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Liver cancer

Key points

  • Cancer that starts in your liver is known as primary liver cancer.
  • There are four types of primary liver cancer, with hepatocellular carcinoma (HCC) being the most common.
  • Primary liver cancer affects people in different ways. Symptoms may include weight loss, fatigue, pain in your abdomen (tummy) or a fever.
  • Treatment depends on how advanced your cancer is, whether it has spread to other areas and your general health.
  • Some of the treatment options for liver cancer may include surgery, chemotherapy and radiotherapy.

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.
 

About liver cancer

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.

The liver and surrounding structures

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.

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.

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.

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

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.

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.

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.


Reviewed by Kuljeet Battoo, Bupa Health Information Team, April 2014

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

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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