Expert Videos

Module 1: Understanding Liver Cancer

What is liver cancer?

What is liver cancer?

Medical oncologist Dr. Ghassan Abou-Alfa, MD, provides an overview of liver cancer and the function of the liver. Dr. Abou-Alfa explains that liver cancer is cancer that starts in the liver cells. It is called primary liver cancer or hepatocellular carcinoma (HCC). Other cancers may spread, or metastasize, to the liver. Only cancer that starts in liver cells is called liver cancer. The liver is the largest organ in your body and performs many essential functions. For example, it helps remove toxins from your body and store necessary nutrients.

Who is at risk of developing liver cancer?

Who is at risk of developing liver cancer?

Transplant hepatologist Dr. Amit Singal, MD, discusses the risk factors for developing liver cancer. Dr. Singal explains that the main risk factor for liver cancer is chronic liver disease, which can lead to cirrhosis. Chronic liver disease can be related to hepatitis B or C, chronic alcohol use, or metabolic dysfunction-associated steatotic liver disease.

What are the symptoms of liver cancer?

What are the symptoms of liver cancer?

Dr. Ghassan Abou-Alfa, MD, of Memorial Sloan Kettering Cancer Center in New York, provides an overview of the symptoms of liver cancer. Symptoms of liver cancer can be mild or nonexistent at first. Dr. Abou-Alfa discusses symptoms such as abdominal pain (especially in the upper right quadrant where the liver is located), yellow-tinged skin and eyes, and dark urine. More advanced liver cancer symptoms may include a distended belly (ascites), fatigue, weight loss, and changes in mental state.

What can I do to decrease my risk of liver cancer?

What can I do to decrease my risk of liver cancer?

Dr. Amit Singal, MD, of UT Southwestern Medical Center in Dallas, discusses ways to decrease the risk of liver cancer. It is possible to control some risk factors for liver cancer. Studies show that the best way to prevent liver cancer is vaccination for hepatitis B and treatment for hepatitis B or C. Avoiding too much alcohol, maintaining a healthy weight, and treating diabetes are also recommended.

What's the outlook for someone with liver cancer?

What's the outlook for someone with liver cancer?

Medical oncologist Dr. Ghassan Abou-Alfa, MD, discusses the overall outlook for someone with liver cancer. He explains that, in general, earlier detection means a better outlook, including a higher chance of curative treatment. The outlook will depend on many other factors too, including liver function. Talk with your healthcare team to understand your treatment options and what you can expect.

Module 2: Screening and Diagnosing Liver Cancer

Who is at risk of developing liver cancer?

Who is at risk of developing liver cancer?

Transplant hepatologist Dr. Amit Singal, MD, discusses the risk factors for developing liver cancer. Dr. Singal explains that the main risk factor for liver cancer is chronic liver disease, which can lead to cirrhosis. Chronic liver disease can be related to hepatitis B or C, chronic alcohol use, or metabolic dysfunction-associated steatotic liver disease.

What are the symptoms of liver cancer?

What are the symptoms of liver cancer?

Dr. Ghassan Abou-Alfa, MD, of Memorial Sloan Kettering Cancer Center in New York, provides an overview of the symptoms of liver cancer. Symptoms of liver cancer can be mild or nonexistent at first. Dr. Abou-Alfa discusses symptoms such as abdominal pain (especially in the upper right quadrant where the liver is located), yellow-tinged skin and eyes, and dark urine. More advanced liver cancer symptoms may include a distended belly (ascites), fatigue, weight loss, and changes in mental state.

Who should be screened for liver cancer?

Who should be screened for liver cancer?

Transplant hepatologist Dr. Amit Singal, MD, provides an overview of who should be screened for liver cancer. The goal of liver cancer screening is to find liver cancer early in people who are at risk, when treatment is more likely to achieve a cure. The risk factors that Dr. Singal discusses include hepatitis B or C, heavy alcohol use, metabolic dysfunction (diabetes and obesity-related liver disease), primary biliary cholangitis, and hemochromatosis. Lastly, Dr. Singal also provides an overview of liver cancer screening guidelines.

What does liver cancer screening involve?

What does liver cancer screening involve?

