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Liver cancer

Cancer is an abnormal and uncontrolled growth of cells. The cells multiply to form a tumour. Tumours can either be benign or malignant. Benign tumours are not cancerous. They normally stay in your liver and don’t spread to other parts of your body. Malignant tumours are cancerous and can spread to other parts of your body.

Primary liver cancer is a type of cancer that starts in your liver.

There are two groups that liver cancer falls into: primary and secondary.

Cancer that starts in your liver is called primary liver cancer. This type of cancer is not that common in the UK, with around 3,400 people diagnosed with it each year. But, it’s the sixth most common form of cancer worldwide. The most common type of primary liver cancer is called hepatocellular carcinoma (HCC).

Most people in the UK that have been diagnosed with tumours in the liver, will have secondary liver cancer. This is when cancer from another part of your body, such as your bowel, breast or lungs spreads to your liver. The spread of cancer is called metastasis.

Our information here will concentrate on primary liver cancer.

The liver

Your liver is a large organ, found beneath your right lung, just under your ribcage. It’s divided into two sections, called lobes.

Your liver carries out many important jobs, including:

  • breaking down and removing harmful and waste substances
  • producing proteins to help your blood to clot
  • converting fats and carbohydrates to energy when your body needs it
  • producing bile to help you digest and absorb food

If your liver is healthy it can also repair itself and can still function when much of it is damaged.

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How cancer develops
Cells begin to grow in an uncontrolled way
An image showing the liver and surrounding structures

Details

  • Types Types of primary liver cancer

    There are four main types of primary liver cancer.

    • HCC is the most common type of primary liver cancer. It starts in the main cells of your liver, called hepatocytes.
    • Cholangiocarcinoma starts in the cells that line your bile ducts and is known as bile duct cancer. Bile ducts are tubes that connect your liver and gallbladder to your small bowel.
    • Angiosarcoma is a very rare form of liver cancer and starts in the blood vessels of your liver.
    • Hepatoblastoma is also a very rare form of liver cancer that usually affects children.

    Bupa Health Assesment: Liver check

    If you are concerned about liver disease, Bupa can help you get a diagnosis.

  • Symptoms Symptoms of primary liver cancer

    Primary liver cancer affects people in different ways. Most of the time there are no symptoms in the early stages. However, as the cancer cells grow, you may have symptoms including:

    • weight loss (when you’re not trying to lose weight)
    • loss of appetite
    • sickness and vomiting
    • pain in your abdomen (tummy)
    • a swollen abdomen
    • skin and eyes turning yellow (jaundice)
    • fatigue
    • a fever

    These symptoms may be caused by problems other than liver cancer. But, if you have any of these symptoms, see your GP.

  • Diagnosis Diagnosis of primary liver cancer

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP will organise for you to have a blood test to see how well your liver is working.

    If the results of your blood test show anything unusual, your GP may refer you to a hospital to have further tests. You may have one or more of the tests described below. They may help to determine if you have liver cancer, its stage and if it has spread to other parts of your body.

    • An ultrasound uses sound waves to produce an image of your liver. This scan may help to show up any unusual growths in your liver. If you’re at a high risk of liver cancer, you may have an ultrasound every six months to check your liver.
    • A CT scan uses X-rays to make a three-dimensional picture of your liver. This test may help to see if you have cancer in your liver or in other parts of your body.
    • An MRI scan uses magnets and radiowaves to produce images of the inside of your body. This test might help to see if you have cancer in your liver or in other parts of your body.
    • A biopsy is when a small sample of your tissue is taken. It will be sent to a laboratory for testing to find out what types of cells are in your liver and if they are benign or malignant. See our FAQ for more information about how a liver biopsy is carried out.
    • A laparoscopy can help diagnose liver cancer. It can also help assess the stage at which your cancer is at. A laparoscopy is a small operation that allows your doctor to look at your liver by inserting a laparoscope through a small cut in your abdomen. A laparoscope is a thin tube that contains a light and a camera. A laparoscopy is performed under general anaesthetic and your doctor may also do a liver biopsy at the same time.
  • Worried about liver disease?

    Get a picture of your current health and potential future health risks with a Bupa health assessment. Find out more today.

