Liver masses can stay silent: Early diagnosis improves treatment options

By Ahmet Taş | Wise News Press

ISTANBUL, TÜRKİYE — Liver masses can develop for long periods without causing noticeable symptoms, making appropriate follow-up particularly important for people with chronic hepatitis, cirrhosis or other established liver disease risks.

Prof. Dr. Cem İbiş of the General Surgery Department at Daviva Avcılar Hospital said many liver lesions are discovered incidentally during ultrasound, CT or MRI examinations performed for unrelated reasons. He stressed that finding a mass does not automatically mean cancer, but determining whether a lesion is benign or malignant is essential for deciding whether observation, surgery or another treatment is needed.

Advances in medical imaging now allow physicians to identify increasingly small liver lesions. For malignant tumors, treatment options are generally broader when disease is localized and liver function remains preserved.

Many benign liver masses are found by chance

Liver masses are broadly divided into benign and malignant lesions, although each group includes several different conditions with different biological behavior.

İbiş said benign lesions are common in clinical practice and may remain unnoticed because the liver has substantial functional reserve. They are frequently identified during routine imaging or examinations ordered for another medical problem.

Common benign lesions such as liver hemangiomas often cause no symptoms and may require no treatment when they are small and have characteristic imaging features.

The key issue is not simply whether a mass exists, but what type of lesion it is, whether it is changing and whether it is causing symptoms or complications.

Some benign lesions can be followed with imaging rather than surgery. The decision depends on factors including lesion type, size, location, growth pattern and the patient’s overall condition.

İbiş noted that benign tumors generally do not behave like cancer by invading surrounding tissues or spreading to distant organs.

Malignant liver tumors may start in the liver or spread from elsewhere

Malignant liver masses fall into two important categories.

The first consists of primary liver cancers, which originate in the liver itself. Hepatocellular carcinoma, or HCC, is the most common form of primary liver cancer in adults.

The second category consists of metastatic liver tumors, which occur when cancer cells from another part of the body spread to the liver.

This distinction matters because a cancer that begins in the liver is biologically and therapeutically different from, for example, colorectal, pancreatic, breast or lung cancer that later spreads to the liver.

İbiş said secondary or metastatic tumors are frequently encountered in clinical practice, particularly because the liver receives a large blood supply and can become a site of spread from other cancers.

Treatment therefore depends not only on the size of the liver lesion but also on where the cancer originated, whether there are tumors elsewhere and how well the liver is functioning.

Unexplained weight loss and loss of appetite should not be ignored

One of the challenges with liver tumors is that early disease may produce few or no specific symptoms.

As a mass enlarges, patients may develop discomfort or a feeling of fullness in the right upper abdomen. Other possible symptoms include unexplained weight loss, loss of appetite, fatigue and weakness.

The U.S. National Cancer Institute lists right-sided upper abdominal discomfort, abdominal swelling, fatigue or weakness, loss of appetite and unexplained weight loss among possible signs of liver cancer. Jaundice, easy bruising and dark urine can also occur in some patients.

However, these symptoms are not specific to liver cancer. They can occur with many other gastrointestinal, metabolic or liver conditions.

Persistent or unexplained symptoms therefore require medical evaluation rather than self-diagnosis.

İbiş emphasized that the absence of symptoms does not necessarily rule out a liver lesion, especially in people who are already known to have chronic liver disease.

Hepatitis B, hepatitis C and cirrhosis increase liver cancer risk

The most important risk factors for hepatocellular carcinoma include chronic hepatitis infections and cirrhosis.

İbiş highlighted chronic hepatitis B and hepatitis C, heavy alcohol use and cirrhosis associated with advanced fatty liver disease as important risk conditions.

The National Cancer Institute similarly identifies chronic hepatitis B and C infection, cirrhosis, heavy alcohol use and nonalcoholic steatohepatitis as established risk factors for liver cancer.

Chronic hepatitis can cause years of inflammation and progressive liver damage. Cirrhosis replaces healthy liver tissue with scar tissue, increasing the risk of hepatocellular carcinoma.

The implications for screening and follow-up differ from one patient to another. People with chronic liver disease should therefore follow a surveillance schedule recommended by their hepatologist or other treating physician rather than relying on a general population screening program.

For people with hepatitis B or C, managing the underlying viral infection is also important. NCI notes that treatment of chronic hepatitis B can reduce liver cancer risk, while effective therapies can cure most hepatitis C infections.

Surgery can offer strong outcomes in selected patients

Treatment of liver tumors is highly individualized.

Doctors consider whether a lesion is benign or malignant, how many tumors are present, their size and location, whether cancer has spread outside the liver and how much healthy liver function remains.

İbiş said surgery is often one of the most effective options when a malignant tumor is localized and the patient has sufficient healthy liver reserve.

One unusual feature of the liver is its ability to regenerate after part of the organ is removed. In selected patients, surgeons can perform a partial hepatectomy, removing the tumor together with a margin of surrounding tissue while preserving enough functioning liver.

The National Cancer Institute lists partial hepatectomy and liver transplantation among treatment options for localized liver cancer.

İbiş also noted that minimally invasive surgical approaches have become increasingly important. In suitable patients, laparoscopic techniques may reduce incision size and postoperative pain and can support a faster recovery compared with conventional open surgery.

The choice of operation still depends heavily on tumor anatomy, underlying cirrhosis and the patient’s overall health.

Ablation and catheter-based therapies expand treatment choices

Not every patient with a liver tumor is a candidate for surgical removal.

For selected tumors, doctors may use ablation, which destroys cancerous tissue by applying heat or other forms of energy. Radiofrequency ablation and microwave ablation are among the techniques currently used.

Another group of treatments works through the blood vessels supplying the tumor.

Transarterial chemoembolization, or TACE, delivers chemotherapy into the artery feeding a liver tumor while also restricting its blood supply.

NCI lists radiofrequency and microwave ablation as options for localized disease and transarterial embolization or chemoembolization among treatments used in certain locally advanced liver cancers.

For more advanced disease, systemic treatments have also changed considerably in recent years. Immunotherapy and targeted therapies can be used in selected patients, sometimes in combination.

This means a diagnosis that is not suitable for surgery does not automatically mean that no effective treatment is available.

A liver mass is not automatically cancer

İbiş’s central message is that liver masses should neither be ignored nor automatically assumed to be malignant.

Many lesions are benign and may only require observation. Others require additional imaging, laboratory tests or, in selected cases, biopsy before their nature becomes clear.

For malignant tumors, earlier detection can be particularly important because localized disease may allow surgery, ablation or other potentially more effective local treatments.

People with known hepatitis, cirrhosis or chronic liver disease should therefore keep up with the follow-up program recommended by their physicians, while people experiencing persistent unexplained symptoms should seek medical evaluation.

The goal is not to create unnecessary anxiety over every incidental liver lesion, but to ensure that a potentially significant finding is correctly characterized and treated at the most appropriate time.

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