Liver Lesions Causes and Treatment
Also Known As a Liver Tumor or Mass
Medically reviewed by Gagandeep Brar, MD
Liver lesions, also known as liver tumors or masses, are abnormal growths of cells in the liver. The majority are benign (non-cancerous) and often don't require treatment. But, in some cases, liver lesions are a sign of a serious problem, like cancer, requiring immediate medical treatment.
This article discusses the different types of benign and cancerous liver lesions, including their causes and symptoms. It also explains how liver tumors are diagnosed and treated.
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What Are Liver Lesions?
Liver lesions are the abnormal growth of cells in the liver. There are many different types of cells in the liver that can evolve into lesions. The most common are hepatocytes, which account for 80% of the mass of the liver.
For reasons poorly understood, liver cells can suddenly change and multiply into a cohesive mass. The tumors are described as benign if they are non-cancerous or malignant if they are cancerous.
One of the main differences between the two is that benign tumors do not spread while malignant ones do.
Benign Liver Lesions
Benign liver tumors are those that stay in their primary location without invading other parts of the body. They do not spread to nearby or distant organs. They tend to grow slowly and have distinct, well-defined borders.
There are different types of benign liver lesions characterized by the cells they develop from. The three most common include:
Hemangioma of the liver: This is the most common type that originates in blood vessels of the liver. Around 5% of the general population have liver hemangiomas.
Focal nodular hyperplasia (FNH): This is the second most common type seen more often in females. FNH is due to changes in hepatocytes that occur when blood flow to the liver is either too high or too low.
Hepatocellular adenoma of the liver: These are uncommon lesions that mostly affect young women on birth control pills and other hormonal contraceptives. They originate from hepatocytes that spontaneously change in an otherwise healthy liver.
Cancerous Liver Lesions
Liver cancer occurs when liver cells divide abnormally and do not undergo a normal process called apoptosis where old cells die so that they can be replaced by new ones. Because of this, cancer cells are considered "immortal" and can keep multiplying and spreading without end. Unlike benign tumors, malignant liver tumors generally do not have well-defined borders.
Liver cancer accounts for roughly 2% of all primary cancers in the United States.
The most common liver cancers include:
Hepatocellular carcinoma (HCC): This is the most common type accounting for 85% of cases. HCC is three times more common in males and is usually preceded by liver cirrhosis.
Cholangiocarcinoma: This is the cancer of the bile duct, the branches of which extend into the liver. It is also known as intrahepatic bile duct carcinoma.
Angiosarcoma of the liver: An uncommon type of liver cancer accounting for 1% of cases. It starts in the blood vessels of the liver.
Metastatic liver cancer: This is when cancer spreads from a tumor in another part of the body to the liver.
Can Benign Liver Tumors Turn Cancerous?
Some types of benign liver tumors have the potential to turn cancerous. Studies suggest that around 5% of people with hepatocellular adenoma will experience disease progression and eventually be diagnosed with hepatocellular carcinoma.
Although hepatocellular adenoma is more common in females, males are around 10 more times likely to experience cancer transformation.
Causes of Liver Lesions
Although the cause of liver lesions is unknown, they are thought to be due to genetic, lifestyle, and environmental factors that cause cells to suddenly replicate abnormally.
Certain factors can increase the risk of benign or malignant liver tumors, including:
Chronic viral hepatitis: These are infections by the hepatitis B virus (HBV) or hepatitis C virus (HCV).
Heavy alcohol use: Alcohol can damage the liver over time, causing liver cirrhosis. Cirrhosis is characterized by progressive liver damage and the loss of liver function.
Obesity: This increases the risk of non-alcoholic fatty liver disease (NAFLD), a liver condition that can progress to cirrhosis in some people.
Diabetes: Uncontrolled high blood sugar can cause damage to the liver over time, raising the risk of NAFLD.
Hormonal contraceptives: The long-term use of estrogen-based birth control is linked to an increased risk of hepatocellular adenoma.