Dr. Amit Singal, MD, of UT Southwestern Medical Center in Dallas, provides an overview of liver cancer screening. Liver cancer screening can include an ultrasound of the liver every 6 months, plus a blood test called AFP (alpha-fetoprotein) to look for a protein that can indicate liver cancer.

How is liver cancer diagnosed?

How is liver cancer diagnosed?

Medical oncologist Dr. Ghassan Abou-Alfa, MD, discusses the steps and tests involved in diagnosing liver cancer. He explains that your doctor will talk with you about your medical history and do a physical examination. Additionally, you may have imaging tests such as a CT scan or MRI, and additional blood tests. Your doctor may also want you to have liver function tests (LFTs). Liver cancer is one of the only cancers that can be diagnosed in high-risk patients using imaging (without biopsy) in some cases. If you are not having surgery, you may need a biopsy. Your doctor will take a small sample of tissue from the liver to look for cancer cells.

How is liver cancer staged?

How is liver cancer staged?

Transplant hepatologist Dr. Amit Singal, MD, discusses the staging of liver cancer. Staging refers to how large the cancer is and whether it has spread outside the liver. Staging helps your doctors plan the best treatment for you. Dr. Singal provides an overview of the Barcelona Clinic Liver Cancer (BCLC) staging system. BCLC stages include the size and number of tumors, and whether you have symptoms, as well as liver health and activity level.

Module 3: Treating and Managing Liver Cancer

What treatment options are available for liver cancer?

What treatment options are available for liver cancer?

Dr. Amit Singal, MD, of UT Southwestern Medical Center in Dallas, provides an overview of the treatment options for liver cancer, and when they are used. He describes surgical resection (hepatectomy), liver transplantation, local ablation, embolization (including chemoembolization or radioembolization), targeted therapy, and immunotherapy for liver cancer.

How is liver resection surgery used to treat liver cancer?

How is liver resection surgery used to treat liver cancer?

Transplant hepatologist Dr. Amit Singal, MD, discusses how liver resection surgery is used to treat early-stage liver cancer. This surgery is called hepatectomy. If only tumors are removed, you will still have liver tissue remaining. Dr. Singal also talks about recent advances in liver resection techniques and the advantages of minimally invasive surgery performed laparoscopically or robotically.

How is liver transplant used to treat liver cancer?

How is liver transplant used to treat liver cancer?

Transplant hepatologist Dr. Amit Singal of UT Southwestern Medical Center in Dallas provides an overview of liver transplantation to treat liver cancer. A liver transplant is intended to cure the cancer, and this treatment has the lowest chance of the cancer coming back. A liver transplant is an operation that removes the entire liver and replaces it with a whole or partial liver from a healthy donor. This might be someone who has died and donated their liver, or someone still living who gives part of their liver. Dr. Singal also discusses eligibility for liver transplant.

How is ablation used to treat liver cancer?

How is ablation used to treat liver cancer?

Dr. Amit Singal, MD, of UT Southwestern Medical Center in Dallas, provides an overview of ablation that may be appropriate for certain patients with liver cancer. Ablation is treatment that destroys liver tumors. Doctors apply heat, cold, or electrical pulses directly to the tumor to destroy it.

How is embolization used to treat liver cancer?

How is embolization used to treat liver cancer?

Transplant hepatologist Dr. Amit Singal of UT Southwestern Medical Center in Dallas provides an overview of how embolization is used to treat liver cancer. If cancer within the liver cannot be removed with surgery, you may have embolization, including chemoembolization or radioembolization. This blocks blood flow to the tumor, sometimes with chemotherapy or internal radiation to kill tumor cells.

How is targeted therapy used to treat liver cancer?

How is targeted therapy used to treat liver cancer?

Medical oncologist Dr. Ghassan Abou-Alfa, MD, provides an overview of targeted therapy to treat liver cancer. He explains that targeted therapy drugs target the specific genes of cancer cells. Targeted therapy blocks the growth and spread of cancer cells and limits damage to healthy cells.

How is immunotherapy used to treat liver cancer?

How is immunotherapy used to treat liver cancer?

Dr. Ghassan Abou-Alfa, MD, of Memorial Sloan Kettering Cancer Center in New York, provides an overview of immunotherapy for treating liver cancer. He explains that immunotherapy drugs help to strengthen or restore the immune system's ability to fight cancer. Dr. Abou-Alfa discusses single-agent immunotherapy and advances in using combination (or doublet) immunotherapy to treat liver cancer.

