What Are The Symptoms of Liver Cancer

As an expert liver surgeon, one of the most common questions that Dr. Sucandy hear from his patients is what are the first symptoms of liver cancer.  Just like many other diseases in the abdomen, people expect to have symptoms such as pain, bloatedness, increased abdominal girth, weight loss, bloody bowel movements, unintentional weight loss, tiredness, etc.  But how about for liver cancer? Are we expecting to see similar signs or symptoms?

Unfortunately, 80% of liver cancer are without symptoms or warning, which make it difficult to diagnose at an early stage.  This subsequently leads to poor outcomes sincemany liver cancers are no longer surgically resectable upon diagnosis. The only hope for cure for a liver cancer is via a curative liver resection, ablation, or transplantation (following a strict criteria for only certain type of tumor).  This principle was true 30 years ago and still holds true today. There have been no drugs or radiation that can cure liver cancer.  Many of the metastatic liver cancers from colon cancer, breast cancer, lung cancer, rectal cancer, soft tissue cancers (sarcomas), and ovarian cancer are only incidentally found during a CT scan surveillance.  Due to the amazing ability of the liver to compensate and regenerate, even a large liver tumor >10cm can be unknown.

In 20% of patients, signs and symptoms of liver cancer include upper abdominal pain, constant bloatedness, early satiety, unintentional weight loss, and jaundice.  First symptoms of liver cancer may be unique to each patients,  depending on the type, size, and location of the liver tumor.  A large liver cancer located within the left lobe of the liver often presents as vaque epigastric pain and early satiety, while others located next to the gallbladder may present as jaundice (yellowing of eyes) and darkening of urine color.  A small liver tumor externally compressing the bile duct can mimic bile duct cancer or pancreatic cancer. A liver tumor located near the liver capsule often triggers a constant dull annoying pain, which is further worsened when it is in contact with rib cage. Therefore, having the first symptoms of liver cancer mentioned above should prompt an immediate medical evaluation or a surgical consultation with a liver specialist or a liver surgeon.

For patients with hepatocellular carcinoma liver cancer, a varying degree of liver cirrhosis is present in more than 85% of patients. In the USA, liver cirrhosis is usually caused by excessive alcohol drinking, hepatitis B and C viral infection, and a long-term morbid obesity leading to steatohepatitis (fatty liver disease). Symptoms of liver cancer and cirrhosis in this circumstance include weight gain due to development ascites (excessive fluid accumulation in the abdomen), abnormal gastrointestinal bleeding due to esophageal varices, generalized weakness, confusion, and presence of dilated veins within the abdominal wall (caput medusae). All of these should also prompt an evaluation by a liver specialist.

The initial evaluation includes a laboratory workup to see the overall liver function,  certain tumor markers, and a CT scan to rule out presence of liver tumor. An MRI scan sometimes help in more specific characterization of liver tumors,  better than a CT scan or ultrasound.  If a metastatic liver cancer is suspected, an investigation of the primary organ needs to start. For example, if a liver cancer is suspected to be originating from the colon and rectum, a colonoscopy is needed.  If a liver cancer is suspected to be coming from the breasts in women, then a bilateral mammographic imaging is indicated. An indeterminate liver tumor requires a percutaneous or endoscopic biopsy to confirm tissue histological diagnosis. This will further guide the type of treatment needed, based on the tissue/tumor type.  A liver surgeon will then decide tumor resectability based on the location, size, major structural involvement, and the extent of anticipated parenchymal resection.  It is very important to see a liver surgeon and hear the expert opinion directly about surgical resectability. As mentioned above, a complete surgical resection is the only chance for cure.  Dr. Sucandy and his team are working diligently to offer a curative surgical resection (both via robotic minimally invasive technique-80%  or open-20%), whenever safe and feasible to achieve the best outcomes.