Liver Cancer: 3 Things You Should Know

Lupus and Cancer

Liver Cancer: 3 Things You Should Know | Johns Hopkins Medicine

Systemic lupus erythematosus (“lupus” or “SLE”) and other autoimmune diseases are linked to an increased risk of certain types of cancer. Specifically, lupus patients may experience an elevated risk of lymphoma and other cancers, such as cancer of the cervix.

Researchers have elucidated certain connections between lupus and cancer. For example, it is widely accepted that immunosuppressive medications, such as azathioprine (Imuran) and mycophenolate mofetil (Cellcept) contribute to elevated cancer risk.

However, one of the largest studies to investigate this connection suggests that the risk of cancer is actually greatest during the earlier stages of lupus, indicating that exposure to immunosuppressive therapy is not the only link between lupus and cancer.

Physicians do not yet understand the precise relationship between lupus and cancer.

Lupus and lymphoma

Studies show an increased risk of both Hodgkin’s and non-Hodgkin lymphoma in lupus patients. It is believed that the elevated risk of lymphoma results from the disease process of lupus—specifically the overstimulation of B-cells coupled with defects in the immune system’s surveillance system—and not just from medications or other associated risk factors.

Some suggest that immunosuppressive medications also increase the risk of lymphoma and other blood cancers, especially 5 or more years after taking the drug.

In addition, people with Sjogren’s syndrome, which is relatively common in lupus, experience an even greater elevation of lymphoma risk, suggesting that lymphoma in lupus patients may also be linked to this condition.

Lupus and breast cancer

Some data indicate that women with lupus experience an increased risk of breast cancer. Increased estrogen levels might contribute to a higher risk of breast cancer in women with lupus.

Lupus and lung cancer

Lung cancer is about 1.4 times more common in people with lupus than in the general population. Interestingly, people with lupus and lung cancer are more ly to experience rare types of lung cancer. However, the general population, many of the people with lupus who develop lung cancer are smokers. In fact, 85% of lung cancer is caused by tobacco.

It is very important that people with lupus do not smoke. Smoking not only increases the chance of developing lung cancer, it also ups the risk for cardiovascular disease (which is also markedly increased in people with lupus), and prevents lupus drugs Plaquenil from working properly. If you need help quitting, talk to your doctor.

S/he can help you find the most effective strategy to curb your smoking habit.

Lupus and cervical cancer

Certain studies have shown an elevated risk of cervical cancer and abnormal PAP tests in women with lupus. One study linked the increased incidence of abnormal PAP tests with histories of sexually transmitted disease, contraceptive use, and immunosuppressive medications.

Some physicians suggest that either the use of immunosuppressives or flawed inherent immunity lead to a decrease in the ability of lupus patients to fight off human papilloma virus (HPV), a virus associated with cervical cancer. [Gardasil (the HPV vaccine)  is recommended for young women with lupus to reduce the risk of later cervical cancer.

] However, much of our knowledge of cancer in lupus, these connections are not fully known or understood.

Lupus and endometrial cancer

New evidence suggests that lupus patients also experience an elevated incidence of endometrial cancer, although the cause for this risk is unknown.

NSAIDs and cancer

It has been found that people with Rheumatoid Arthritis, another autoimmune disease, experience a lower incidence of colorectal cancer than the general population.

Although the precise cause of this phenomenon is unknown, it has been attributed to the long-term (10 years or more) use of non-steroidal anti-inflammatory drugs (NSAIDS) and aspirin.

Evidence has also been found that long-term aspirin and NSAID use may also reduce the risk of colorectal, breast, and prostate cancer in the general population.

It is ly that this benefit also holds for people with lupus, but that does not mean that one should begin taking aspirin and NSAIDs for this reason. In fact, long term NSAID use can increase cardiovascular disease. Therefore, you should only take medications as directed by your physician.

The importance of regular cancer screenings

Despite the increased risk of cancer in people with lupus, studies show that lupus patients are actually equally or even less ly than the general population to undergo cancer screenings. Thus, it is very important that you speak with your doctor about lupus and cancer to ensure that you see the appropriate physicians for cancer screenings as often as recommended.

Healthy habits

Certain risk factors, such as smoking, obesity, hormone replacement therapy, and exposure to immunosuppressive medications, increase the chance that an individual will develop cancer. Therefore, it is also important that you practice healthy lifestyle habits. Obesity also increases the risk of certain cancers, so try to eat foods that help you maintain a healthy weight.

Sunlight causes lupus flares and also increases the risk of skin cancer. People with lupus should avoid the sun whenever possible. If you need to be outdoors, wear sunscreen with an SPF of 85 or greater and be sure that your sunscreen contains Helioplex to protect you from both UV-A and UV-B rays.


  • Gayed M, Bernatsky S, Ramsey-Goldman R, Clarke A, Gordon C. Lupus and cancer. Lupus. 209; 18(6); 479-85.
  • Research Update: Cancer in Lupus. ( presentation by Dr. Sasha Bernatsky at BC Lupus Society Symposium.) 22 Oct. 2005. Available at .


Johns Hopkins Pathology

Liver Cancer: 3 Things You Should Know | Johns Hopkins Medicine

Understanding Liver Cancer

Introduction +

In the United States approximately 10,000 new patients are diagnosed with primary liver cancer (hepatocellular carcinoma) each year. This is the most common type of cancer to arise in the liver. The number of liver cancers diagnosed in the US and throughout the world is increasing at an alarming rate. The number of liver cancers will continue to increase over the next few decades.

Most of the increase in liver cancer is attributable to patients who became infected with hepatitis B and C viruses. Hepatitis B and hepatitis C viral infections peaked in the 1950's to 1980's. Approximately 4 million (that is about 2% of the US population!) Americans are infected with Hepatitis C virus.

People become infected with hepatitis viruses by coming in contact with infected person's blood. After 2 to 3 decades patients infected with these viruses can develop complications of long-standing (chronic) viral infection. The complications of long-standing (chronic) viral infection include liver scarring (cirrhosis) and liver cancer.

Liver cancer is a lethal cancer with untreated patients rarely surviving more than one year. The Johns Hopkins Medical Institution is a leader in the treatment and investigative study of liver cancer.

We have created this Web site as a resource for patients and physicians to access the latest clinical and research developments as well as to the multidisciplinary team assembled here to treat liver cancer.

We have also included a chat room so that users of the web page can directly support each other.

Diagnosis +

Masses that occur in the liver can be determined to be harmless (benign) or malignant (cancerous) in various ways. The first, involves the use of imaging techniques such as Computed Axial Tomography (CT) scan / Magnetic Resonance Imaging (MRI) or the injection of a dye into the blood vessels (angiography).

The larger the liver cancer the more ly these imaging techniques will be able to diagnose it. Liver cancer has special features, such as a rich blood supply or tendency to increase in size, which these imaging techniques can detect.

If imaging can not determine if a tumor is benign or malignant, a fine needle biopsy may be performed. In this procedure, a fine (very thin) needle is passed through the skin, into the liver and directed toward the tumor using an exterior ultrasound to guide the needle.

If a needle biopsy is performed, Johns Hopkins' pathologists, Drs. Robert Anders, Michael Torbenson, John Boitnott all have focused interest on interpreting these biopsies. The normal liver cells grow in columns that are one or two cells thick.

In liver cancer, the columns of liver cells become wider than one or two cells. The wide columns of liver cells can be seen on microscopic examination and are one helpful feature of liver cancer.

Screening +

Screening tests are used to detect liver cancer at the earliest possible stage. There are no good screening tools for liver cancer. Current screening methods include a blood test, Computed Axial Tomography (CT) scan / Magnetic Resonance Imaging (MRI) or angiography (the injection of a dye into the blood vessels).

There are currently no reliable blood test to diagnose liver cancer. A test for alpha fetal protein (AFP) may be slightly elevated in 2/3 of patients with liver cancer, but may also be slightly elevated in patients with chronic liver disease. Very high levels of serum AFP is a good indication of liver cancer, but is only seen in a few patients.

At risk individuals can also be screened using imaging techniques such as Computed Axial Tomography (CT) scan / Magnetic Resonance Imaging (MRI) or angiography (the injection of a dye into the blood vessels).

At Johns Hopkins, the Department of Gastroenterology and Hepatology are actively involved in day to day screening of patients at high risk for developing liver cancer.

Prevention +

Since most liver cancer develops in patients with long standing (chronic) hepatitis viral infection, prevention of infection is vital.

Avoiding contact with an infected person's blood can prevent the transmission of hepatitis viruses. In addition, there is an effective vaccine for hepatitis B.

To learn more about this vaccine click here. However, there is no vaccine for hepatitis C virus.

Once patients develop chronic infection with hepatitis viruses, the goal is to preserve liver tissue and prevent scarring (cirrhosis). This requires a multi-disciplinary approach involving the patient, a hepatologist and pathologist.

Once it is established that a patient is chronically infected with a hepatitis virus, the patient will need to enter into a treatment program to minimize liver damage. This program involves regular visits to a hepatologist who will monitor the relative health of the liver.

This monitoring may involve simple blood tests or occasionally a liver needle biopsy. A pathologist experienced in interpreting liver biopsies will determine the amount of liver damage and scarring.

Patients need to learn to avoid activities with can further damage the liver, such as consuming alcohol or taking certain medications. In addition, patients can engage in liver healthy activities such as maintaining an ideal body weight and a liver healthy diet.

Treatment +

Treatment of liver injury
Most liver cancers develop in patients with chronic liver disease. Chronic liver injury and liver scarring (cirrhosis) are fertile environments for the development of liver cancer.

Current treatments are aimed at reducing chronic injury and attempt to prevent cirrhosis. These treatments include interferons, ribavirin and lamivudine.

These medications are given as an injection or a pill and require supervision of a doctor.

Treatment of liver cancer Once liver cancer develops there are 3 main treatment options. First, surgery that involves the removal of the tumor or even liver transplant in which the entire liver is surgically removed and replaced with a new liver from a donor, offers the best hope of a cure.

The size and location of the tumor, the health of the remaining liver, if the tumor has spread and the overall health of the patient determines if this is an option.

Second, tumor ablation in which the cancer cells in the tumor are directly killed by radiofrequency, freezing or chemical injection are relatively new treatment options.

Tumor ablation techniques involve placing a fine probe into the center of the tumor and injecting cold or toxic chemical that destroy the tumor cells. Third, radiation and chemotherapy have been used. Radiation can shrink a tumor but is not a curative procedure.

Similarly, chemotherapy has been shown to shrink liver cancers, but it is unclear if this increases patient survival.

Although most cancers develop in patients with liver scarring (cirrhosis), some patients develop liver cancer without first developing cirrhosis. Johns Hopkins researchers have a particular interest in this type of liver cancer.

Cancer Types +

As the largest internal organ, the liver performs a variety of vital functions. Different cell types are responsible for these diverse functions. The basic liver cells (known as hepatocytes) produce blood clotting factors, synthesize bile, metabolize proteins and remove toxins from the blood.

The liver has a rich network of blood vessels carrying nutrients and toxins from the intestine to the liver and back to the circulation. The liver also has a system of bile ducts which carry bile (a green fluid that helps digestion of food) from the liver and gall bladder into the intestine.

Tumors may arise from any of these types of cells and thus there is a wide variety in types of liver cancer.

Tumors can be generally thought of as benign or malignant. Benign tumors are unly to metastasize (spread throughout the body) while malignant tumors are cancerous and are ly to spread to other organs.

Liver Cancer types listed by cell of origin
List of benign tumors and cell of origin List of malignant (cancerous) tumors and cell of origin
  • – Hepatocytes
    • Adenoma
    • Focal nodular hyperplasia
  • – Vessels
  • – Bile duct
    • Adenoma
    • Hamartoma (Von Myenberg Complex)
  • – Hepatocytes
    • Hepatocellular carcinoma
    • Hepatoblastoma
    • Fibrolamellar carcinoma
  • – Vessels
  • – Bile duct


Liver: Function, Failure & Disease

Liver Cancer: 3 Things You Should Know | Johns Hopkins Medicine

The liver is an abdominal glandular organ in the digestive system. It is located in the right upper quadrant of the abdomen, under the diaphragm and on top of the stomach. The liver is a vital organ that supports nearly every other organ to some capacity. 

The liver is the body's second-largest organ (skin is the largest organ), according to the American Liver Foundation (ALF), weighing about 3 lbs. (1.4 kilograms). At any given moment, the liver holds about 1 pint (half a liter) of blood — about 13 percent of the body's blood supply, according to Johns Hopkins Medicine. 

The liver is shaped a football, or a cone, and consists of two main lobes. Each lobe has eight segments that consist of 1,000 small lobes, or lobules, according to Johns Hopkins. The lobules are connected to ducts that transport bile to the gallbladder and small intestine.


“The liver has a complex role in the function of the body,” said Jordan Knowlton, an advanced registered nurse practitioner at the University of Florida Health Shands Hospital. “Detoxification, metabolism (including regulation of glycogen storage), hormone regulation, protein synthesis, digestion, and decomposition of red blood cells, to name a few.” 

In fact, more than 500 vital functions have been identified with the liver, according to Johns Hopkins, including:

  • Production of bile, which helps carry away waste and break down fats in the small intestine during digestion.
  • Production of certain proteins for blood plasma. 
  • Production of cholesterol and special proteins to help carry fats through the body
  • Conversion of excess glucose into glycogen for storage (glycogen can later be converted back to glucose for energy) and to balance and make glucose as needed 
  • Regulation of blood levels of amino acids, which form the building blocks of proteins
  • Processing of hemoglobin for use of its iron content (the liver stores iron)
  • Conversion of poisonous ammonia to urea (urea is an end product of protein metabolism and is excreted in the urine)
  • Clearing the blood of drugs and other poisonous substances
  • Regulating blood clotting
  • Resisting infections by making immune factors and removing bacteria from the bloodstream
  • Clearance of bilirubin, also from red blood cells. If there is an accumulation of bilirubin, the skin and eyes turn yellow.  


One of the best-known roles of the liver is as a detoxification system. It removes toxic substances from blood, such as alcohol and drugs, according to the Canadian Liver Foundation. It also breaks down hemoglobin, insulin and excessive hormones to keep hormone levels in balance. Additionally, it destroys old blood cells. 

The liver is vital for healthy metabolic function.

It metabolizes carbohydrates, lipids and proteins into useful substances, such as glucose, cholesterol, phospholipids and lipoproteins that are used in various cells throughout the body, according to Colorado State University's Department of Biomedical Sciences' Hypertexts for Pathophysiology: Metabolic Functions of the Liver. The liver breaks down the unusable parts of proteins and converts them into ammonia, and eventually urea.

Liver disease

According to the Canadian Liver Foundation, there are more than 100 types of liver disease, and they are caused by a variety of factors, such as viruses, toxins, genetics, alcohol and unknown causes. The following are among the most common types of liver disease: 

  • Alagille syndrome
  • Alpha 1 anti-trypsin deficiency
  • Autoimmune hepatitis
  • Biliary atresia
  • Cirrhosis
  • Cystic disease of the liver
  • Fatty liver disease
  • Galactosemia
  • Gallstones
  • Gilbert's syndrome
  • Hemochromatosis
  • Liver cancer
  • Liver disease in pregnancy
  • Neonatal hepatitis
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Porphyria
  • Reye's syndrome
  • Sarcoidosis
  • Toxic hepatitis
  • Type 1 glycogen storage disease
  • Tyrosinemia
  • Viral hepatitis A, B, C
  • Wilson disease

According to the National Institutes of Health (NIH), one symptom of liver disease is jaundice — yellowish skin and eyes. Other symptoms include abdominal pain and swelling, persistent itchy skin, dark urine, pale stools, bloody or black stools, exhaustion, bruising easily, nausea and loss of appetite.

Fatty liver

There are two types of fatty liver, according to the Cleveland Clinic: that caused by excessive alcohol consumption (fatty liver) and that which is not (non-alcoholic fatty liver or non-alcoholic steatohepatitis). 

Speaking of both conditions, Knowlton said, “Some fat on the liver is normal, but when it starts to accumulate to greater than 5-10 percent, it can lead to permanent liver damage and cirrhosis.

” It also increases the chance of liver failure or liver cancer. Fatty liver “can be caused by genetics, obesity, diet, hepatitis, or alcohol abuse,” said Knowlton.

Other risk factors include rapid weight loss, diabetes, high cholesterol, or high trigycerides, according to the ALF. 

Some people may get fatty liver even if they don't have any risk factors. Up to 25 percent of the U.S.

population suffers from fatty liver disease, according to the University of Michigan Health System.

There are no medical treatments for fatty liver disease, though avoiding alcohol, eating a healthy diet, and exercising can help prevent or reverse fatty liver disease in its early stages.

Enlarged liver

According to the Mayo Clinic, an enlarged liver (or hepatomegaly) isn't a disease itself, but a sign of an underlying serious problem, such as liver disease, cancer or congestive heart failure.

There may be no symptoms of an enlarged liver, though if they are they are the same as the symptoms for liver disease. Normally, the liver cannot be felt unless you take a deep breath, but if it is enlarged, your doctor may be able to feel it, according to the NIH.

The doctor may then do scans, MRIs, or ultrasounds of the abdomen to determine if you have an enlarged liver. Treatment will involve addressing the underlying problem.

Liver pain

Liver pain is felt in the upper right area of the abdomen, just below the ribs. Usually, it is a dull, vague pain though it can sometimes be quite severe and may cause a backache. Sometimes people perceive it as pain in the right shoulder.

It is often confused with general abdominal pain, back pain or kidney pain, according to New Health Guide. It can be hard to pinpoint the exact location or cause of such pains, so it is important to see a doctor.

Doctors may do blood tests, ultrasounds or biopsies to determine the cause of pain.

Liver pain can be the result of a variety of causes. Some common causes are: ascites (fluid in the abdomen), cirrhosis, hepatitis, liver failure, enlarged liver, liver abscess, and liver tumors. 

Liver failure

Liver failure is an urgent, life-threatening medical condition. It means that the liver has lost or is losing all of its function. “Livers typically fail gradually,” said Knowlton, “but sometimes [it] can be rapid.

” Early symptoms of liver failure are general, making it difficult to know that the liver is failing. Knowlton said, “Symptoms of liver failure may include nausea, appetite changes, fatigue, diarrhea, jaundice, easy bleeding.

” As the condition worsens, she said symptoms might include “mental confusion and coma.”

“Typical causes of liver failure include Tylenol overdose, viruses, hepatitis B & C, cirrhosis, alcoholism, and some medications,” said Knowlton. Georgia's Emory Healthcare stated that there are two types of liver failure: chronic and acute.

Chronic liver failure is the most common type of liver failure. It is the result of malnutrition, disease and cirrhosis, and it can develop slowly over years. Acute liver failure is rarer, and it can come on suddenly.

Acute liver failure is usually the result of poisoning or a drug overdose.

Liver failure treatments depend on the case. Knowlton said, “Treatment options are mostly supportive (hospitalization and treatment until the liver recovers), but ultimately may require liver transplantation.”

Liver transplant

Donated livers can come from cadavers or living donors. In the case of living donors, the donor donates part of his or her liver to another person, according to the American College of Gastroenterology.

The liver can regrow itself, so both people should end up with healthy, functional livers.

According to the National Institute of Diabetes and Digestive and Kidney Diseases the most common reason adults get liver transplants is cirrhosis, though transplants can also be done for patients with various liver diseases or early stage liver cancer.

A liver transplant is a very serious surgery that may take up to 12 hours. According to the Mayo Clinic, there are several risks involved with liver transplants, including:

  • Bile duct complications, including leaks or shrinking
  • Bleeding
  • Blood clots
  • Failure of donated liver
  • Infection
  • Memory and thinking problems
  • Rejection of donated liver

If you have a liver transplant, you can expect to stay in the hospital for at least a week after the surgery, to get regular checkups for at least three months, and to take anti-rejection and other medications for the rest of your life. It will take six months to a year to feel fully healed from the surgery.

Liver transplant success depends on the individual case. Transplants from cadavers have a 72 percent success rate, meaning that 72 percent of liver transplant recipients lived for at least five years after the surgery. Transplants from living donors had a slightly higher success rate, at 78 percent, according to the Mayo Clinic.

Things that can harm the liver

While some liver diseases are genetic, others are caused by viruses or toxins, such as drugs and poisons.

Some risk factors, according to the Mayo Clinic, include drug or heavy alcohol consumption, having a blood transfusion before 1992, high levels of triglycerides in the blood, diabetes, obesity and being exposed to other people's blood and bodily fluids. This can happen from shared drug needles, unsanitary tattoo or body piercing needles, and unprotected sex.

Alcohol is big player in liver damage. It is believed that alcohol could possibly change the type of fungi living in the liver, leading to disease, according to a small study published May 22, 2017, in the Journal of Clinical Investigation. If this is true, it could lead to new treatment options.

The findings suggest that “we might be able to slow the progression of alcoholic liver disease by manipulating the balance of fungal species living in a patient's intestine,” study co-author Dr. Bernd Schnabl, an associate professor of gastroenterology at the University of California, San Diego School of Medicine, said in a statement.

[How Alcohol & Gut Fungus Team Up to Damage Your Liver]

Additional reporting by Alina Bradford, Live Science contributor.

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