  • Treatment Treatment of primary liver cancer

    The treatment you have will depend on how advanced your cancer is, whether it has spread to other areas and your general health. Treatments will try to either:

    • remove your cancer
    • shrink your cancer to relieve your symptoms
    • delay how your cancer grows to make surgery possible

    Surgery

    Surgery may help to cure your liver cancer. However, it’s important to remember that surgery isn’t always possible and is only offered to a small number of people. Surgery will depend on:

    • what stage your cancer is at
    • the size and position of your tumour
    • if your cancer has spread to other parts of your body

    There are a number of surgery options. Some examples are listed below.

    • A liver resection. This is when the affected part of your liver is removed. It’s the most common type of surgery for liver cancer. You might have a liver resection if your cancer is at an early stage. If you have a small tumour, a liver resection may reduce the chance of it recurring. You might not be offered a liver resection if you have cirrhosis.
    • A liver transplant. This is when your liver is replaced with a donor’s liver. Only a small number of people are suitable for this type of surgery and it may depend on the size of your tumour and your general health.

    Non-surgical treatments

    Ablation

    Ablation means to remove or destroy. There are two different ways of ablating a tumour in your liver which are described below.

    Percutaneous ethanol injection

    A percutaneous ethanol injection (PEI) is when ethanol (pure alcohol) is injected directly into your tumour to try and destroy the cancer cells.

    If you can’t have surgery, you may be offered this treatment option. However, you might only be able to have PEI if your tumour is no bigger than 5cm. PEI will involve you having more than one injection on separate days.

    It’s important to remember that PEI doesn’t always work. However, it may be more effective in destroying the cancer cells in tumours that are between 1 to 2cm in size.

    Radiofrequency ablation

    You might receive radiofrequency ablation (RFA) if you’re waiting to have a liver transplant.

    During an ultrasound or CT scan, a thin needle will be placed in your tumour. Radiowaves will then be passed down the needle – they heat up your tumour and destroy it. RFA may be a better treatment option than PEI if your tumour is larger.

    Chemotherapy

    Chemotherapy involves using medicines to help shrink your tumour and reduce your symptoms. You may receive chemotherapy if your cancer is at an advanced stage. If you have chemotherapy you might have it through a drip into one of your veins or as tablets. It’s important to remember that liver cancer doesn’t always respond well to chemotherapy.

    Chemoembolisation

    Chemoembolisation is when chemotherapy medicines are given directly to your liver through the artery (hepatic) that is connected to your liver. Chemotherapy medicines are mixed with a substance called lipiodol. This helps them stay in your liver for longer and increase their effectiveness. This is followed by an injection of a gel or tiny plastic beads which help to block the blood flow to your tumour. This may limit the oxygen supply to your tumour, and will therefore destroy the tumour cells.

    You might have chemoembolisation if you’re waiting to have a liver transplant. You may also receive chemoembolisation in a palliative way. This is when a treatment is given to you to help reduce how severe your symptoms are or to slow down the growth of your tumour.

    Medicines

    Sorafenib is a medicine that is sometimes used to treat liver cancer. You may only receive sorafenib if you have advanced liver cancer as this treatment can be expensive. If you do receive sorafenib, you will continue to receive it as long as it helps to improve your symptoms. Some evidence suggests that sorafenib may help to improve your symptoms when compared to chemotherapy. However, some research indicates that sorafenib might increase your chance of getting high blood pressure.

    Radiotherapy

    Radiotherapy uses radiation to destroy cancer cells. Radiotherapy isn’t often used to treat primary liver cancer as your liver may not respond well to radiation. However, you may receive radiotherapy if your cancer has spread to your bones as it may help treat any pain you have.

  • Causes Causes of primary liver cancer

    Primary liver cancer, particularly HCC, may be caused by cirrhosis. This is when your liver becomes scarred and damaged. Drinking too much alcohol over time can cause cirrhosis. It can also be caused by infections, such as hepatitis B, hepatitis C and non-alcoholic steatohepatitis (a type of fatty liver disease).

    Other factors that may put you more at risk of developing liver cancer include:

    • haemochromatosis – a condition when your body absorbs too much iron
    • chronic inflammation of your liver (a chronic illness is one that lasts a long time, sometimes for the rest of your life)
    • diabetes
    • smoking
    • using steroids for a long period of time
  • Help and support Help and support

    Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors (oncologists) and nurses are experts in providing the support you need. You may also find it helpful to join a support group.

    If you have more advanced cancer, further support is available to you in hospices or at home, and this is called palliative care.

  • FAQs FAQs

    How is a liver biopsy carried out and are there risks involved?

    Answer

    A liver biopsy is carried out using a needle, which is inserted through your skin, directly into your liver to get a sample. As with all procedures, there are some risks involved. The main complication associated with a liver biopsy is pain, but this is uncommon.

    Explanation

    A liver biopsy is a test that takes a small sample from your liver so that it can be examined in a laboratory. Before you have a biopsy, you will be asked if you’re taking any medicines that thin your blood, such as aspirin. If you are, you may be asked to stop taking them for a few days prior to having your biopsy.

    The most common technique for collecting a liver sample is a percutaneous liver biopsy. A hollow needle will be inserted through your skin, directly into your liver. An ultrasound or CT scan may be used to guide the needle into your liver.

    Depending on where the biopsy needle is inserted, you may be asked to lie on either your back or your side. A local anaesthetic will be given to you to numb the feeling in the area and you will stay awake during the procedure. You will be asked you to hold your breath for a few seconds while the needle is quickly pushed in and out of your skin. This is because your liver moves slightly when you breathe, so you will need to remain very still during the biopsy.

    You may have to remain in bed on your back or side for between six and eight hours while your wound heals.
    If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    A liver biopsy is a common procedure and is generally safe. The main complication associated with a liver biopsy is pain, but this is uncommon.

    If you have questions or concerns about liver biopsy, talk to your doctor before your procedure.

    How is bile duct cancer treated?

    Answer

    If you have bile duct cancer, also known as cholangiocarcinoma, you may have surgery to remove the tumour. However, surgery isn’t always possible and is only offered to a small number of people. Non-surgical treatments include chemotherapy and radiotherapy.

    Explanation

    If you have bile duct cancer, your treatment will depend on the position and size of your cancer and if it has spread to other parts of your body.

    Surgery for bile duct cancer is a major operation and isn’t always possible. It’s usually only offered to a small number of people. If you’re going to have surgery for bile duct cancer it may involve removing your bile duct and part of your liver or the insertion of a stent (a small mesh tube made of plastic or metal).

    Bile duct cancer can sometimes block your bile duct and this may cause jaundice. If this happens to you, a stent may be inserted into your bile duct to allow bile back into your bowel.

    Chemotherapy (medicines used to kill cancer cells) and radiotherapy (radiation used to destroy cancer cells) may be used after your surgery to try and prevent the cancer from returning.

    If you’re unable to have surgery, you may have chemotherapy or radiotherapy to try and shrink the cancer and ease your symptoms. Sometimes, you may be given a combination of both.

    What is haemochromatosis and how does it increase the risk of developing liver cancer?

    Answer

    Haemochromatosis is a genetic condition which can cause your body to absorb too much iron from the food you have eaten. If you have haemochromatosis and it isn’t treated, it may lead to complications such as cirrhosis, diabetes and heart disease.

    Explanation

    Untreated haemochromatosis can cause long-term health conditions, such as heart disease, diabetes and cirrhosis. Cirrhosis is scarring of your liver and means that your liver isn’t able to function as well as it should.

    Having haemochromatosis may only increase your risk of liver cancer if you develop cirrhosis. If you’re diagnosed and receive treatment early, damage to your liver and other organs can be prevented. This will help reduce your risk of developing cirrhosis and subsequently liver cancer.

    Treatment for haemochromatosis involves regularly removing blood from your body until your iron level is normal.

    If you have any questions about haemochromatosis or liver cancer, talk to your GP.

    Why are people with hepatitis B or hepatitis C more at risk of developing liver cancer?

    Answer

    The exact link between hepatitis and liver cancer isn’t clear. However, hepatitis B and hepatitis C can cause cirrhosis, a condition that may lead to liver cancer.

    Explanation

    Hepatitis B and hepatitis C are infectious diseases that cause your liver to become chronically inflamed and damaged. A chronic illness is one that lasts a long time, sometimes for the rest of your life. When describing an illness, the term ‘chronic’ refers to how long you have had a certain condition, not how serious it is.

    If you have hepatitis B or hepatitis C you may develop cirrhosis. This is when your liver becomes scarred and means it isn’t able to work as well as it should. If you have hepatitis B or hepatitis C, cirrhosis can take as long as 20 years to develop.

    Cirrhosis may cause the cells in your liver to grow in an abnormal and uncontrolled way. If this happens, it may increase your chance of developing hepatocellular carcinoma (HCC). HCC is the most common type of primary liver cancer.

    It’s important to note that HCC may only develop in a small number of people with cirrhosis. In half of the people with hepatitis B related HCC it occurs without cirrhosis. If you have hepatitis C related HCC, you’re likely to have cirrhosis.

