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Liver cancer

Cancer that starts in your liver is called primary liver cancer. With around 5,500 people getting it each year, this type of cancer isn’t very common in the UK.

When you hear about someone having cancer in their liver, the chances are that it isn’t primary liver cancer. It’s much more likely to be what’s called secondary (or metastatic) liver cancer. This is when cancer from another part of the body, such as the bowel, breast or lungs spreads to the liver.

Our main information here will be about primary liver cancer. For guidance on how to find out more about cancer that’s spread from other parts of the body, see ‘secondary liver cancer’ below.

An image showing the liver and surrounding structures XX

The liver

Your liver is a large organ, found beneath your diaphragm, just under your ribcage. It lies across the top of your abdomen (tummy), mostly on the right side. It’s divided into two sections, called lobes.

Your liver carries out many important jobs, including:

  • storing nutrients absorbed from the gut, then converting them to energy when your body needs it
  • breaking down and removing harmful and waste substances
  • producing proteins for many different functions, including to help your blood to clot
  • 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

The most common type of primary liver cancer is called hepatocellular carcinoma (HCC) or hepatoma. It starts in the main cells of your liver, called hepatocytes. Most primary liver cancers are of this type.

A second, less common type of primary liver cancer is cholangiocarcinoma, or bile duct cancer. It starts in the cells that line your bile ducts. Bile ducts are tubes that connect your liver and gallbladder to your small bowel.

There are some other, very rare forms of primary liver cancer. These include hepatoblastoma, which usually affects young children, and angiosarcoma, which usually affects those in their 70s and 80s. Here we focus mainly on hepatocellular carcinoma.

Secondary liver cancer

Secondary liver cancer is when cancer spreads to the liver from cancers in other parts of the body.

Cells from cancers in other parts of the body travel in the bloodstream and get picked up by the liver. Here they grow and form secondary cancers. These are also called liver secondaries, or liver metastases.

You can find out more about secondary liver cancers by looking for information on the original (primary) cancer. For example, to find out more about liver cancer secondary to breast cancer, look for information on breast cancer. Other types of cancer which commonly spread to the liver include bowel and lung cancer.

You’ll find detailed information about the different types of cancer and secondary liver cancer from the organisations listed under ‘other helpful websites’.

Symptoms of primary liver cancer

Primary liver cancer affects people in different ways. Often there are no symptoms in the early stages. If you’re at risk of liver cancer because of other medical problems, your doctor may offer you regular screening tests. These may pick up liver cancer before you have symptoms. See our section on causes below to find out about medical conditions that increase your chance of getting liver cancer.

As the cancer cells grow, you may have symptoms including:

  • weight loss (when you’re not trying to lose weight)
  • loss of appetite, feeling full after even a small meal
  • pain in your abdomen (tummy), especially in the upper right side
  • a swollen abdomen
  • skin and eyes turning yellow (jaundice)
  • sickness and vomiting
  • feeling unusually tired, weak and unwell
  • a fever

These symptoms are usually caused by problems other than liver cancer. But, if you have any of these symptoms, contact your GP.

Diagnosis of primary liver cancer

Primary liver cancer may be diagnosed after you see a doctor because of your symptoms. Or it may be diagnosed after a screening test such as an ultrasound. You may be offered regular screening tests if you have other medical conditions which increase your chance of getting liver cancer. See our section on causes below. If you see your GP because you have symptoms, they’ll ask about these and examine you. They may also ask you about your medical history. Your GP will arrange 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. These help to find out if you have liver cancer and if it has spread to other parts of your body.

  • An ultrasound scan uses sound waves to produce an image of your liver. If you have a high risk of liver cancer, you may have an ultrasound every six months to check your liver. Your GP may arrange this test.
  • A CT scan uses X-rays to make a three-dimensional picture of your liver.
  • An MRI scan uses magnets and radiowaves to produce images of the inside of your body.
  • A liver biopsy is when your doctor takes a small sample of your liver with a fine needle. They send it to a laboratory to look for cancer cells. See our FAQ on liver biopsy for more information.
  • A laparoscopy is a procedure where your doctor looks inside your abdomen (tummy) using a thin tube (endoscope) while you’re asleep.

