Liver cancer

This factsheet is for people who have liver cancer, or who would like information about it.

Primary liver cancer is an abnormal and uncontrolled growth of cells that start in your liver.

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About liver cancer

Cancer that starts in your liver is called primary liver cancer. It’s quite rare in the UK with about 3,400 people diagnosed with primary liver cancer each year.

Most people in the UK that have been diagnosed with tumours in the liver, will have secondary liver cancer. This means that the tumour has spread from another part of your body, such as your bowel, breast or lungs. The spread of cancer is called metastasis. It’s also possible for cancerous tumours to grow through your liver and spread to other parts of your body, where they may grow and form secondary tumours.

Tumours can be either benign or malignant. Benign tumours stay in the liver and don’t spread to other parts of your body. These aren’t cancerous and are rarely life-threatening. Malignant tumours are cells that grow uncontrollably and can spread to other parts of your body and invade healthy tissue. Cancer is the name given to a malignant tumour.

This factsheet 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 harmful substances, such as alcohol and drugs
• breaking down waste products from normal bodily functions
• converting fats to energy when you need it
• producing bile to help you digest and absorb food

It can also repair itself and still functions when much of it’s damaged.

Types of primary liver cancer

There are four main types of primary liver cancer.

• Hepatocellular carcinoma. Also known as hepatoma or HCC. It’s the most common type of primary liver cancer and starts in the main cells of your liver, called hepatocytes.
• Cholangiocarcinoma. This starts in the cells that line your bile duct and is known as cancer of the bile duct. Your bile duct is a tube that connects your liver to your small bowel.
• Angiosarcoma. This is a very rare form of liver cancer and starts in the blood vessels of your liver.
• Hepatoblastoma. This is also a very rare form of liver cancer that usually affects children.

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 of primary liver cancer because your liver can still function when only a part of it’s working. Later symptoms may include:

• weight loss (when you’re not trying to lose weight)
• loss of appetite
• being sick
• feeling bloated after small meals
• skin and eyes turning yellow (jaundice)
• fatigue
• pain and discomfort around the area of your liver
• sweating and a high temperature

These symptoms aren’t always caused by liver cancer but if you have any of them, see your GP.

Causes of primary liver cancer

Primary liver cancer is usually caused by cirrhosis. This is scarring of your liver and poor liver function. Drinking too much alcohol is the most common cause of liver cirrhosis in the UK. It can also be caused by infections, such as hepatitis B and hepatitis C.

Other factors that put you more at risk of developing liver cancer include the following.

• Having haemochromatosis. This is a condition where your body has 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.
• Having diabetes.
• Using anabolic steroids for a long period of time.
• Having a low level of immunity.

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 refer you to a hospital where you will have several tests to determine if you have liver cancer and what stage the cancer is at. The tests will also show if the cancer has spread to other parts of your body.

You may have one or more of the following tests.

• A blood test. This will determine how well your liver is working.
• An ultrasound scan. This scan uses sound waves to produce an image of your liver.
• A CT scan. This uses X-rays to make a three-dimensional picture of your liver.
• An MRI scan. This uses magnets and radiowaves to produce images of the inside of your body.
• A biopsy, where a small sample of tissue is taken. It will be sent to a laboratory for testing to find out the type of cells and if they are benign (not cancerous) or cancerous.
• A laparoscopy. This is a minor operation that allows surgeons to look at your liver by inserting a thin tube containing a light and a camera through a small cut in your abdomen (tummy). It will be performed under general anaesthetic and your surgeon may do a liver biopsy at the same time.
• A hepatic angiography. This is an X-ray of the blood vessels supplying your liver. It’s done if there is doubt about your diagnosis after a CT and MRI scan.

Treatment of primary liver cancer

The treatment you have will depend on how advanced your cancer is and your general health. Treatments will try to either:

• remove the cancer
• shrink the cancer to relieve your symptoms
• delay progression to make surgery possible

Your treatment will also depend on where the cancer is and whether it has spread to other areas.

Surgery

Surgery is the only treatment that offers a chance of curing your liver cancer. Surgery isn’t always possible and will depend on the size and position of your tumour and if the cancer has already spread to other parts of your body. If your liver is severely damaged by cirrhosis, it may not be safe to have surgery. Only a small number of people with liver cancer will be able to have surgery.

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

• A liver resection to remove the affected part of your liver. This is the most common type of surgery for liver cancer.
• A lobectomy to remove a lobe of your liver if you have no underlying medical problems with your liver, such as cirrhosis. Your liver may grow back over time and work normally.
• A liver transplant to replace your liver with a donor’s liver. Only a small number of people are suitable for this type of surgery.

Non-surgical treatments

Ablation

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

• Percutaneous ethanol injection. Ethanol (pure alcohol) injections can be used to treat tumours smaller than 5cm. Your doctor will inject ethanol through your skin into the affected area during an ultrasound and stops the blood supply to your tumour, killing the cancer cells.
• Radiofrequency ablation. During an ultrasound or CT scan, your doctor will place a thin needle in the tumour and then radiowaves will be passed down the needle – they heat up the tumour and destroy it.

Chemotherapy

Chemotherapy involves using anti-cancer medicines to shrink the tumour and reduce your symptoms. Liver cancer doesn’t usually respond well to chemotherapy so is not often used.

Chemoembolisation

Chemoembolisation may be more effective than chemotherapy. Chemotherapy medicines are mixed with a substance called lipiodol, which helps them stay in your liver for longer, increasing their effectiveness. Sometimes, your doctor will also inject a gel or tiny plastic beads to block the blood flow to the tumour. This should limit the oxygen supply and kill the tumour cells.

Cryosurgery

This treatment may be possible if you can’t have surgery. Liquid nitrogen is placed on the tissue around your tumour to freeze and destroy the cancer.

Stents

A stent is a small mesh tube. Stents are sometimes inserted if you have cancer in your bile ducts that is causing a blockage, or if pressure from a tumour closes your bile duct. The stent is inserted into your duct to allow bile to flow through.

Radiotherapy

Radiotherapy isn’t often used to treat primary liver cancer as radiation can damage your healthy liver cells.

Produced by Dylan Merkett, Bupa Health Information Team, April 2012

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.