What if liver cancer comes back after treatment?

What if liver cancer comes back after treatment?

Medical oncologist Dr. Ghassan Abou-Alfa, MD, discusses options if liver cancer comes back after treatment. The good news, he says, is that many treatment options are available to try next and he describes some of the possibilities. Treatment options depend on your general health, liver health, previous treatments, and stage of cancer.

What opportunities do liver cancer clinical trials offer patients?

What opportunities do liver cancer clinical trials offer patients?

Dr. Ghassan Abou-Alfa, MD, of Memorial Sloan Kettering Cancer Center in New York, provides an overview of clinical trials for liver cancer and the opportunities they offer patients. Dr. Abou-Alfa explains that all the approved liver cancer therapies we have today were made possible because of clinical trials. Ask your doctor about clinical trials as soon as you are diagnosed. You can search for clinical trials by visiting Blue Faery's clinical trials finder tool at bluefaery.org or visiting ClinicalTrials.gov.

How can I manage the side effects of liver cancer treatment?

How can I manage the side effects of liver cancer treatment?

Medical oncologist Dr. Ghassan Abou-Alfa, MD, discusses some of the potential side effects of liver cancer treatments, and how to manage them and get support. He provides a general overview of targeted therapy and immunotherapy side effects, and how to work with your doctor to manage them. Dr. Abou-Alfa emphasizes the importance of good communication with your doctor about any symptoms you may experience. Lastly, Dr. Abou-Alfa recommends reaching out to the liver cancer advocacy and support group Blue Faery (bluefaery.org) to find a support group.

Module 4: Understanding Clinical Trials in Liver Cancer

What are liver cancer clinical trials?

What are liver cancer clinical trials?

Medical oncologist Dr. Ghassan Abou-Alfa, MD, provides an overview of liver cancer clinical trials. Clinical trials are research studies in which people volunteer to test a new drug or treatment before it is available to the public or approved by the regulatory authorities. These trials play a crucial role in advancing ways to diagnose, treat, and prevent diseases like liver cancer. While participation remains low, Dr. Abou-Alfa emphasizes the importance of clinical trials as safe, well-designed opportunities that can benefit both current patients and future liver cancer care.

What are the benefits and risks of being in a liver cancer clinical trial?

What are the benefits and risks of being in a liver cancer clinical trial?

Transplant hepatologist Dr. Amit Singal, MD, discusses the benefits and possible risks of participating in a liver cancer clinical trial. Dr. Singal explains that participants may benefit personally from participating in a clinical trial and that they will help others with liver cancer in the future. Like every treatment, clinical trials have some risks. It is important to learn about these risks before volunteering for a trial. The risks are often like the risks of standard cancer treatment, such as side effects or the treatment not working as well as you hoped.

How are liver cancer clinical trials carried out? What are the phases?

How are liver cancer clinical trials carried out? What are the phases?

Dr. Ghassan Abou-Alfa, MD, of Memorial Sloan Kettering Cancer Center in New York, explains how liver cancer clinical trials are conducted and what patients should expect. He describes the series of steps (called phases) of trials, and emphasizes that each phase builds on the last, with patient safety and effectiveness as top priorities throughout the process.

How are liver cancer clinical trials monitored?

How are liver cancer clinical trials monitored?

Transplant hepatologist Dr. Amit Singal, MD, explains how liver cancer clinical trials are monitored to maintain participant safety. He explains that oversight is provided by the clinical trial team and a data safety monitoring board, which reviews the trial data regularly to check that the research is done correctly and that your safety and privacy are protected. This rigorous safety oversight continues throughout all trial phases.

How do I find a liver cancer clinical trial?

How do I find a liver cancer clinical trial?

Liver cancer expert Dr. Ghassan Abou-Alfa, MD, of Memorial Sloan Kettering Cancer Center in New York, discusses how to find liver cancer clinical trials. If you are interested in joining a trial, speak with your medical team. They can help you find a trial right for you. You can also search for clinical trials by visiting the https://ClinicalTrials.gov website or by visiting Blue Faery's clinical trials finder at https://bluefaery.org/clinical-trials.

