Liver and biliary tract cancers are cancers of the liver and/or the biliary tract.
Liver and biliary tract cancer are malignancies * of the liver * , and/or the biliary tract * , the system of tubes that carry digestive juices (bile) between the liver, gallbladder * , and small intestine.
Liver cancer can be primary, meaning that it originates in the liver from liver cells, or secondary, meaning that it occurs due to the spread or metastasis * of cancer cells from some other organ. Because the body's entire blood supply is filtered through the liver, the organ is particularly susceptible to receiving cancer cells that originate in other body organs. Lung, breast, and colon cancers are particularly likely to spread to the liver. In the United States, only about 2 percent of all cancers are due to primary liver cancer.
There are a number of different types of primary liver cancers. Seventy-five percent of all primary liver cancers arise in the most prominent type of liver cell, called the hepatocyte. These cancers are called hepatocellular carcinoma. Ten to 20 percent of all primary liver cancers are the type called cholangiocarcinomas (ko-LAN-jee-oh-kar-si-NO-mah), meaning that the cancer has originated in the cells that line the bile-carrying tubes or ducts. Rarer forms of primary liver cancer originate in the blood vessels of the liver and are called angiosarcomas or hemangiosarcomas. These types of liver cancer are usually found only after they have already spread significantly. They are difficult to treat and frequently fatal within a few months after diagnosis.
Men are twice as likely as women to develop a primary liver cancer. In the United States, people over 50 years of age are also at higher risk of liver cancer. In Africa and Asia, people between 20 and 50 years of age are at high risk of developing liver cancer. Other risk factors for the development of liver cancer are diabetes * , obesity * , chronic * hepatitis * , family history of liver cancer, exposure to aflatoxin (a toxic substance produced by fungi that grow on crops such as corn, soybeans, and peanuts), diseases of the liver or bile ducts (such as cirrhosis * of the liver or the bile duct disease called primary sclerosing cholangitis), arsenic in the water supply (as can occur in some developing countries), use of anabolic steroids or male hormones, use of birth control pills, excess alcohol consumption, smoking, and exposure to toxic substances (particularly those used in plastics manufacturing).
Symptoms of liver and biliary tract cancer include unintentional weight loss; decreased appetite; a sensation of fullness after eating only a small quantity; abdominal swelling, especially in the area of the liver (on the right side of the abdomen); pain in the abdomen, sometimes stabbing through to the back and/or shoulder; yellow cast to the whites of the eyes and/or the skin (jaundice * ); itchy skin; dark urine; significant loss of energy, weakness, fatigue; nausea and vomiting; fever, chills, and/or night sweats; and increased severity of symptoms associated with preexisting hepatitis or liver cirrhosis.
Liver and biliary tract cancer may be suspected based on the presence of characteristic symptoms, as well as due to knowledge of the individual's personal or family history. A physical examination may reveal tenderness or swelling in the area of the liver. Blood tests may be ordered to see whether the liver is functioning properly and to test for levels of a substance called alpha-fetoprotein, which is elevated in liver cancer. Tests such as an ultrasound * , computed tomography * (CT) scan, or MRI * may be performed in order to visualize the liver and look for tumors. An angiogram (an-JEE-oh-gram) involves the use of dye that is injected into an artery. The dye goes through the liver's blood circulation, allowing x-rays to reveal the presence of liver tumors and demonstrating which blood vessels are feeding those liver tumors. A biopsy may be performed in order to remove a small sample of liver tissue, either with a very thin needle (fine needle aspiration), with a hollow needle (core biopsy) through a tiny incision during laparoscopic * surgery, or through a classical incision during an open operation. Examination of this tissue under a microscope allows identification of the specific type of cancer cell.
The risk of developing liver and biliary tract cancer can be lowered by making sure that people are vaccinated against hepatitis B; avoiding behaviors that increase the chance of being exposed to hepatitis C (such as sharing dirty needles, having unprotected sex, or receiving contaminated blood transfusions); improving food storage (to decrease aflatoxin exposure); discouraging smoking and excess alcohol use; and purifying drinking water.
See also Cancer: Overview
Mukherjee, Siddhartha. The Emperor of All Maladies: A Biography of Cancer. New York: Scribner, 2010.
American Cancer Society. “Liver Cancer.” http://www.cancer.org/acs/groups/cid/documents/webcontent/003114-pdf.pdf (accessed November 17, 2015).
MedlinePlus. “Liver Cancer.” U.S. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/livercancer.html (accessed November 17, 2015).
Surveillance, Epidemiology, and End Results Program. “SEER Stat Fact Sheets: Liver and Intrahepatic Bile Duct Cancer.” http://seer.cancer.gov/statfacts/html/livibd.html (accessed November 17, 2015).
American Liver Foundation. 39 Broadway, Suite 2700, New York, NY 10006. Toll-free: 800-465-4837. Website: http://www.liverfoundation . org (accessed November 17, 2015).
National Cancer Institute. 9609 Medical Center Dr., Bldg. 9609, MSC 9760, Bethesda, MD 20892-9760. Toll-free: 800-4-CANCER. Website: www.cancer.gov (accessed November 17, 2015).
* malignant (ma-LIG-nant) is a condition that is severe and progressively worsening.
* liver is a large organ located beneath the ribs on the right side of the body. The liver performs numerous digestive and chemical functions essential for health.
* biliary tract (BIH-lee-ah-ree) refers to the organs and ducts, including the liver and gallbladder, that produce, store, and transport bile, a substance that aids in digestion.
* gallbladder is a small pearshaped organ on the right side of the abdomen that stores bile, a liquid that helps the body digest fat.
* metastases (me-TAS-ta-seez) are tumors formed when cancer cells from a tumor spread to other parts of the body.
* diabetes (dye-uh-BEE-teez) is a condition in which the body's pancreas does not produce enough insulin or the body cannot use the insulin it makes effectively, resulting in increased levels of sugar in the blood. This can lead to increased urination, dehydration, weight loss, weakness, and a number of other symptoms and complications related to chemical imbalances within the body.
* obesity (o-BEE-si-tee) is an excess of body fat. People are considered obese if they weigh more than 30 percent above what is healthy for their height.
* chronic (KRAH-nik) means lasting a long time or recurring frequently.
* hepatitis (heh-puh-TIE-tis) is an inflammation of the liver. Hepatitis can be caused by viruses, bacteria, and a number of other noninfectious medical conditions.
* cirrhosis (sir-O-sis) is a condition that affects the liver, involving long-term inflammation and scarring, which can lead to problems with liver function.
* jaundice (JON-dis) is a yellowing of the skin, and sometimes the whites of the eyes, caused by a buildup in the body of bilirubin, a chemical produced in and released by the liver. An increase in bilirubin may indicate disease of the liver or certain blood disorders.
* metabolize refers to the processes within the body that are involved in converting food into energy and waste products.
* pancreas (PAN-kree-us) is a gland located behind the stomach that produces enzymes and hormones necessary for digestion and metabolism.
* ultrasound, also called a sonogram, is a diagnostic test in which sound waves passing through the body create images on a computer screen.
* computed tomography (kom-PYOO-ted toe-MAHgruhfee), or CT, also called computerized axial tomography (CAT), is a technique in which a machine takes many x-rays of the body to create a three-dimensional picture.
* MRI, short for magnetic resonance imaging, produces computerized images of internal body tissues based on the magnetic properties of atoms within the body.
* laparoscopy (lap-uh-ROS-kuhpee) is a type of surgery in which a small fiber-optic instrument is inserted through a very small incision to examine the inside of the abdomen or remove small amounts of tissue. Also called minimally invasive surgery.