Liver Cancer | Symptoms & Treatment | MedStar Health
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State-of-the-art liver cancer care delivered by nationally-known specialists

Liver cancer is one of the most common types of gastrointestinal cancers worldwide. While some men and women develop cancer in the liver (primary), it's more common for people to have other types of cancer that spread to the liver. When this happens, it's called secondary liver metastases. Knowing the difference is important because treatment options will vary based on where cancer begins.

At MedStar Health, we have a dedicated Liver Mass Clinic where our experts focus exclusively on evaluating benign and cancerous masses in the liver. This allows us to personalize a treatment plan that will be most effective in eliminating your cancer and improving your quality of life. We take a multidisciplinary approach to caring for you, and your care team may involve specialists with advanced training in surgery, radiation and medical oncology, gastroenterology, hepatology, liver transplant, interventional radiology, nutrition, psychology, and others.

This experienced team works together to treat hundreds of patients every year, including both adults and children. Because we offer an integrated Pancreas and Liver Disease program, our patients benefit from a full spectrum of cancer care that ranges from minimally invasive and robotic surgeries to innovative clinical trials that offer promising new treatment options⁠—and everything in between. Through the Ruesch Center for the Cure of Gastrointestinal Cancer at the Georgetown Lombardi Comprehensive Cancer Center, we also conduct and translate the latest research into clinical care that leads to exceptional outcomes for our patients.

 

Symptoms and risk factors

Yellowing of skin or pain in the abdomen could be signs of liver cancer.

Most often, people are asymptomatic in the early stages of this kind of cancer. However, if you have the following symptoms, this can be an early indicator or another related condition:

  • Pain or swelling on the right side of the abdomen
  • Yellowing of the skin and whites of the eyes (jaundice)
  • A hard lump on the right side of the abdomen below the rib cage
  • Nausea or vomiting
  • Loss of appetite or sudden weight loss
  • Unusual bowel movements that are chalky or pale

If you notice any of these symptoms, talk to your doctor.

People with Hepatitis B or Hepatitis C have an increased risk of developing cancer.

The hepatitis B and hepatitis C viruses significantly increase your risk of developing cancer in the liver. Other factors that may increase your risk are:

  • Having liver scarring (cirrhosis) caused by:
    • Hepatitis
    • Excessive alcohol use
    • A long-term liver injury
  • Having nonalcoholic fatty liver disease (NAFLD), which commonly occurs in people who have metabolic syndrome (group of conditions involving extra fat around the abdomen, high blood sugar and blood pressure, and abnormal cholesterol)
  • Having hemochromatosis, a hereditary condition that causes the body to absorb too much iron

Having a risk factor doesn't mean you will develop the disease, but you should talk to your doctor about your risk so they can help determine if you would benefit from screening.

Screening and prevention

Screening can help patients with a high risk of liver cancer detect it early while it's treatable.

Unlike breast cancer or colon cancer, there are no universal guidelines for undergoing regular screening for the entire population. However, patients who know they have one or more risk factors may benefit from a screening to identify the disease while it is more easily treated.

At MedStar Health, we offer a High-Risk Gastrointestinal Cancer Prevention program for patients with a high risk. Through the prevention program, we take a proactive and personalized approach to helping you understand and mitigate your risk of the disease through screening, genetic counseling, and other strategies. Screening tests are typically performed every six months and may include:

  • Liver MRI
  • Alpha-fetoprotein (AFP) blood test

Adequate imaging is the best way to ensure we can accurately see what's happening in the liver. That's why it's so important to seek screening at a facility that offers the latest technology and highly-trained radiologists who specialize in reading these types of test results. Because we have a team that focuses exclusively on abdominal imaging, we know the nuances of these tests and are at the forefront of advanced techniques for screening for and diagnosing.

Ways to minimize your chances of developing liver cancer

This cancer may not be preventable but you can significantly decrease your likelihood of the disease by:

  • Living a healthy lifestyle through exercise and a nutritious diet
  • Limiting alcohol use
  • Protecting yourself against hepatitis B and C infections by:
    • Getting the hepatitis B vaccine
    • Avoiding sharing unsterilized needles
    • Using protection during sex

Types of cancer

There are two categories of liver cancers, including primary and secondary. And there are several types that fall within these categories. Understanding the type of cancer you have is important because it affects which treatment options will be most effective.