Hereditary hemochromatosis: This a rare genetic disorder that causes abnormal iron deposits throughout the body, including the liver.
Smoking: Cigarette smoke is independently linked to an increased risk of liver cancers.
Industrial chemicals: Long-term occupational exposure to vinyl chloride (used to make PVC) is linked to an increased risk of liver cancer.
Related: Causes and Risk Factors of Liver Cancer
Symptoms of Liver Lesions
Benign liver tumors are not usually problematic, while malignant liver tumors inherently are. The symptoms can vary significantly, and, in some cases, there may be no symptoms at all.
Benign Liver Lesions
Benign liver tumors usually do not cause any symptoms or require treatment. It is only when they become large that they can press on adjacent organs and cause chronic abdominal pain.
In rare instances, a large hemangioma can cause heart failure in infants if the tumor places undue pressure on the baby's heart muscle. This can cause symptoms like:
Poor appetite
Trouble breathing, especially after eating
Weakness or tiredness
Irritability
Sudden weight loss or gain
Persistent cough
Rapid heartbeat
Hepatocellular adenomas over 5 millimeters (mm) can also sometimes rupture and bleed into the abdominal cavity. The rupture of the tumor can cause severe abdominal pain but is rarely life-threatening. Severe cases may need treatment in a hospital to stem the bleeding.
Cancerous Liver Lesions
The symptoms of liver cancer vary by the stage of the malignancy. Early-stage liver cancer (Stages 1 and 2) is often asymptomatic (without symptoms) and only becomes symptomatic when the disease progresses to Stages 3 or 4.
Symtoms of liver cancer include:
Unintended weight loss
Pain in the upper right side of the abdomen
Loss of appetite
Feeling full after a small meal
Tiredness or weakness
Itchiness
Nausea or vomiting
Jaundice
Dark urine
Clay-colored stool
Ascites (fluid build-up in the abdomen)
Related: Symptoms of Liver Cancer
Diagnosis
The diagnostic process for a liver tumor is largely the same whether the mass is thought to be cancerous or non-cancerous.
The diagnosis starts with a physical exam to palpate (examine by touch) the area over the liver to check the size and consistency of the liver and see if there is any pain. This will be accompanied by a review of your medical history (including your alcohol consumption, history of diabetes or hepatitis, and family history of cancer).
Thereafter, the healthcare provider will order tests to not only check for suspected causes but rule out more serious causes, like cancer.
The tests and procedures may include:
Liver function tests (LFTs): This panel of blood tests measures enzymes that increase when the liver is inflamed It is a strong indicator of liver disease.
Alpha-fetoprotein (AFP): This is a blood test that serves as a tumor maker. If there is cancer, levels of a compound called AFP will increase in the body. AFP can also increase with pregnancy, so high results don't always mean cancer.
Abdominal ultrasound: This is a non-invasive imaging study that uses reflected sound waves to visualize internal organs.
Computed tomography (CT): This is an imaging study that composites multiple X-rays to create a three-dimensional visualization of internal organs.
Magnetic resonance imaging (MRI): This is an imaging study that creates highly detailed images of soft tissues using high-intensity magnetic and radio waves.
If there are indications of cancer, your healthcare provider will order a biopsy to obtain a sample of tissue to evaluate in the lab. This is generally the only definitive way to diagnose cancer.
Options include:
Fine-needle aspiration: This involves the insertion of a thin needle through the abdomen into the liver to obtain a sample of tissues or cells.
Core needle biopsy: This is the same procedure using a slightly wider needle.
Laparoscopy: This is a minimally invasive surgery using tiny incisions and specialized tools to obtain a larger sample of tissues.
Related: How Liver Cancer Is Diagnosed
Treatment
Many benign liver tumors don't need treatment—and never will. By comparison, malignant liver tumors always do.
Benign Liver Lesions
Benign liver lesions are often found by accident when an imaging test is performed for another reason. Generally speaking, benign liver tumors do not need treatment. It is only when they cause symptoms or are exceptionally large that treatment may be pursued.
