Glenn Ellis

*The number of new cases of hepatocellular carcinoma (HCC), a type of primary liver cancer, has increased in the U.S. over the past several years, reaching an incidence rate of 3.2 cases per 100,000 persons in 2006, according to the latest figures reported by the Centers for Disease Control and Prevention (CDC) in the May 7, 2010 issue of Morbidity and Mortality Weekly Report. Blacks and people in the 50-59 year age group had the largest annual percentage increases in HCC.

In fact, I have lost a sister, and several other people close to me from liver cancer. Almost all of them did not understand how they might have avoided their situation.

The liver is the largest organ inside the body. It lies under your right ribs, just below the right lung. If you were to poke your fingers up under your right ribs, you would almost touch your liver.

The liver is shaped like a pyramid and is divided into right and left lobes. Unlike most other organs, the liver gets blood from 2 sources. The hepatic artery supplies the liver with blood that is rich in oxygen. The portal vein carries nutrient-rich blood from the intestines to the liver.

You cannot live without your liver. It has many vital jobs:

It breaks down and stores many of the nutrients absorbed from the intestine.

It makes some of the clotting factors needed to stop bleeding from a cut or injury.

It makes bile that goes into the intestine to help absorb nutrients.

It plays an important part in getting rid of toxic wastes from the body.

The liver has many other functions. Some of the functions are: to produce substances that break down fats, convert glucose to glycogen, produce urea (the main substance of urine), make certain amino acids (the building blocks of proteins), filter harmful substances from the blood (such as alcohol), storage of vitamins and minerals (vitamins A, D, K and B12) and maintain a proper level or glucose in the blood. The liver is also responsible for producing cholesterol. It produces about 80% of the cholesterol in your body. Although these are all important jobs that the liver performs they are but a few, remember there are more than 500 functions!

Because the liver is made up of different types of cells, many types of tumors can form in the liver. Some of these are cancer and some are not. Tumors that are cancer are called malignant. The medical word for tumors that are not cancer is benign. These tumors have different causes and are treated different ways. The outlook for your health or your recovery (prognosis) depends on what type of tumor you have.

Liver cancer is the third most common cancer in the world. A deadly cancer, liver cancer will kill almost all patients who have it within a year. In 2000, it was estimated that there were about 564,000 new cases of liver cancer worldwide, and a similar number of patients died as a result of this disease. About three-quarters of the cases of liver cancer are found in Southeast Asia (China, Hong Kong, Taiwan, Korea, and Japan).

Hepatocellular carcinoma (HCC): This is the most common form of liver cancer in adults. It begins in the hepatocytes, the main type of liver cell. About 3 out of 4 cancers that start in the liver are this type. HCC can have different growth patterns.

Bile duct cancers (cholangiocarcinomas): Bile duct cancers account for 1 or 2 out of every 10 cases of liver cancer. These cancers start in the small tubes (called bile ducts) that carry bile to the gallbladder.

Cancers that begin in blood vessels in the liver (angiosarcomas and hemangiosarcomas): There are rare cancers that start in the blood vessels of the liver. These tumors grow quickly. Often by the time they are found they are too widespread to be removed. Treatment may help slow the disease, but most patients do not live more than a year after these cancers are found.

Hepatoblastoma: There is a very rare kind of liver cancer that is usually found in children younger than 4 years old. About 70% of children with this disease have good outcomes with surgery and chemotherapy. The survival rate is greater than 90% for early-stage disease.

Most of the time when cancer is found in the liver it did not start there, but started somewhere else and spread to the liver. This is called metastatic cancer. This can happen to people with advanced breast cancer, colorectal cancer, lung cancer, and many other cancers, too. Under a microscope, theses cancer cells in the liver look like the cancer cells that they came from. If someone has lung cancer that has spread to the liver, the cancer cells in the liver will look and act like lung cancer cells and they will be treated the same way.

Most people don’t have signs and symptoms in the early stages of primary liver cancer. When symptoms do appear, they may include:

  • Losing weight without trying
  • Loss of appetite
  • Upper abdominal pain
  • Nausea and vomiting
  • General weakness and fatigue
  • An enlarged liver
  • Abdominal swelling
  • Yellow discoloration of your skin and the whites of your eyes (jaundice)


The liver has a considerable reserve so that a very large part of it has to be diagnosed as non-functioning before it affects the whole body. Patients with liver failure often complain of swollen ankles or an increase in their abdominal girth, which is due to fluid leaking out of the blood vessels and accumulating in other tissue and body compartments. 

Maintaining a steady glucose level also becomes increasingly difficult resulting in low blood sugar levels. This leaves a person feeling tired and unable to function well. Detoxification of ingested material is impacted leaving the brain at the mercy of unprocessed or poorly processed drugs and toxins. This results in “brain fog” which leaves a person unable to think clearly.

A classic feature of liver failure is jaundice: the yellow pigmentation of skin and the whites of our eyes (sclera) that results from deposition of bilirubin into these areas.

Bleeding and bruising is another common feature of liver failure. The body’s blood vessels and other body tissues constantly sustain minor tears even without any antecedent trauma. Clotting factors, which are key to maintaining the integrity of the blood vessels and tissues, are produced by the liver.

It’s important to meet your nutrition needs before, during, and after cancer treatment. You need the right amount of calories, protein, vitamins, and minerals. Getting the right nutrition can help you feel better and have more energy.

However, you may be uncomfortable or tired, and you may not feel like eating. You also may have side effects of treatment such as poor appetite, nausea, vomiting, or diarrhea. Your doctor, a registered dietitian, or another health care provider can advise you about ways to have a healthy diet.

Vitamin and mineral supplements may also help provide nutrients that your diet may not. Vitamins and minerals also offer a boost where the liver cancer may have depleted your body. In many situations, dietary supplements help support your immune system and reduce toxic side effects. Your dietitian may recommend daily dosages of various nutrients, including:

  • Beta carotene
  • Selenium
  • Vitamin C
  • Eicosapentaenoic acid (EPA)
  • Vitamin E
  • Others as appropriate
Careful planning and checkups are important. Liver cancer and its treatment may make it hard for you to digest food and maintain your weight. Your doctor will check you for weight loss, weakness, and lack of energy. 

The outlook for liver cancer patients depends on their overall health, as well as the type, location, and behavior of the cancer. Primary liver cancers typically do not respond well to treatment, yielding a poor outlook and low survival rates. The outlook for patients with metastatic liver cancer depends greatly on the cancers original location.

Remember, I’m not a doctor I just sound like one.

Take good care of yourself and live the best life possible!


This column is not intended as medical advice. It is for informational purposes only. If you have medical concerns, see your doctor immediately

Glenn Ellis,  is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and is  a health columnist and radio commentator who lectures, and is an active media contributor nationally and internationally on health related topics.

His second book, “Information is the Best Medicine”, is due out in Fall, 2011.

For more good health information, visit: