A diagnosis of a liver tumor can be difficult and complex to understand and navigate. Our mission is to stand by you and walk with you every step of the way. While every patient’s journey is different, and may start at different paths, a typical journey consists of:
Your Journey Starts Here
Understanding Your Liver
The liver is an important organ located in the right upper abdomen. It is responsible for more than 500 different tasks in your body! Some of the important ones include:
- Conversion of food to energy
- Detoxification of drugs and poisons
- Metabolism of medications
- Production of bile for digestion
- Production of blood clotting factors
Conversion of food to energy, detoxification of drugs and poisons, metabolism of medications, production of bile for digestion, production of blood clotting factorsProblems With Your Liver
The liver has an amazing ability to regenerate when damaged. However, there are certain conditions which permanently effect the liver and require medical intervention. Some of these include:
Hepatitis
Hepatitis is a viral infection that affects the liver. The first sign of hepatitis may be flu-like symptoms or yellowing of the skin and eyes (jaundice). In some cases no symptoms might be noted.
Hepatitis is a viral infection that affects the liver. There are different types, but the two most common are Hepatitis B and Hepatitis C . The virus is spread through contact or contamination of blood.
If the disease has been left untreated for many years, hepatitis may lead to cirrhosis, cancer, or end-stage liver disease requiring liver transplant.
The first sign of hepatitis may be flu-like symptoms or yellowing of the skin and eyes (jaundice). In some cases no symptoms might be noted.
If a patient has risk factors for infection, hepatitis can be diagnosed with blood tests.
Sometimes patients may require further specialized imaging or liver biopsies to determine the extent of damage to the liver.
There are a number of FDA approved medications for hepatitis B and C. Newer medications are all-oral and have low side effects. After taking these medications, more than 95% of people are cured for life. Patients who develop liver cancer or cirrhosis may require surgery or transplant.
Fatty Liver Disease
Fatty liver occurs when the liver begins to store fat at levels that are not normal. This usually occurs when a patient is at least 20 pounds overweight.
- About Fatty Liver Disease/NASH
- Diagnosis of Fatty Liver Disease/NASH
- Treatment of Fatty Liver Disease/NASH
Fatty liver occurs when the liver begins to store fat at levels that are not normal. This usually occurs when a patient is at least 20 pounds overweight. In some individuals, the liver becomes fatty but no damage is done, this is called non-alcoholic fatty liver disease or NAFLD. In other people, the fat in the liver causes damage, and this is known as non-alcoholic steatohepatitis (NASH). NASH is the form of fatty liver that is very dangerous to your health.
NASH occurs when there is inflammation of the liver because of fat. This often occurs in people who are overweight, pre-diabetics/diabetics, those who have high cholesterol, or people who take certain medicines. Because of the damage being done to the liver, the “enzymes” become elevated, which is another way of saying your liver cells are dying faster than expected. As your liver cells die, they are replaced with scar tissue (fibrosis).
Fatty liver may not cause any symptoms in some people, others may complain of pain on their right side where the liver is. The liver actually does not have nerves to sense pain, but it has a capsule or skin around it that does have nerves. As the capsule stretches because of the fat, patients may experience a constant dull pain. If a patient’s weight increases 10% above the ideal amount, then probably fatty liver is present.
Blood Tests
If fat is harming the patient would be to check a blood test, specifically measuring liver enzymes. If the AST and ALT are high, this may be a sign that the patient has NASH.
Imaging
Fatty liver disease can be diagnosed by a ultrasound, MRI, CT or fibroscan, which can also tell your doctor if there is serious scar tissue present.
Liver Biopsy
A liver biopsy can tell us what stage you are at and confirm the diagnosis of NASH.
Currently, the best treatment for fatty liver is diet and exercise, along with good control of other medical condition like diabetes and high cholesterol. Losing just 20 pounds brings most patients back to health. Vitamin E may help but increases risk of heart disease and prostate cancer, so we don’t recommend it.
What is the best diet for me?
- Please avoid animal fat and refined sugars. Red meat, fried food and sweets are especially harmful. This may be because of a genetic difference between you and other people.
- Diets rich in vegetables, fruits, nuts, olive oil and lean meats like salmon is a good option, this diet is commonly known as the Mediterranean diet.
- A registered dietician is the best person to go through this with you. We will help you find one.
What can I eat?
Breakfast
- Fruits: Papaya, berries (raspberries, strawberries, blueberries), peaches, apricots, apples, pears, kiwi and melons.
- Non-fat yogurt is the only dairy you are permitted to eat.
- High fiber cereals.
- No bacon or ham.
- Don’t use butter.
- No milk, eggs, or cheese. If you plan on eating eggs, only eat egg whites.
- Vitamin D and calcium pills can replace your dairy intake.
- Lots of water. Coffee is good.
Lunch
- Soup is best. Should be a clear broth with vegetables.
- Chicken is “OK”.
- No excessive pasta. Small amounts may be ok.
- Avoid canned food since it often has a lot of salt.
- Salads should never contain anything white. No cream or cheese.
- Avoid sodas.
- Drink water or green tea.
Dinner
- Vegetables and fish. Fish should not be bigger than your palm and salmon is preferred.
- No bread/tortillas, no rice, no potatoes.
- Absolutely no RED meat. No pork.
- Fish or organic chicken that has not been fried is acceptable.
- No sugary desert. Artificially sweetened or fruit may be the best replacement.
What can’t I eat?
- Avoid anything from a cow or a pig.
- Nothing fried.
- Reduce the amount of milk and cheese significantly.
- Avoid butter.
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No white bread or tortillas.
Cirrhosis
Cirrhosis occurs when the liver becomes “scarred,” oftentimes due to chronic alcohol use or infection with hepatitis virus.
Cirrhosis is inflammation and scarring of the liver. It can be a consequence of fatty liver disease, hepatitis, or heavy alcohol abuse. Both women and men who drink too much can have this condition. Some information suggests that genetics and problems with alcohol metabolism can make this condition worse. Cirrhosis can also occur at any age, but usually takes many years to develop.
Cirrhosis can be diagnosed by clinical exam. Patients with cirrhosis oftentimes can develop:
- Jaundice
- Swelling in the belly and legs
- Confusion
- Severe fatigue
- Bruising and easy bleeding
- Coma
Cirrhosis can also be diagnosed by:
Blood Tests
Patients will have low albumin and high bilirubin levels, both of which are markers of liver function. Additionally, as the liver becomes more scarred blood is shunted to spleen and platelets get trapped there, which causes patients to have very low platelet counts.
Imaging
Cirrhosis can be diagnosed by a ultrasound, MRI, CT or fibroscan, which can also tell your doctor if there is serious scar tissue present.
Liver Biopsy
A liver biopsy can tell us what stage of cirrhosis you are at.
Unfortunately there is no cure for cirrhosis. However, the ability to slow down the disease from getting worse is critical. Liver doctors are known as hepatologist, and they are usually the medical specialist best suited to handle complex cases of the liver.
In cases where cirrhosis progressed to end-stage liver disease, patients may need a liver transplant evaluation, which can be curative.
Liver Cysts
Liver cysts are usually benign, but can sometimes lead to problems which require treatment.
What are liver cysts?
Cysts in the liver can be single or multiple. They usually contain fluid which is either consistent with serum or bile. Sometimes they can contain infectious materials.
What are the signs and symptoms of liver cysts?
The symptoms of liver cysts can be variable, but oftentimes include nausea, vomiting, pain, or jaundice. Some patients may not have any symptoms.
Liver Cysts
- Simple cysts
- Biliary cystadenoma
- Hydatid cysts
- Polycystic liver disease
- Choledochal cysts
How are liver cysts diagnosed?
Cysts of the liver are best diagnosed by an imaging procedure. Common tests include:
CT SCAN
Sometimes referred to as a “cat” scan, CT imaging uses x-rays to create very detailed black and white images of your insides. Oftentimes it is necessary to inject contrast dye into your veins during a CT scan to better visualize tumors.
ULTRASOUND
Using sound waves, ultrasound is a non-invasive and painless way to detect liver tumors. The procedure is typically performed by an ultrasound technician after application of ultrasound “gel” on your skin.
MRI
after being placed in a tube, a magnetic field is applied which can then be used to visualize your liver. Oftentimes it is necessary to inject contrast dye into your veins during a MRI to better visualize tumors. If you are claustrophobic or have metal implants, pacemakers, or shrapnel, please alert your care team prior to undergoing an MRI.
How are liver cysts treated?
Once a liver cyst is diagnosed, the next step involves a treatment plan depending on a number of factors, including symptom, concern for malignancy, or infectious risk. The vast majority of cysts do not require any treatment, but sometimes may be treated with:
Observation
If cysts are thought to be benign on imaging or atypical for a simple cyst, sometimes your doctor may want to recommend close follow-up with repeat imaging or laboratory tests to make sure the cyst doesn’t grow or warrant treatment.
Surgery
The goal of liver surgery is to either remove the cyst completely or “unroof” the cyst to allow it to drain freely into your abdomen. Surgery can be performed using an abdominal surgical incision (“open surgery”), laparoscopic “keyhole” surgery, or with the assistance of a robot.
Antibiotics
If the cyst is suspected to be infectious, oftentimes antibiotics are started for control. If the infection resolves and the cyst becomes smaller, no further treatment is required. However, if the infection persists then sometimes percutaneous drainage or surgical drainage is performed.
Drainage
Typically for infectious cysts that are not responding to antibiotics, patients undergo placement of a small drainage catheter through the skin to drain the cyst. The catheter is then removed after the cyst resolves. Percutaneous drainage is not performed for simple cysts because once the catheter is removed, the simple cyst usually reaccumulates!
Liver Tumors
Tumors in the liver can start in the liver or spread to the liver from other sites (“metastases”).
Tumors in the liver can either start in the liver (“primary”) or spread there from cancers that start in other parts of the body (“metastatic”). The symptoms of liver tumors can be variable, but oftentimes include weight loss, fatigue, jaundice (yellowing of the skin or eyes), itching, or pain. Some patients may not have any symptoms.
Primary Tumors
- Hepatocellular Carcinoma (HCC)
- Cholangiocarcinoma
- Hepatic Adenoma
Metastatic Tumors
- Colon Cancer
- Rectal Cancer
- Neuroendocrine
How are liver tumors diagnosed?
Tumors of the liver are best diagnosed by an imaging procedure and confirmed with a biopsy once detected. Common tests include:
CT SCAN
Sometimes referred to as a “cat” scan, CT imaging uses x-rays to create very detailed black and white images of your insides. Oftentimes it is necessary to inject contrast dye into your veins during a CT scan to better visualize tumors.
ULTRASOUND
Using sound waves, ultrasound is a non-invasive and painless way to detect liver tumors. The procedure is typically performed by an ultrasound technician after application of ultrasound “gel” on your skin.
MRI
after being placed in a tube, a magnetic field is applied which can then be used to visualize your liver. Oftentimes it is necessary to inject contrast dye into your veins during a MRI to better visualize tumors. If you are claustrophobic or have metal implants, pacemakers, or shrapnel, please alert your care team prior to undergoing an MRI.
PET Scan
Because tumors are typically metabolically active, a special type of sugar is injected into your veins a few hours prior to the scan. Those areas of your body which use a lot of sugar (like tumors) will light up on the scan. It is important to not eat or drink anything before the scan for most accurate results.
Biopsy
After a tumor is identified, frequently a biopsy must be performed to confirm the presence of a cancer. A biopsy is a procedure where a needle is passed through your skin and a small piece of the tumor is removed for analysis. Biopsies usually require the assistance of ultrasound or CT scan to precisely guide the needle into the tumor. The majority of biopsies are outpatient procedures and patients can go home the same day!
How are liver tumors treated?
Once a liver tumor is diagnosed, the next step involves a treatment plan after discussion of your case in a Multidisciplinary Tumor Board . Safe and effective treatment of liver tumors depends on the type of tumor, its location, your general liver health, and other underlying medical problems you may have.
Observation
If tumors are thought to be benign on imaging or atypical for cancer, sometimes your doctor may want to recommend close follow-up with repeat imaging or laboratory tests to make sure the tumor doesn’t grow or warrant treatment.
Surgery
The goal of liver surgery is to either remove the tumor completely. Surgery can be performed using an abdominal surgical incision (“open surgery”), laparoscopic “keyhole” surgery, or with the assistance of a robot.
Transplant
Depending on the type of tumor you have and size, sometimes liver transplant is the best option for long-term cure.
Ablation
Liver ablation
is a procedure which can be performed through your skin (percutaneously) or surgically via laparoscopic (“keyhole”) or open surgery. The goal of ablation is to destroy tumors with energy.
Embolization
Most tumors have a dominant blood vessel which feeds it with nutrients. The goal of embolization is to block that vessel and prevent the tumor from receiving nutrients and oxygen. Sometimes at the same time, chemicals like chemotherapy or radiation are directed to the tumor as well to help destroy it. Access to the blood vessel is usually gained through an artery in your groin or leg.
Chemotherapy
For tumors that are advanced beyond the point of surgery, ablation, or embolization, sometimes chemotherapy is best option. Chemotherapy can be delivered through a pill form or intravenously depending on the tumor type. For some patients, chemotherapy may be offered before or after surgery, ablation or embolization to help control the tumor.