If your doctor recommends these or other tests they’ll carefully explain what each one involves. Feel free to ask any questions you have.

You can find out a lot more information about tests for liver cancer and how they are carried out from the following websites.


Treatment of primary liver cancer

The treatment of primary liver cancer depends on how advanced your cancer is, whether it’s spread to other areas, and your general health. You’ll have a team of doctors and other cancer specialists involved in planning your care. Your doctor will explain your options and take your wishes into account.

This section is about treatment of the main type of primary liver cancer, hepatocellular carcinoma (HCC, hepatoma). See our FAQ below for some information about how bile duct cancer is treated. If you’re looking for information about treatment of secondary liver cancer, see our section above – this will depend upon the type of cancer.

Surgery

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

The main types of surgery for primary liver cancer are listed below.

  • Removing the affected part of your liver (liver resection). This is the most common type of surgery for liver cancer. Your surgeon might offer you a liver resection if your cancer is at an early stage. They may remove anything from a small wedge to up to four fifths of your liver.
  • 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. It may take months to find a suitable donor and you may need other treatments while you’re waiting.

Ablation

Ablation means to remove or destroy. Your doctor may offer ablation as a treatment for early liver cancer. You may also be offered ablation if you can’t have surgery or choose not to have it, or if you’re waiting for a liver transplant. There are several different ways of ablating a tumour in your liver. The two main ways are described below.

Radiofrequency ablation (RFA) destroys cancer cells with heat. Your doctor places a thin needle into your tumour, guided by an ultrasound or CT scan. An electric current is then passed down the needle to heat up your tumour and destroy it.

Percutaneous ethanol injection (PEI) is a type of ablation where your doctor injects ethanol (pure alcohol) directly into your tumour through a fine needle. This is carried out with a local anaesthetic. The ethanol then destroys the cancer cells. This is usually only used for very small tumours, and you may need repeated injections.

Transarterial chemoembolisation (TACE)

Transarterial chemoembolisation is when chemotherapy medicines are given directly to your liver through the artery that supplies it. After injecting the medicines, your doctor injects a gel or tiny plastic beads which help to block the blood flow to your tumour. Blocking the flow of blood reduces the oxygen supply to your tumour, so this helps to kill the cancer cells. It also helps to keep the chemotherapy medicines in the liver for longer.

Chemoembolisation may be used together with ablation. You might have chemoembolisation if you’re waiting to have a liver transplant. Your doctor may also offer you chemoembolisation to help reduce your symptoms or to slow down the growth of your tumour. You can have the procedure done more than once if your doctor thinks that would help.

Other medicines – sorafenib

Sorafenib is a medicine that is sometimes used to treat advanced liver cancer. It’s one of a group of medicines which are often called targeted therapies, or biological therapies. Sorafenib isn’t routinely available on the NHS because it has been judged not to bring enough benefits to justify its high cost. Your doctor can discuss with you whether sorafenib may be an option in your particular circumstances. If you do receive sorafenib, you’ll continue to receive it as long as it helps to improve your symptoms.

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 of primary liver cancer

Primary liver cancer usually develops in livers which are affected by a condition called cirrhosis. This is when your liver becomes scarred and damaged. Cirrhosis may cause the cells in your liver to grow in an abnormal and uncontrolled way.

Drinking too much alcohol over time can cause cirrhosis. Cirrhosis can also be caused by infections, such as hepatitis B, hepatitis C and non-alcoholic fatty liver disease.

Other things that may increase your risk of developing liver cancer include:

  • having haemochromatosis – a condition when your body absorbs too much iron. See our FAQ about this.
  • having primary biliary cirrhosis – a long-term condition that damages the small bile ducts.
  • having diabetes.
  • smoking.

However, one in four people with primary liver cancer don’t have any of these factors.

The risk of getting primary liver cancer goes up as you get older. Seven out of 10 people with primary liver cancer were first found to have it when they were over 65. It’s more common in men than women.