Learn more about the types we treat:

Primary liver cancers

Primary liver cancer originates from within the liver itself.


  • Hepatocellular carcinoma (HCC)

    The most common type is hepatocellular carcinoma (HCC). This type comes from the liver cells called hepatocytes. A significant risk factor for HCC is chronic, long-term liver disease. These tumors require a careful and thorough initial multidisciplinary evaluation to assess both the tumor and the health of the underlying liver. There are many treatment options available, including surgical, procedural, and medical options.

  • Intrahepatic cholangiocarcinomas

    Cholangiocarcinomas are cancers of the bile duct. They can occur anywhere along the length of the bile duct, and are generally treated differently depending on their location. When it occurs in the biliary system inside the liver, it is called intrahepatic cholangiocarcinoma.

    Cholangiocarcinomas also require a thorough evaluation by a multidisciplinary team of specialists to determine which treatment is best for each patient. The options include surgical resection, chemotherapy, and sometimes liver transplantation. This continues to be an area of active investigation, and we offer clinical trials to our patients, when appropriate.

  • Hepatic sarcomas

    Hepatic sarcoma is a primary cancer of the supportive liver cells that work like glue to keep the organ together. When those cells turn to cancer, they are called liver sarcomas. Resection surgery is an effective treatment for this type of cancer.

Secondary liver cancer (liver metastases)

Secondary liver cancer, also called liver metastases, are cancers that originate from another organ and spread to the liver. These tumors are called liver metastases, and they most commonly come from other organs in the gastrointestinal tract, such as the colon or rectum. They can also come from other locations like the breast or skin.

  • Colorectal hepatic metastases

    Colorectal hepatic metastases are tumors in the liver that have spread from the colon or rectum to the liver through the blood by a special circulation called the portal venous system. If the metastases are limited to the liver, they can often be removed surgically while also treating the primary colorectal cancer. Rarely, patients who have tumors that cannot be removed by traditional surgical approaches can be considered for liver transplantation using a living liver donor.

  • Non-colorectal hepatic metastases

    Most cancers can travel to the liver and seed there, including breast cancer and pancreas cancer. We are constantly developing and improving our knowledge of various metastases. Some of these secondary cancers benefit from surgical treatment in specific circumstances. Our multidisciplinary teams will help you weigh the risks and benefits of all treatment options to find the right plan for you.

Diagnosis

Diagnostic tests give us information about the location, size, and extent of your cancer.

There are several diagnostic tests that help us detect and stage this cancer, including:

  • Blood tests: We may use a serum tumor marker test to measure the amounts of alphafetoprotein (AFP) in the blood. A high AFP level may indicate cancer, although other conditions can also elevate AFP.
  • Diagnostic imaging: Advanced imaging tests help us view your tumor and help us understand its exact size and location. Unlike other types of cancers who rely on biopsies for diagnosis, diagnostic imaging is often the best way to diagnose, if you have the right equipment used under the guidance of experienced radiologists. We may use a combination of computed tomography (CT scan), positron emission tomography (PET), magnetic resonance imaging (MRI), or ultrasound tests to accurately evaluate any abnormalities in the liver.
  • Biopsies: If we need a biopsy to diagnose, we'll take tissue samples from the liver. There are different procedures that we use to collect samples, including fine-needle and core needle biopsies and a minimally-invasive procedure called laparoscopy. We can also analyze these tissue samples to better understand the genetic or molecular characteristics (biomarkers) of the tumor which can help us predict how a tumor will respond to certain treatments.

Treatments

Advances in surgery and therapies are helping more and more patients survive.

Your liver treatment will include input from several specialists, including surgeons, medical oncologists, radiation oncologists, interventional radiologists, and others. This collaborative approach ensures we think through the least invasive and most effective way to remove your cancer and give you the best chance at living a healthier, longer life.

