Benign liver tumors

What are benign liver tumors?

Benign liver tumors are not uncommon and there are a number of them. A characteristic feature of benign tumors in the liver is that they do not grow into neighbouring tissue and do not form metastases in other organs. Nevertheless, benign liver tumors can grow, reach considerable sizes and impair the function of organs. Doctors distinguish between different types of benign liver tumors.

Hemangiomas in the liver

Liver hemangiomas are the most common benign liver tumors that originate in the blood vessels. Colloquially they are called “blood sponges” and in technical jargon also cavernous hemangiomas. They usually occur as single tumors. However, hemangiomas are found in both the right and left lobe of the liver in up to 40 percent of those affected. They can vary in size – from a few millimeters to more than 20 centimeters. However, most liver tumors are small and measure less than five centimeters. Those affected often do not experience any symptoms.

Focal nodular hyperplasia

Focal nodular hyperplasia, or FNH for short, is the second most common benign liver tumor. Women between the ages of 20 and 50 are particularly likely to develop this liver tumor. The use of hormonal oral contraceptives probably causes the tumor to grow, but is not considered a direct trigger. As a rule, a single nodule develops in the liver that measures less than five centimeters. Sometimes other liver tumors can be detected at the same time. Most patients only experience symptoms when the tumor takes on larger dimensions, for example discomfort in the upper abdomen. FNH do not degenerate into a malignant tumor.

Liver cell adenoma (hepatocellular adenoma)

Adenomas of the liver are rather rare and when they do occur, they are more common in women (approx. 90 percent). They are also usually between 15 and 45 years old. Sometimes other liver tumors are present at the same time. The development of adenomas is often linked to the use of hormonal oral contraceptives (oestrogens) (“the pill”). However, adenomas are less common today. One reason is that the dosage and composition of the hormones in today’s preparations is much lower and different from the “pills” of the first generations. Adenomas can grow large and have an increased risk of bleeding. After stopping the hormonal contraceptive, the liver tumor often shrinks again.

People who take male sex hormones (androgens, e.g. anabolic steroids = derivatives of testosterone) also run the risk of developing an adenoma. Examples are bodybuilders (doping) or transsexual people. In addition, the risk of these liver tumors is increased in glycogen storage diseases. The carbohydrate metabolism is disturbed.

Benign liver tumors can have consequences

Even if the liver tumors are benign – they can

• grow,
• press on surrounding organs,
• impair blood flow to or from the liver and thus disrupt organ function or
• Trigger pain.

Therefore, even benign liver tumors sometimes require an operation in which a surgeon removes the tumor. In addition, some liver tumors carry the risk of benign tumors becoming malignant and developing into liver cancer. This risk exists, for example, with adenomas. Doctors therefore either check this liver tumor at close intervals or remove it as part of an operation.

Benign liver tumors – frequency and age

Hemangioma is the most common benign liver tumor. Experts estimate that around 0.4 to 20 percent of the population suffer from it. This means that hemangiomas are widespread. Around 60 to 80 percent of those affected are between 30 and 50 years old. Women develop hemangiomas about three times as often as men.

Focal nodular hyperplasia (FNH ) – the second most common benign liver tumor – usually affects women between the ages of 20 and 50. Liver adenomas, on the other hand, are very rare and also predominantly affect women. Most of the women are between 15 and 45 years old.

Benign liver tumors: causes and risk factors

The causes and mechanism of the development of benign liver tumors are not yet fully understood in many cases. However, some risk factors are known for certain types of liver tumors.

• hemangiomas: The causes are still unclear. However, doctors suspect that the hemangiomas are vascular malformations or dispersed embryonic tissue (hamartomas). Female sex hormones (estrogens, gestagens) also appear to play a role, as hemangiomas often grow during pregnancy and when taking hormonal contraceptives. Despite this, researchers have not yet been able to detect any docking sites (receptors) for estrogen on the benign tumor cells. In addition, the hemangioma also grew in women without estrogen intake or in the postmenopause. The hypothesis is therefore “shaky” and there is no clear evidence of a connection.
• Focal nodular hyperplasia (FNH): Researchers have not yet found the exact causes of FNH either. Although a connection between the intake of estrogen-containing preparations and the development or growth of FNH is considered probable, it has not yet been sufficiently scientifically proven.
• Adenomas: A risk factor for the development and growth of adenomas appears to be the use of estrogen-containing preparations. This is also supported by the fact that the adenoma often shrinks again after stopping the hormones. Male sex hormones – the androgens – are probably also involved in the development of adenomas.

