About Liver Cancer

About Liver Cancer

At Penn Medicine, patients with liver cancer, or hepatocellular carcinoma (HCC), receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

The Abramson Cancer Center's interdisciplinary gastrointestinal cancer program was the first of its kind. Its close collaboration with Penn Medicine's transplant program provides access to comprehensive medical and surgical care for patients who require a liver transplant. Penn Transplant Institute has performed more than 1,500 liver transplants.

The liver is the largest solid organ in the body and is located on the right side of the abdomen. The liver is responsible for such functions as filtering the blood for excess toxins, helping regulate blood sugar, creating bile for digestion, and creating enzymes responsible for blood clotting.

There are two main types of liver cancer.

  • Primary liver cancer: Cancer that forms in the tissues of the liver. The most common type is hepatocellular carcinoma (HCC).
  • Secondary liver cancer: Cancer that spreads, or metastasizes, to the liver from another part of the body like the breast, lung, thyroid or other gastrointestinal cancers.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).


Liver Cancer Risk and Prevention

There are risk factors that can increase the chance of developing liver cancer. Having a risk factor, or even several, does not mean that someone will get cancer. There are different kinds of risk factors. Some factors, like age or race, can't be changed, while other factors can be reduced by changes in lifestyle.

Hepatocellular Carcinoma (HCC) Risk Factors

Primary liver cancer, cancer that does not originate in another part of the body, affects more than 20,000 people in the United States each year, and these numbers are expected to continue to grow.

Risk factors for liver cancer include:

  • Cirrhosis. Cirrhosis is scarring of the liver and poor liver function, resulting from chronic liver disease.  There are several conditions that can cause cirrhosis:
    • Hepatitis C: Infection acquired through needle sticks, IV drug use, or a blood transfusion before 1992
    • Hepatitis B: Infection acquired through sex with an infected partner, IV drug use or, in some countries, mother-to-fetal transmission
    • Hereditary hemochromatosis: Genetic disease that causes excessive amounts of iron to be absorbed by the intestine
    • Alcohol abuse
    • Nonalcoholic steatohepatitis (NASH): Liver inflammation caused by a buildup of fat in the liver; condition is associated with obesity and diabetes
  • Tobacco use: Tobacco use has been shown to increase risk of liver cancer in some people.
  • Aflatoxin: This fungus, found in foods like grains and nuts that are not properly stored, may increase the risk for liver cancer and is associated with HCC in southern Africa.

Liver Cancer Risk Assessment

Patients with cirrhosis of the liver, or those with long standing hepatitis B or C infections, are at risk for developing liver cancer and should speak with their physician about screening options.

Liver Cancer Prevention

There are ways to reduce the risk of liver cancer:

  • Get the hepatitis B vaccine: Preventing hepatitis B infection with the hepatitis B vaccine has shown to lower the risk of liver cancer in children.
  • Eliminate tobacco use. Tobacco use has been linked to an increased risk for developing liver cancer.
  • Practice safe sex. Unprotected sex puts a person at risk for contracting many diseases including hepatitis B and C, which have been shown to increase cancer risk.
  • Don’t use IV drugs. Contaminated needles shared during drug use put people at risk for contracting hepatitis C.
  • Curb alcohol intake. Excessive amounts of alcohol, or alcohol abuse, can increase the risk of cirrhosis, a risk factor for liver cancer.

Types of Liver Cancer

There are two main types of liver cancer.

  • Primary liver cancer
  • Secondary liver cancer

Primary Liver Cancer

Primary liver cancer forms in the tissues of the liver. The most common type is hepatocellular carcinoma (HCC).

Secondary Liver Cancer

Secondary liver cancer is cancer that spreads, or metastasizes, to the liver from another part of the body like the breast, lung, thyroid or other gastrointestinal cancers.

Liver Cancer Symptoms

In its earliest stages, liver cancer is typically not associated with any symptoms. As the disease progresses, symptoms may include:

  • Jaundice or yellowing of the skin and eyes
  • Fatigue
  • Weight loss without dieting
  • Loss of appetite
  • Feeling of abdominal fullness or bloating
  • Pain and/or discomfort on the right side of the abdomen
  • Pain or discomfort that occurs in the right shoulder blade

Staging Liver Cancer

Staging systems provide doctors with a common language for describing tumors. After cancer is first diagnosed, a series of tests are used to investigate the extent of the cancer and to see whether it has spread to other parts of the body from where it started. Staging is a way of recording the size and growth of a cancer, and determining the plan for treatment. By understanding the stage of their cancer, patients can make informed decisions about their treatment.