No two treatments are the same, and your treatment will consider:

  • The size of your liver tumor
  • How far the cancer has spread
  • How well your liver is functioning
  • Your overall health

Surgery

Many patients need surgery as part of their treatment plan, especially for early-stage cancers. We're one of the most experienced surgical teams in the region offering a full range of surgical options, from traditional open surgeries to complex procedures using minimally invasive laparoscopic and robotic approaches. These techniques offer shorter hospital stays, less pain and risk, and faster recoveries. And because our surgeons have experience performing extremely precise surgeries, we can often take out a portion of the liver and leave the healthy parts of the liver intact through a liver resection. The liver can quickly grow back to normal size after this procedure.

For patients who would benefit from a solid liver transplant, we also offer seamless, integrated care through the MedStar Georgetown Transplant Institute, the region's largest and most successful liver transplant center.

Interventional radiology

For patients who cannot safely undergo surgery or those who are waiting for a transplant, our doctors are skilled in minimally invasive techniques that use imaging to guide targeted treatments to the liver. Our experienced interventional radiologists use a wide spectrum of techniques, including those that are both standard of care and others in clinical trials that are revolutionizing how we treat primary liver tumors. These may include:

  • Ablation, which destroys early-stage tumors using:

    • Heat (microwave ablation or radiofrequency ablation)
    • Cold (cryoablation)

    • Electrical currents (irreversible electroporation)
  • Embolization, including:
    • Radioembolization, which delivers tiny radioactive particles to the hepatic artery, blocking or reducing the blood supply to the tumor while also radiating the tumor
    • Trans-arterial Chemoembolization (TACE), which delivers chemotherapy and embolizing material directly to the blood vessels feeding an intermediate liver tumor

Research shows that these treatments are most effective and safe when performed by a team who focuses exclusively on using these techniques regularly for treatment.

Chemotherapy

Chemotherapy uses medication (or a combination of medications) to kill cancer cells that have spread to the liver from other parts of the body. Other patients may receive chemotherapy if other lines of treatment haven't worked. Sometimes chemotherapy is combined with other treatments, including targeted therapy or embolization techniques. It may be given orally or through a vein to shrink intermediate tumors to improve candidacy for surgical resection or transplantation.

Immunotherapy and targeted therapy

Targeted therapy uses drugs that inhibit cancer cell growth while leaving healthy cells unharmed. This type of treatment doesn't work for everyone, but for those whose cancer has specific genes or proteins, it can be effective and less toxic than systemic therapies. We continue investigating new drugs and new combinations of drugs that target specific molecular profiles in advanced liver tumors.

Our cancer doctors and researchers are leading the way for new FDA-approved therapies that retrain the immune system to fight back against cancer cells. Immunotherapy uses a patient's immune system to find and attack cancerous tumors. Immunotherapy may be used to treat advanced cases alone or in combination with other therapies through approved medications or those under investigation in clinical trials. This approach has proven to improve survival rates for patients with advanced stage cancer, and we continue studying its effectiveness in earlier stage cancers in combination with other therapies.

Radiation therapy

Radiation therapy uses high-energy x-rays and other forms of radiation to prevent cancer cells from growing. At MedStar Health, we offer some of the latest advances in radiation therapy which allow us to deliver the most precise radiation for patients who would benefit from this type of treatment. If your tumor hasn’t responded to other treatments and can’t be surgically removed, your treatment may involve radiation, including:

  • External beam radiation, standard type of radiation therapy given over six weeks using 3D conformal radiation therapy technology or image-guided radiation therapy (IGRT)
  • Internal radiation therapy (brachytherapy), which places radioactive seeds or pellets near the tumor
  • Intraoperative radiation therapy (IORT), a leading-edge therapy that delivers a single dose of radiation within minutes during surgery
  • Proton beam therapy, an exceptionally precise accuracy and less radiation dose than traditional radiation therapies

Looking for expert cancer care?

With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.