    If you have cirrhosis, you may be offered regular check-ups and scans. This is to see if you have developed liver cancer.

    If you have any concerns or questions about liver cancer, hepatitis B or hepatitis C, talk to your GP.

  • Resources Resources

    Further information

    Sources

    • Liver cancer, about the liver, other diagnostic tests. British Liver Trust. www.britishlivertrust.org.uk, accessed 12–20 February 2014
    • Chemotherapy for liver cancer. Cancer Research UK. www.cancerresearchuk.org, published 24 October 2013
    • Types treatment for liver cancer. Cancer Research UK. www.cancerresearchuk.org, published 16 October 2013
    • Types of primary liver cancer, risks and causes of liver cancer, tests for liver cancer, further tests for liver cancer. Cancer Research UK. www.cancerresearchuk.org, published 15 May 2013
    • The liver. Cancer Research UK. www.cancerresearchuk.org, published 14 May 2013
    • Steatohepatitis and steatosis (fatty liver). PatientPlus. www.patient.co.uk/patientplus.asp, published 2 July 2013
    • Liver biopsy. PatientPlus. www.patient.co.uk/patientplus.asp, published 25 January 2013
    • Hepatitis C. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 July 2012
    • Hepatocellular carcinoma. PatientPlus. www.patient.co.uk/patientplus.asp, published 13 June 2012
    • Cirrhosis. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 October 2011
    • What you need to know about liver cancer, treatment. National Cancer Institute. www.cancer.gov, published 29 April 2009
    • What is cancer? National Cancer Institute. www.cancer.gov, published 2 August 2013
    • Hepatitis B. BMJ Best Practice. bestpractice.bmj.com, published 31 January 2014
    • Hepatoma. BMJ Best Practice. bestpractice.bmj.com, published 8 July 2013
    • Cholangiocarcinoma. BMJ Best Practice. bestpractice.bmj.com, published 17 June 2013
    • Cirrhosis. BMJ Best Practice. bestpractice.bmj.com, published 12 April 2013
    • Hepatitis C. BMJ Best Practice. bestpractice.bmj.com, published 2 April 2013
    • Haemochromatosis. BMJ Best Practice. bestpractice.bmj.com, published 22 March 2013
    • Concise colour medical dictionary. 3rd ed. Oxford: Oxford University Press 2002: 2, 76–8, 397, 505, 585, 701 (printed version)
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press; 2010:432 (printed version)
    • The liver, chemotherapy for primary liver cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 February 2012
    • Hepatocellular cancer - suspected. Map of Medicine. www.mapofmedicine.com, published 9 September 2011
    • How is liver cancer diagnosed? American Cancer Society. www.cancer.org, published 25 September 2013
    • Duan C, Liu M, Zhang Z, et al. Radiofrequency ablation versus hepatic resection for the treatment of early-stage hepatocellular carcinoma meeting Milan criteria: a systematic review and meta-analysis. World J Surg Onc, 2013; 11(1):190. doi:10.1186/1477-7819-11-190
    • Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. British Society of Gastroenterology. www.bsg.org.uk, published 2003
    • Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. British Society of Gastroenterology. www.bsg.org.uk, published 2012
    • Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology. www.bsg.org.uk, published October 2004
    • Management of hepatocellular carcinoma. American Association for the Study of Liver Diseases. www.aasld.org, published July 2010
    • Hepatocellular carcinoma (advanced and metastatic) - sorafenib (first line). National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published May 2010
    • Microwave ablation of hepatocellular carcinoma. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published March 2007
    • Radiofrequency ablation of hepatocellular carcinoma. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published July 2003
    • Hepatitis B. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2010
    • Salhab M, Canelo R. An overview of evidence-based management of hepatocellular carcinoma: a meta-analysis. J Cancer Res Ther, 2011; 7(4):463–75. doi:10.4103/0973-1482.92023
    • Verslype C, Rosmorduc O, Rougie P. Hepatocellular carcinoma: ESMO-ESDO clinical practice guidelines. Ann Oncol, 2012; vii41–vii8. doi:10.1093/annonc/mds225
    • Lammer J, K Malagari, Vogl T, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol, 2010; 33(1):41–52. doi:10.1007/s00270-009-9711-7
    • Percutaneous liver biopsy. Medscape. emedicine.medscape.com, published 18 November 2013
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    Reviewed by Kuljeet Battoo, Bupa Health Information Team, April 2014

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