Learn more about how liver cancer is staged using the TNM staging system.

Liver Cancer Treatment at Penn

After being diagnosed with liver cancer, patients at the Abramson Cancer Center may be evaluated through the Gastrointestinal Cancer Evaluation Center (GICEC). The center provides patients with expert support and evaluation to discuss treatment options and individualized treatment plans.

ADAM Image

Patients with liver cancer are treated by a multidisciplinary team of cancer specialists who see more patients with gastrointestinal (GI) cancers in one year than many doctors see in their careers. Physicians from gastroenterology, gastrointestinal surgery, radiology and infectious diseases meet weekly in a hepatocellular carcinoma (HCC) clinic to discuss cases.

Penn Medicine’s GI cancer physicians are nationally recognized for their expertise in the diagnosis and treatment of cancer.

Penn’s GI cancer treatment team includes:

  • Nationally recognized medical experts with years of experience in diagnosing and treating GI cancer.
  • Nurses with advanced training and experience in caring for patients with GI cancer.
  • Oncology Navigation Specialists to help patients navigate the health system.
  • Registered dietitians to provide nutrition counseling.
  • Cancer counselors to provide individual or family counseling for the physical and emotional issues many cancer patients face.
  • Rehabilitation therapists who specialize in the diagnosis and treatment of physical effects from cancer and its treatment.

Penn Medicine offers many treatment options including clinical trials for those with liver cancer. In addition to standard treatments, or treatments commonly used, clinical trials are studies meant to help improve current treatments or obtain information about new treatments.

Patients at Penn Medicine can benefit from participating in clinical trials that take place at Penn. Patients interested in learning more about clinical trials should speak with someone on their treatment team.

Penn Transplant Institute

Penn’s GI cancer program also works closely with the liver transplant team at the Penn Transplant Institute.

Patients with liver cancer who are candidates for transplant surgery are cared for by a multidisciplinary team of specialists who manage their care from the first evaluation visit to postoperative care.

Learn more about the liver transplant team at the Penn Transplant Institute.

Patient navigation Specialists

Every step of cancer treatment; from a cancer diagnosis, to surgery and treatment to forming a survivorship plan; comes with different needs and issues that should be addressed.

Oncology Navigation Specialists at the Abramson Cancer Center are available to make a patient’s experience as seamless as possible. As experts in navigating complex health care situations, Oncology Navigation Specialists serve as a consistent point of contact and a reliable source for advice, support and direction for patients and families. They can help in a variety of ways including; provide emotional support, identify resources, and ensure access to information, support services, educational programs and community resources.

Learn more about patient navigation specialists at the Abramson Cancer Center.

Diagnosing Liver Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first step in getting personalized treatment options to treat liver cancer.

Patients who choose Penn's Abramson Cancer Center, benefit from a multidisciplinary team of cancer specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and treatment plan designed specifically for each patient with liver cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing cancer and are actively researching better and more precise ways to detect liver cancer.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right person. Penn Medicine's contact center has experienced cancer nurses available and ready to guide patients in finding the cancer specialist right for them.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Diagnosing Liver Cancer

Liver Cancer Treatment

Following the diagnosis and staging of liver cancer, cancer specialists at Penn's Abramson Cancer Center develop a personalized treatment plan. Penn's treatment options for liver cancer include:

  • Surgery
  • Radiation therapy
    • 3-D conformal radiation therapy
    • Intensity-modulated radiation therapy (IMRT)
    • Volumetric-modulated arc therapy (VMAT)
    • Proton therapy
    • Stereotactic body radiotherapy
  • Chemotherapy
    • Liver-directed therapies
      • Ethanol injection
      • Chemoembolization of the hepatic artery
  • Biologic therapies
  • Other treatments

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Liver Cancer Treatment

Liver Cancer Survivorship

There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete. Survivorship programs at Penn Medicine are a distinct phase of liver cancer care and are designed to help patients transition from their cancer treatment routine to a post-cancer care lifestyle.

Read more Liver Cancer Survivorship


Maryann Volpe

"There is a plan and meaning for everyone. If you get through cancer it really does change you. It makes you a better person: you live more in the moment, you become more compassionate, and you deeply understand what other people are going through

Stand Up to Cancer

Peter O'Dwyer, MD, professor of Hematology-Oncology and program director of Development Therapeutics in the Abramson Cancer Center, was interviewed on NBC10's 10! Show about Penn's work as part of the Stand Up to Cancer Dream Team... Read more

Clinical Trials

Liver Cancer Trials

Phase III Randomized Trial of the Role of Whole Brain Radiation Therapy in Addition to Radiosurgery... more