How cancer develops

Help and support

Being diagnosed with cancer and facing treatment 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 and nurses are experts in providing the support you need. Talk to your doctor or nurse if you’re finding your feelings hard to cope with.

Everyone has their own way of coping. But for further support and advice you may find it helpful to contact one of the well known cancer organisations or visit their websites. They have information about most types of cancer – often in more detail than we can go into here. Some have a telephone helpline you can ring, or an online forum you can join for a chat with others in your position. There may also be local groups where you can meet other people with similar medical issues, or other carers. Your cancer team may know of some.

See our section ‘other helpful websites’ for contact details of relevant organisations. You may also find our general cancer articles helpful. We also have a lot of useful tips and hints on dealing with cancer in our health blog. If you have more advanced cancer, further support is available to you with hospice care. See the FAQ on hospice care to find out what this involves.

FAQ: Why do people with hepatitis B or C get liver cancer?

Hepatitis B and hepatitis C are infectious diseases caused by viruses that can lead to long-term inflammation in your liver. This may lead to a condition called cirrhosis. This is when your liver becomes scarred and means it isn’t able to work as well as it should.

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 the main type of primary liver cancer, hepatocellular carcinoma (HCC, hepatoma).

Hepatitis B infection can also sometimes cause liver cancer without causing cirrhosis first.

If you have hepatitis B or C your doctor will probably advise you not to drink alcohol. This is to help prevent cirrhosis developing, and so reduce your risk of liver cancer.

FAQ: How is haemochromatosis linked to liver cancer?

Haemochromatosis is a genetic condition which can cause your body to absorb too much iron from the food you’ve eaten.

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 cirrhosis of the liver increases your chance of getting hepatocellular carcinoma (HCC, hepatoma), the main form of liver cancer.

Having haemochromatosis will usually only increase your risk of liver cancer if you develop cirrhosis. Treatment for haemochromatosis involves regularly removing blood from your body until your iron level is normal. This helps to prevent your body becoming overloaded with iron, and so aims to reduce damage to your liver and other organs. This will help reduce your risk of developing cirrhosis and subsequently liver cancer.

FAQ: What does a liver biopsy involve?

A liver biopsy is a test that takes a small sample from your liver so that it can be examined in a laboratory. Your doctor may recommend you have a liver biopsy if they suspect you have liver cancer. However, it’s not always needed.

Liver biopsy is a generally safe procedure. Your doctor will explain what will happen and answer any questions you have.

If you’re taking any medicines that thin your blood, (eg aspirin), you may need to stop taking them for a few days before your biopsy.

The most common technique for collecting a liver sample is with a hollow needle passed through the skin into your liver. This is called a percutaneous liver biopsy.

Your doctor will give you a local anaesthetic injection to numb the area and you’ll stay awake during the procedure. They’ll ask you to hold your breath for a few seconds while they push the needle quickly in and out of your skin. This is because your liver moves slightly when you breathe, so you’ll need to remain very still during the biopsy. Your doctor may use an ultrasound or CT scan to guide the needle into your liver.

After having the biopsy, you’ll stay in hospital for a few hours, or even overnight. You may have to lie on your right side for the first few hours to help reduce the chance of bleeding.

A liver biopsy is generally safe. Around one in three patients have some pain afterwards, but this usually goes away after a few hours. Your nurse can give you some painkillers for this.

Before you leave, your nurse will tell you when your results should be back, and how you’ll find out about them. They’ll also tell you what to do if you have any problems once you get home following your biopsy.

FAQ: How is bile duct cancer treated?

Treatment of bile duct cancer (cholangiocarcinoma) depends on a number of things. These include the position and size of your cancer, whether it’s spread to other parts of your body and your general health.

Surgery for bile duct cancer is a major operation and usually only suitable for a small number of people. Your doctor will discuss with you whether surgery is an option in your particular circumstances. Surgery to remove bile duct cancer involves removing your bile duct and often part of your liver too.

Bile duct cancer can sometimes block your bile duct and this may cause jaundice (yellowing of the skin). Your surgeon may recommend inserting a stent into your bile duct to allow bile to flow freely again. A stent is a small plastic or metal tube which holds your bile duct open. Your surgeon may put this in using an endoscope (long tube) through your mouth. Or they may put the stent in through your skin – using a special needle with a wire attached to guide it into place.

