Fibrolamellar Carcinoma, from the CureRays guide library.

Fibrolamellar carcinoma is a rare liver cancer that strikes teens and young adults who usually have healthy livers, and surgery to remove the tumor is the main path to cure.

What it is.

Fibrolamellar carcinoma (FLC) is an unusual form of liver cancer that mostly affects adolescents and young adults — typically people in their teens to thirties — who do not have the cirrhosis, hepatitis, or alcohol-related liver damage seen with ordinary liver cancer. Under the microscope the tumor cells are separated by bands of fibrous tissue arranged in layers ('lamellae'), which gives the disease its name. Almost every case is driven by a single, distinctive genetic event: a fusion of two genes called DNAJB1 and PRKACA that switches on abnormal cell growth. Because symptoms (vague belly pain, fullness, weight loss) are easy to dismiss in a healthy young person, FLC is often found late, after it has grown large or spread to nearby lymph nodes. Complete surgical removal offers the best chance of long-term survival.

How radiation treats it.

Radiation damages the DNA inside cancer cells so they can no longer divide. In fibrolamellar carcinoma, surgery does the curative work, but radiation has a valuable supporting role: highly focused techniques such as SBRT can wipe out a tumor that cannot be removed or an isolated spot of spread, while protecting the healthy liver these young patients depend on. Modern liver radiation accounts for the way the liver moves with each breath, so the beam stays locked on the target. It is painless and leaves no radioactivity behind.

The ways we can treat it.

Stereotactic body radiation therapy (SBRT). Delivers a few high, pinpoint doses to a liver tumor or an isolated site of spread, controlling disease that cannot be surgically removed while sparing the surrounding healthy liver.

Conformal / IGRT photon radiation. Image-guided beams shape the dose around the tumor and adjust for breathing motion, useful for larger or awkwardly placed tumors or for easing symptoms.

Proton beam therapy. Protons stop after reaching the tumor, helpful for preserving as much healthy liver as possible in young patients who may need their liver for decades.

Questions we hear often.

Why did I get liver cancer when my liver is healthy? Fibrolamellar carcinoma is different from ordinary liver cancer. It is not caused by cirrhosis, hepatitis, or alcohol. Instead it is driven by a specific gene fusion (DNAJB1-PRKACA) that arises in the tumor itself — it is not something you did, and in most people it is not inherited.

Is surgery really the main treatment? Yes. Completely removing the tumor offers the only proven chance of cure, and because the rest of your liver is healthy, surgeons can often remove a large amount safely. If the cancer returns, further surgery is frequently possible because FLC tends to grow slowly.

Does radiation help? Radiation is not the main treatment, but focused techniques like SBRT can control tumors that cannot be removed or treat an isolated area of spread, while sparing your healthy liver. Your team will weigh it alongside surgery, systemic therapy, and clinical trials.

This guide is informational only. It is not medical advice — please confirm anything here with your care team.