Liver cancer


liver cancer (Hepatocellular carcinoma) is a malignant tumor of the liver that often develops as a result of liver cirrhosis or chronic inflammation of the liver. Liver cancer usually causes no complaints at first. At an advanced stage, liver cancer manifests itself as nonspecific symptoms such as upper abdominal pain or unwanted weight loss. Men are more likely to be affected by liver cancer than women. At an early liver cancer stage, partial liver removal can cure the disease. Read all important information about liver cancer here.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. C22C24ArtikelübersichtLeberkrebs

  • description
  • symptoms
  • Causes and risk factors
  • Examinations and diagnosis
  • treatment
  • Disease course and prognosis

Liver cancer: description

The liver is an organ that fulfills many important functions in the body. For example, it stores energy-rich glycogen and vitamins, which are transported via the portal vein from the intestine. The liver is also the largest gland of the body and produces important hormones and other proteins. In addition, the liver is an important detoxification organ. It forms bile, which not only dissolves fats in the porridge for better digestion into droplets, but with the help of which it also excretes toxins through the intestine. In addition, it processes bilirubin, the breakdown product of red blood cells.

Liver cancer is a malignant tumor of the liver. Origin are cells whose genetic material is pathologically altered. The degenerated liver cells grow faster and displace healthy tissue. Apart from their aggressive growth, the diseased cancer cells lose their functionality and can no longer fulfill their natural tasks. Since the liver plays a central role in many metabolic processes of the body, this loss of function becomes more and more noticeable as the cancer cells spread.

Three different liver cancers

In the liver, there are other types of tissue besides the actual liver cells, such as the cells of the bile ducts and the blood vessels. Cancer can develop from any of these types of tissues. There are therefore different types of liver cancer, depending on which cells the tumor originated from.

80 percent of primary liver cancers are so-called hepatocellular carcinoma (HCC), This means that the tumor has developed directly from the liver cells (hepatocytes). If the degenerated cells descend from the cells of the bile ducts, the cancer is called cholangiocellular carcinoma (CCC), The blood vessels of the liver can also be the source of liver cancer. This type of liver cancer is called angiosarcoma referred to the liver.

The liver also hosts preferred malignant secondary tumors (metastases) of other cancers. The original tumor (primary tumor) often sits in the lungs, breast, uterus, prostate or the gastrointestinal tract. Overall, such metastases in the liver are more common than a tumor that has developed primarily in the liver.

Frequency of liver cancer

Liver cancer is a relatively rare tumor in Germany. The Robert Koch Institute in Berlin estimates that in 2014 about 8900 people (6200 men and 2700 women) in Germany will develop liver cancer. However, more people develop liver cancer in Asia and Africa than in Europe. On average, patients in these regions also contract earlier. In these cases, the tumors occur particularly frequently between the ages of 30 and 40, in Europe between the ages of 50 and 60 years. One possible reason: While alcohol is the main cause of liver cancer in Europe, in some regions of Africa and Asia, mold and infection with hepatitis B and C play a greater role. This is due to poorer sanitary conditions and poorer medical care.

Classifications of liver function and tumor spread

Doctors classify liver cancer using various classifications. The so-called Child-Pugh classification describes the functional disorders of the liver. The spread of the tumor is described with the TNM classification and the UICC stages.

Child-Pugh classification

The Child-Pugh classification classifies liver dysfunction due to liver cirrhosis or liver cancer in three stages (Child-Pugh A, B, C). The more points reached, the more advanced the stage - and the more impaired the liver function. It takes into account the accumulation of water in the abdominal cavity (ascites), brain dysfunctions (encephalopathy), the content of bilirubin and albumin in the blood, and blood clotting (quick test):


1 point

2 points

3 points





Morbid brain changes (encephalopathy)


Grade I to II

Grade III to IV

Bilirubin in serum (mg / dl)


2 to 3


Quick test (percent)




Serum albumin (g / dl)


2.8 to 3.5


Child-Pugh A: 5 to 6 points; Child Pugh B: 7 to 9 points; Child-Pugh C: 10 to 15 points

Liver cancer stages: TNM classification and UICC stages

Liver cancer is divided into different stages according to the UICC (Union international contre le cancer). The classification depends on the spread of the tumor. This is in turn defined by the so-called TNM classification. The letters "TNM" stand for three different parameters: T = tumor size, N = lymph node involvement, M = metastases (daughter colonies). Based on the classification, the doctor describes how far the tumor has already spread to the surrounding tissue. The staging according to UICC thus depends directly on the TNM classification.

TNM classification:

Tumor size (T):

  • TX: Primary tumor can not be assessed
  • T0: No evidence of a primary tumor in the liver
  • T1: Solitary tumor without vascular involvement
  • T2: Single (solitary) tumor with vascular involvement or multiple tumors ≤ five centimeters
  • T3: multiple tumors> five centimeters or tumor growth into a larger branch of the hepatic, portal vein (s)
  • T4: Continuous involvement in adjacent organs except the gallbladder or breakthrough of the tumor into the peritoneum

Lymph nodes (N):

  • NX: Regional lymph nodes can not be assessed
  • N0: Lymph nodes are not affected by cancer cells
  • N1: Regional lymph nodes are infected with cancer cells

Distant metastasis (M):

  • MX: Remote metastases can not be assessed
  • M0: There are no liver metastases in other organs
  • M1: There are liver metastases in other organs

UICC stages:

UICC stage

TNM classification

Stage I

Up to T1 N0 M0

Stage II

Up to T2 N0 M0

Stage III

Up to T4 N0 M0

Stage IVa

Each T N1 M0

Stage IVb

Every T, every N and from M1

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Liver cancer: symptoms

Read all important information about typical liver cancer symptoms here.