If I take part in a liver cancer clinical trial, how will my safety be protected?

If I take part in a liver cancer clinical trial, how will my safety be protected?

Dr. Ghassan Abou-Alfa, MD, of Memorial Sloan Kettering Cancer Center, explains that participation in clinical trials is entirely voluntary, with full respect for patient choice, safety, and privacy. Personal information remains confidential, and data is anonymized. If safety issues arise, they are promptly addressed. An Institutional Review Board (IRB), which includes patient representatives, oversees a trial to ensure ethical conduct, protect participants, and evaluate risks and benefits. Dr. Abou-Alfa concludes with gratitude for patients and their families, recognizing their vital role in advancing research through partnership with physicians and researchers.

Module 5: Understanding Liver Cancer Surgery and Liver Transplant

How is surgical resection and liver transplant used to treat liver cancer?

How is surgical resection and liver transplant used to treat liver cancer?

Dr. Amit Singal, MD, of UT Southwestern Medical Center in Dallas, provides an overview of surgery and transplant for hepatocellular carcinoma (HCC). He explains that liver resection and liver transplantation are the two main surgeries that may offer the best chance of a cure. These procedures offer the best long-term survival and lowest recurrence risk but are generally limited to patients with early-stage disease. Dr. Singal emphasizes the importance of identifying tumors early and referring patients promptly for evaluation, as timely access to surgery or transplant can greatly improve outcomes in liver cancer treatment.

What are my options for liver cancer surgery?

What are my options for liver cancer surgery?

Liver cancer expert Dr. Amit Singal, MD, of UT Southwestern Medical Center in Dallas, discusses the two main surgical options for treating liver cancer: surgical resection and liver transplantation. The choice between these treatments depends on several key factors, including the number, size, and location of tumors, as well as the overall liver function. Most patients with hepatocellular carcinoma (HCC) also have chronic liver disease or cirrhosis, making it a "disease within a disease." Therefore, treatment decisions must consider the cancer itself, the condition of the liver, and the patient's overall health and fitness. A thorough evaluation of all three helps determine the most appropriate surgical approach for each patient.

How should I prepare for liver resection? What should I expect?

How should I prepare for liver resection? What should I expect?

Transplant hepatologist Dr. Amit Singal, MD, provides an overview of how patients can prepare for liver cancer surgical resection. He explains that the first essential step is discussing eligibility and treatment details with your healthcare team. Preparation begins with a consultation involving the clinical care team, including a surgeon who will explain the procedure. The two approaches to liver resection are traditional open surgery, which uses a single large incision in your abdomen, and minimally invasive laparoscopic surgery, which uses several small incisions and tiny instruments with cameras. Patients should expect hospitalization for recovery following either procedure.

How should I prepare for liver transplant? What should I expect?

How should I prepare for liver transplant? What should I expect?

Dr. Amit Singal, MD, a transplant hepatologist, discusses what to expect when preparing for a liver transplant. Transplant is a major operation that requires a significant recovery period and carries potential short-term complications. To be considered for a transplant, patients must undergo a thorough evaluation, including assessment of liver function, cancer status, heart and lung health, and social support system. If you are deemed eligible, you will be placed on a waiting list for a donated liver. Transplants can come from either a living or a deceased donor. During the waiting period, you may receive bridging treatments to prevent your cancer from growing or spreading, such as ablation, embolization, or immunotherapy.

What follow-up will I need after liver cancer surgery?

What follow-up will I need after liver cancer surgery?

Dr. Amit Singal, MD, of UT Southwestern Medical Center in Dallas, discusses follow-up care after liver resection or liver transplantation. While both treatments are considered potentially curative, there remains a risk of cancer recurrence, so continued monitoring is essential. You will need to see your healthcare team regularly for CT and MRI scans, and make sure to follow all their instructions. With a transplant, you'll need to take medications to keep your body from rejecting the donor liver.

What are the potential risks of liver transplant and liver resection?

What are the potential risks of liver transplant and liver resection?

