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How Do I Know If I Have Liver Cancer?

Screening for early detection of primary liver cancer is not performed routinely, but it may be considered for people at high risk for the disease, even though studies haven't determined if screening is beneficial for anyone. To diagnose liver cancer, a doctor must rule out other causes of the symptoms.

Patients at high risk include alcoholics and patients with chronic hepatitis.

Additional tests include:

• Blood studies that measure tumor markers — substances elevated in the presence of a particular cancer — can aid diagnosis. Liver cancers secrete a substance called alpha fetoprotein (AFP) that is normally present in fetuses but goes away at birth. An elevated AFP in adults may indicate liver cancer.
• Imaging with ultrasound and CT scans may reveal existing tumors, but only a biopsy will distinguish a benign tumor from a malignant one.

What Are the Treatments?

Any liver cancer is difficult to cure. Primary liver cancer is rarely detectable early, when it is most treatable. Secondary or metastatic liver cancer is hard to treat because it has already spread. Also, the liver's complex network of blood vessels and bile ducts makes surgery difficult. Most treatment concentrates on making patients feel better and perhaps live longer.

Patients with early-stage tumors that can be removed surgically have the best chance of being cured. Unfortunately, most liver cancers are inoperable at diagnosis, either because the cancer is too advanced or the liver is too diseased to permit surgery. In some patients, radiation or chemotherapy reduces their tumors to operable size. After surgery, chemotherapy or low-dose radiation may help kill remaining cancer cells. Patients in remission must be monitored closely for potential recurrence. A few patients may be eligible for a liver transplant; although the procedure is risky, it offers some chance of cure.

Advanced liver cancer has no standard curative treatment. Chemotherapy and low-dose radiation may control the cancer's spread and ease pain, however these are of modest benefit in this type of cancer. Most patients receive strong painkilling medication along with drugs to relieve nausea and swelling or to improve appetite.

People with advanced liver cancer may choose to join clinical trials testing new approaches to treatment. Such studies include freezing tumor cells to kill them; using biological agents such as interferon or interleukin-2 to stimulate immune cells into attacking cancer more vigorously; and delivering lethal agents directly to cancer cells through synthetic proteins designed to target specific tumors.