Chemotherapy (medicines used to kill cancer cells), and much more rarely radiotherapy, (radiation used to destroy cancer cells) may be used for bile duct cancer. Your doctor may offer them after your surgery to try and prevent the cancer from returning. If you can’t have surgery, you may have chemotherapy or radiotherapy to try and shrink the cancer and ease your symptoms. Sometimes, you may be offered both.

FAQ: What does hospice care involve?

If you have liver cancer that can’t be cured and you need support to control your symptoms, your doctor may recommend hospice care. This is care which looks after your medical needs at a time when cure is not possible. But it also looks after your other needs – emotional, practical, social and spiritual – and supports your family.

You may be familiar with this type of care being given during a stay in a hospice – a special care home. But many people have hospice care in their own home, or as a day patient to a hospice.

For some people, a hospice is where they stay during the final stage of their illness. But many people go into a hospice for short periods to get their symptoms under control, and then return home. You may choose to have a short stay in a hospice to allow your carers to take a break. This is called respite care.

Hospices are usually smaller and quieter than hospitals and try to be more like home for you. You’ll be looked after by a team of specialist nurses and doctors who are experienced in the care of people with advanced cancer. They’ll work in partnership with your GP and cancer team to give you the best care.

Hospice care can include:

  • control of pain and other symptoms
  • psychological and social support for you and your carers
  • counselling
  • practical and financial advice
  • spiritual care
  • support in bereavement
  • complementary therapies

There is no cost to you for hospice care. It’s funded by charities with some NHS funding too. You can find out about local hospices from your GP or district nurse. You can also contact the charity Hospice UK, who have an online list of hospice providers.

Details

  • Other helpful websites Other helpful websites

    Sources

    • Upper gastrointestinal cancer. Oxford handbook of oncology (online). Oxford Medicine Online. oxfordmedicine.com, published September 2015
    • Hepatoma. BMJ Best Practice. bestpractice.bmj.com, last updated 26 September 2016
    • Hepatocellular carcinoma. Medscape. www.emedicine.medscape.com, updated 3 May 2017
    • Liver anatomy. Medscape. emedicine.medscape.com, updated 9 September 2015
    • Primary liver cancer. PatientPlus. patient.info/patientplus, last checked 28 October 2015
    • Secondary liver cancer. PatientPlus. patient.info/patientplus, last checked 28 October 2015
    • Primary liver cancer. The MSD Manuals. www.msdmanuals.com, last full review/revision August 2016
    • Metastatic liver cancer. The MSD Manuals. www.msdmanuals.com, last full review/revision August 2016
    • Sorafenib for the treatment of advanced hepatocellular carcinoma. National Institute for Health and Care Excellence (NICE), 2010. www.nice.org.uk
    • Liver cancer. Cancer Research UK. www.cancerresearchuk, last reviewed 4 February 2015
    • Bile duct cancer. Cancer Research UK. www.cancerresearchuk, last reviewed 22 January 2015
    • Cancer statistics. Cancer Research UK. www.cancerresearchuk, accessed 1 June 2017
    • Primary liver cancer. Macmillan. www.macmillan.org.uk, reviewed 31 July 2014
    • Haemochromatosis. BMJ Best Practice. bestpractice.bmj.com, last updated 13 July 2016
    • Haemochromatosis. PatientPlus. patient.info/patientplus, last checked 10 December 2015
    • Cholangiocarcinoma. BMJ Best Practice. bestpractice.bmj.com, last updated 3 October 2016
    • Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology. www.bsg.org.uk, published October 2004
    • Diagnostic liver biopsy. Medscape. www.emedicine.medscape.com, updated 22 February
    • Liver biopsy. PatientPlus. patient.info/patientplus, last checked 23 October 2015
    • What is hospice care? Hospice UK. www.hospiceuk.org, accessed 1 June 2017
    • End of life care. NHS Choices. www.nhs.uk, last reviewed 9 July 2015
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