radiation therapy (IMRT) delivers precisely targeted radiation directly to the tumor, while sparing healthy tissue. Stereotactic body radiotherapy (SBRT) delivers pencil-thin beams of radiation to target the diseased area.
Targeted therapies (also called biologic therapies) include drugs that aim to specifically target cancer cells or impede the growth of the blood vessels a tumor needs to grow, while generally sparing healthy cells. The most commonly used targeted therapy for primary liver cancer is sorafenib (NexavarŽ). Patients living with liver cancer who take targeted therapies may experience a better quality of life.
Metastatic Liver Cancers
Metastatic liver cancers most commonly originate in the lungs, breast, colon, small intestine, pancreas, or stomach. Leukemia and lymphoma may also affect the liver. When cancer cells break away from a primary cancer, they often travel through the bloodstream. Since the liver filters most of the blood from the rest of the body and has two blood supplies, it is a common site for cancer metastases.
The treatment of metastatic liver cancer depends on how far the cancer has spread, the size and number of tumors, and the source of the primary cancer. Treatment at the CADC may include:
The goal of chemotherapy for metastatic liver cancer is to shrink tumors, slow their growth, and prolong a patient's life. Major advances have occurred in recent years, with the development of new drugs that are more potent against cancer cells and associated with fewer side effects than conventional therapy. Drugs delivered intravenously (by vein) are most commonly used; direct infusion into the main artery of the liver (the hepatic artery) is another approach. The CADC has strong expertise in the use of chemotherapy to treat liver metastases from colorectal cancer and offers the latest approaches to improve quality of life and extend survival.
Radiation therapy for metastatic liver cancer is palliative, meaning it is used to relieve pain. Targeted radiation approaches such as IMRT and SBRT are under investigation for treating liver metastases. Some patients with metastatic liver cancer receive brachytherapy, in which radioactive seeds are implanted temporarily or permanently near the tumor to deliver pinpointed radiation to kill cancer cells.
If they are confined to one part of the liver, metastases can be removed surgically, sometimes with the chance of achieving a cure.
About 20 to 30 percent of colorectal cancer metastases in the liver can be surgically removed. Advances in surgical tools and techniques, better imaging, and a better understanding of liver anatomy now make it possible for surgeons to remove up to 75 percent of a diseased liver while leaving the remaining healthy liver tissue to regenerate itself. Whenever possible, CADC surgeons remove colorectal liver metastases using minimally invasive laparoscopy.
Surgical removal of colorectal liver metastases has been shown to significantly improve a patient's survival. In conjunction with newer chemotherapy regimens and enhanced interventional radiology techniques, CADC physicians have pushed the limits of surgery, and a growing number of patients who were once declared inoperable can now undergo surgery.
Benign (Non-Cancerous) Liver Tumors
Benign tumors of the liver are quite common and usually do not produce symptoms. As a result, many of these tumors remain undetected. When diagnosed, they are often an incidental finding when an ultrasound, CT scan, or MRI is performed for another reason.
Most benign liver tumors do not require treatment. State-of-the-art imaging and an expert opinion are essential to avoid unnecessary surgery and identify those rare cases that do require treatment. Due to the benign nature of these tumors, when surgery is indicated, CADC surgeons perform minimally invasive laparoscopy whenever possible.
There are several types of benign liver tumors, including:
A hemangioma is a benign mass of abnormal blood vessels in the liver. Up to five percent of adults have small liver hemangiomas that cause no symptoms. Most hemangiomas require no treatment; only giant hemangiomas that cause symptoms or complications require surgery.
Hepatocellular adenoma occurs most often in women of childbearing age and can be associated with oral contraceptive use. Sometimes an adenoma will rupture and bleed into the abdomen, requiring surgery. While adenomas rarely become cancerous, doctors often recommend having them removed surgically because of the risk of bleeding. Women diagnosed with hepatocellular adenoma are advised not to use oral contraceptives.
Focal Nodular Hyperplasia
Focal nodular hyperplasia occurs primarily in women of childbearing age. These tumors are the second most common tumors of the liver. Like hemangiomas, they are often easily identified by MRI. They usually appear as a single mass and have no potential for becoming cancerous. Surgeons remove focal nodular hyperplasia only when it causes symptoms.
The CADC has an extremely active research program for patients with primary liver cancer or liver metastases. Patients have access to some of the most important and advanced clinical trials in the country. These studies have included investigations assessing:
Ablative therapies for liver tumors
Hepatic pumps for chemotherapy
A new drug to prevent immune system suppression following surgery
Research has also been under way to develop gene vectors to deliver chemotherapy directly to liver metastases.