Liver Cancer Surgery

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Our locations

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MedStar Franklin Square Cancer Center at Loch Raven Campus

5601 Loch Raven Blvd.
Russell Morgan Building
First Floor
Baltimore, MD 21239

MedStar Georgetown Cancer Institute at MedStar Franklin Square Medical Center

9103 Franklin Square Dr.
The Harry and Jeanette Weinberg Cancer Institute
Suite 220
Baltimore, MD 21237

Why choose us

Our team has decades of combined experience across a variety of specialties. Research proves that multidisciplinary cancer care leads to better clinical outcomes and experiences for patients. Through our Pancreas and Liver Disease program, patients have access to an integrated and collaborative team of doctors and surgeons who have specialty training in certain areas. Our team approach ensures we deliver comprehensive care with input from world-class specialists in:

Our surgical program is the only one of its kind in the region specializing in minimally invasive, open, and hybrid approaches to liver surgery. Our board-certified, fellowship-trained surgeons are pioneers in new techniques that lead to better outcomes, fewer complications, and faster recoveries for patients who may benefit from surgery.

And because our Center for Liver and Pancreas Surgery is part of the region's largest transplant center, the MedStar Georgetown Transplant Institute, patients benefit from seamless, coordinated care with one of the best transplant teams in the area. This is important because many patients with this cancer also have underlying liver disease that must be addressed to minimize recurrence of cancer. A liver transplant may offer the best option for restoring a patient with liver disease or cancer to a healthy life.

We offer and lead state-of-the-art therapies approved by the FDA and under discovery in clinical trials. Cancer is changing all the time. That's why it's important to get care from a place that has nationally-recognized leaders who are conducting the latest research, rather than reading it in a textbook or journal months or years after it's discovered. Our clinical trials have led to FDA-approved therapies for treating this sort of cancer, which translates into better outcomes for our patients and others seeking treatment around the world.

We deliver patient-centered care and help you navigate your treatment with compassion. Our patients are mothers, fathers, sisters, brothers, aunts, uncles, and grandparents, and we treat them with the same empathy and respect that we'd want for our own family members. From your nurses and care coordinators to your doctors and surgeons, your entire care team is here to support you, encourage you, and help you achieve the highest quality of life throughout your journey.

Awards and recognition

Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons’ Commission on Cancer (CoC)

Numerous surgeons, oncologists, and gastroenterologists recognized as "Top Doctors" by both Baltimore Magazine and the Washingtonian

Magnet® designation from the American Nurses Credentialing Center (ANCC)

Clinical trials and research

Clinical trials

Clinical trials offer patients an opportunity and hope for the treatments of the future, today. We continue improving patient care by investigating new medications, procedures, therapies to effectively treat cancer and improve our patient's quality of life. Many of these therapies are hard to find elsewhere, but we're helping them become the standard of care.

Research

Through our partnership with the area's only National Cancer Institute-designated comprehensive cancer center, the Georgetown Lombardi Comprehensive Cancer Center, we are actively involved in the latest research to advance liver cancer care. We regularly lead and participate in investigations that result in new FDA approvals paving the way for how liver cancer is treated in the future.

Patient stories

Support services

Cancer affects your body, but it can also affect your mind and spirit. That's why we offer comprehensive services that help you navigate treatment and life after cancer. From patient and family support groups and counseling to personalized follow-up care and nutritional support, we'll support you however you need us.

Genetic counseling

This cancer isn't hereditary but a family history of certain risk factors can affect your chance of developing the disease, including hepatitis B and hepatitis C infections, which can be passed down through blood. Our genetic counseling services can help you understand your risk for developing this cancer and other gastrointestinal cancers. Knowing your genetic or hereditary risk can help you take steps to lower your risk through screening and lifestyle changes.

Personalized rehabilitation

Exercise and nutrition are important for restoring your body to overall health during and after surgery and treatment. From inpatient rehabilitation following a liver transplant to physical or occupational therapy at an outpatient clinic close to home, our rehabilitation experts are here to help you regain your independence, strength, and wellness. Our patients benefit from personalized and comprehensive therapy plans tailored to address their unique challenges.

Survivorship

After treatment, we'll continue caring for you as long as you need us. Through our survivorship program, we'll help you transition back to your life with the emotional and physical support you may need. From addressing lingering pain or side effects to helping you manage your risk for recurrent cancer diagnosis or other gastrointestinal cancers, we're here for you.