Examples include:
Large hemangiomas and FNH tumors may be surgically removed if they are causing chronic pain. Radiation therapy may be used to shrink the tumor for people who cannot tolerate surgery.
Hepatocellular adenomas should be removed if they have ever caused any bleeding. The bleeding can be stopped with embolization (using injected chemicals to close blood vessels).
Hepatocellular adenomas in males should always be removed to reduce the risk of cancer.
Large benign tumors may also be removed in people with bleeding disorders, such as hemophilia, to prevent potentially serious internal bleeding should the tumor ever rupture.
Cancerous Liver Lesions
The treatment of liver cancer varies based on the cancer type and stage as well as the cancer grade (a measurement of how normal or abnormal the cancer cells are).
Liver cancer treatment may involve:
Surgical resection: This is the removal of the liver tumor with a margin of healthy tissues.
Chemotherapy: This involves a combination of drugs that target and kill fast-replicating cells like cancer
Tumor ablation: This procedure destroys tumors using extreme heat or cold. It is an option for smaller tumors or for people who cannot tolerate surgery.
Embolization therapy: This involves cutting off the blood supply to the tumor, effectively "starving" it so that it cannot grow.
Radiation therapy: This can be used to control the tumor's growth when surgery is not an option. It may also be used after surgical resection to kill any remaining cancer cells.
Immunotherapy: This involves drugs like Tecentriq (atezolizumab) that spur the immune system to better fight cancer.
Targeted drugs: This involves drugs like Avastin (bevacizumab) that directly target and attack cancer cells and leave normal ones alone.
Liver transplant: This may be used when there are no other options for survival. Only certain people without metastatic disease are candidates for a transplant.
Related: How Liver Cancer Is Treated
Prevention of Liver Tumors
Not all liver lesions can be prevented, particularly benign ones. But there are certain steps you can take to avoid liver cancer, especially if you have risk factors for the disease.
These include:
Hepatitis B vaccination: Anyone at risk of hepatitis B should seek vaccination, including sexually active people in non-monogamous relationships.
Limiting your alcohol intake: The Centers for Disease Control and Prevention (CDC) recommends no more than one drink per day for females and two drinks per day for males.
Quit smoking: Many smoking cessation aids are fully covered by insurance under the Affordable Care Act. Speak with your healthcare provider.
Lose weight: Having obesity increases your risk of diabetes and NAFLD, both of which are linked to liver cancer. Weight loss can control and potentially reverse both of these conditions.
Get treated for hepatitis C: Newer hepatitis C drugs offer cure rates of 95% or greater with only 8 to 12 weeks of treatment. Curing hepatis C reduces your risk of liver cancer by 75%.
Outlook for Liver Lesions
If you have been diagnosed with a benign liver tumor, the prognosis (likely outcome) is generally good. Many benign tumors require no treatment and will never cause you any problems.
With that said, people with hepatocellular adenoma should be monitored regularly due to the potential for liver cancer. Oral contraceptives may also need to be stopped.
If liver cancer is diagnosed, the prognosis varies based on the stage of the disease. The current five-year survival rate (meaning the percentage of treated people who live at least five years following their diagnosis) is:
Localized (meaning the tumor is contained within the liver): 42%
Regional (meaning a spread of cancer to nearby lymph nodes or tissues): 28%
Distant (meaning a spread of cancer to distant organs): 19%
Summary
Liver lesions are the abnormal growth of liver cells. These lesions, also known as tumors or masses, may be non-cancerous (benign) or cancerous (malignant). While uncommon, some types of benign liver tumors can become cancerous.
Benign liver lesions tend to grow slowly, have defined borders, do not invade other organs, and generally do not need to be treated unless they cause pain or bleeding.
Liver cancer grows rapidly and erratically, can invade other organs, and needs treatment in the form of surgery, chemotherapy, radiation, immunotherapy, and others.
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