Dr. Amit Singal, a liver cancer specialist at UT Southwestern Medical Center, explains the potential risks and benefits of liver surgery and liver transplant. Both procedures can potentially cure liver cancer and offer long-term survival with a low chance of the cancer coming back. Like any surgery, there are risks such as bleeding or infection. After a liver transplant, patients need to take medication to prevent their body from rejecting the new liver, and these can sometimes cause side effects over time. Still, most people do very well after a transplant and are able to return to a full, active life. Dr. Singal encourages patients to talk with their care team about these options, as they offer a significant chance of long-term survival and improved well-being.

Module 6: Understanding Fatty Liver Disease and HCC

What is fatty liver disease? How does it start and progress?

What is fatty liver disease? How does it start and progress?

Dr. Amit Singal, MD, of UT Southwestern Medical Center in Dallas, provides an overview of fatty liver disease and discusses the increasing role of fatty liver disease as a cause of liver cancer. Fatty liver disease is also called non-alcoholic fatty liver disease, or a newer term, metabolic dysfunction-associated steatotic liver disease (MASLD). As fat buildup from MASLD damages the liver, a more serious condition called metabolic-associated steatohepatitis (MASH), can develop. As obesity, diabetes, and alcohol use have become more prevalent, so too have cases of fatty liver disease. This condition can lead to chronic liver inflammation, cirrhosis, and ultimately liver cancer. Dr. Singal highlights the importance of recognizing and addressing fatty liver disease, given its growing role in liver cancer incidence in the modern era.

How is fatty liver disease diagnosed?

How is fatty liver disease diagnosed?

Transplant hepatologist Dr. Amit Singal, MD, discusses how fatty liver disease is diagnosed. He explains that diagnosis requires evaluating a combination of medical history, physical examination, lab results, and imaging. Dr. Singal notes that fatty liver disease is often under-recognized, despite its strong association with common conditions like obesity and diabetes.

What are the stages of fatty liver disease?

What are the stages of fatty liver disease?

Liver cancer expert Dr. Amit Singal, MD, of UT Southwestern Medical Center in Dallas, describes the stages of fatty liver disease. He explains that fatty liver disease, like other chronic liver conditions, progresses through stages based on how much scar tissue (fibrosis) builds up in the liver. Dr. Amit Singal explains that fibrosis is scored from Stage 0 (no scarring) to Stage 4 (severe scarring and cirrhosis). These stages help doctors understand how serious the disease is and guide treatment.

What is metabolic-associated steatohepatitis (MASH) and how is it diagnosed?

What is metabolic-associated steatohepatitis (MASH) and how is it diagnosed?

Transplant hepatologist Dr. Amit Singal of UT Southwestern Medical Center in Dallas provides an overview of metabolic-associated steatohepatitis (MASH) and how it is diagnosed. He explains that MASH is a progressive form of fatty liver disease characterized by fat buildup, inflammation, and damage to liver cells. While some individuals have fat deposits in the liver without complications (referred to as bland steatosis), others develop inflammation that can lead to scarring (fibrosis) and potentially cirrhosis.

Can MASH be cured? How can I stop symptoms from getting worse?

Can MASH be cured? How can I stop symptoms from getting worse?

Dr. Amit Singal, MD, a liver cancer specialist at UT Southwestern Medical Center, discusses how to manage and potentially improve outcomes for patients with metabolic-associated steatohepatitis (MASH). The first key step is to stop drinking alcohol, as it can worsen liver damage. Next, making lifestyle changes, such as adopting a healthy diet (like the Mediterranean diet) and exercising for 20 to 30 minutes daily, is very important. Dr. Singal also notes new medications that target MASH and its underlying metabolic issues, are showing promise in reducing liver fibrosis and supporting weight loss. While these treatments have potential, every patient is different. It's important to work closely with your liver specialist (hepatologist) to develop a personalized plan that incorporates healthy habits and possibly medication to help manage MASH and reduce the risk of long-term liver problems.

This educational activity has been developed by Blue Faery: The Adrienne Wilson Liver Cancer Association in collaboration with Mechanisms in Medicine Inc.

This activity is supported by independent educational grants from AstraZeneca, Eisai, Exelixis, Merck, and Genentech.

Thank you to the funders of You And Liver Cancer. All content is developed independently by Blue Faery and Mechanisms in Medicine Inc., in collaboration with an Expert Faculty group; funders are allowed no influence on the content of You And Liver Cancer: An Animated Patient^® Guide to Liver Cancer.

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