Symptoms: Benign liver tumors often remain undetected for a long time

In many cases, benign liver tumors cause no or only mild symptoms. They therefore go unnoticed for a long time. Doctors often find liver tumors by chance during another examination, for example during an ultrasound, computer tomography (CT) or magnetic resonance imaging (MRI). Only when they grow and become very large do they cause discomfort. The following signs may indicate a benign tumor in the liver:

• Hemangioma: These liver tumors are usually small and cause no symptoms. However, as they grow, abdominal pain and a feeling of fullness and pressure can occur. If hemangiomas bleed or form blood clots (thromboses), severe abdominal pain, nausea and fever may also occur. Hemangiomas often cause symptoms, especially in young women.
• Focal nodular hyperplasia (FNH ): Some patients experience upper abdominal discomfort, most have no symptoms.
• Adenomas: Many of those affected are completely symptom-free. As the adenoma grows larger, some people experience a severe feeling of illness with pain in the right upper abdomen. Sometimes the tumor can also be felt from the outside due to its size.

Benign liver tumors: Diagnosis with us

The diagnosis of benign liver tumors is often an incidental finding. Doctors discover the tumor in the liver during an examination that takes place for a different reason. The following methods are used in the diagnosis of benign liver tumors:

• Ultrasound examination (sonography), sometimes contrast-enhanced ultrasound
• Computed tomography (CT) – an X-ray examination in which radiologists take images of the body “slice by slice” and create cross-sectional images.
• Magnetic resonance imaging (MRI = magnetic resonance imaging): Radiologists use strong magnetic fields and also record the body “in slices”.
• Blood test: We routinely determine the blood values. They generally show how well the organs are functioning. Sometimes the liver values (e.g. alanine aminotransferase, alpha-fetoprotein = AFP) are informative.

Sometimes we also combine different imaging procedures.

Benign liver tumors: prevention, early detection, prognosis

There are no special measures for the prevention or early detection of benign liver tumors. Doctors usually discover tumors in the liver by chance. Female sex hormones appear to be a risk factor for the development or growth of benign tumors. If you are taking hormonal contraceptives and have symptoms such as upper abdominal pain, always consult your doctor. You may have to stop taking the preparation. The same applies if you are taking male sex hormones (androgens).

In general, it is always advisable to see a doctor if you have unusual symptoms that do not go away on their own.

Course and prognosis of benign liver tumors

The course and prognosis of benign liver tumors cannot be generally predicted. In many cases, the tumors remain small and cause no symptoms. In others, the tumors grow in the liver and cause unpleasant symptoms. Surgery is then sometimes necessary. Tumors in the liver (rupture) rarely rupture spontaneously (if they are larger) or as a result of external force. Medical interventions such as a liver biopsy or fine needle aspiration can also lead to a rupture. We therefore do not use either method in the diagnosis of liver tumors.

Caution is advised with adenomas. This is because they can cause bleeding, which is dangerous and must be treated by doctors immediately. In addition, adenomas can degenerate and develop into liver cancer. According to the literature, the probability of this is between eight and 13 percent.

Benign liver tumors: Treatment means observation or surgery

There are various ways in which we treat benign liver tumors. Which therapy is used depends on the size of the liver tumor, but also on your symptoms. As a benign liver tumor grows, the symptoms usually increase. In addition, larger tumors can impair the function of the liver or neighboring organs. With some initially benign liver tumors, there is a risk that they will degenerate and become malignant.

The following treatment options are available:

• Wait, observe and monitor: Benign liver tumors do not always require immediate treatment. This is especially true for smaller tumors. However, you must attend regular check-ups with your doctor, who will use imaging techniques to see how the liver tumor is behaving. The intervals are longer for smaller tumors and shorter for larger ones.
• Surgery: Surgical intervention is advisable for larger tumors and complaints. In the case of adenomas, we often advise surgery in order to avert the risk of degeneration and thus the development of liver cancer. Otherwise, it is possible to have the adenoma checked by ultrasound at short intervals.

There are various surgical methods: Excision of the tumor (enucleation), partial removal of the liver or, in very severe cases, even a liver transplant. In many cases, the operation can be performed minimally invasively (“keyhole surgery”) as part of a laparoscopy. Only a few small incisions are necessary here.

Treatment of benign liver tumors: what you can do yourself

• Discontinue oral contraceptives in consultation with your doctor and switch to another contraceptive method. The tumor then often shrinks again.
• You should also stop taking anabolic steroids, for example for doping purposes. Transsexual people should talk to their doctor about what options are available.
• In the case of large benign tumors in the liver, it is better to avoid sports with intensive physical contact. Handball and football, for example, are often rougher. The force applied to the abdominal cavity can lead to a rupture and cause bleeding. It is better to choose low-injury sports such as cycling, jogging or swimming. Gentle sports such as yoga, tai chi or qi gong are also better for the liver.