The liver is the largest organ in the body, situated in the upper part of the abdomen on the right-hand side of the body. It’s functions include:
- regulating sugars and fats for energy use
- producing proteins that help the blood to clot
- destroying harmful substances such as alcohol and drugs, and also getting rid of waste products.
There are different types of primary liver cancer. Knowing the exact type of cancer helps the doctors to decide on the most appropriate treatment.
Hepatocellular carcinoma (HCC)
85% of primary liver cancers are this type. HCC is sometimes known as hepatoma and it arises in the main cells of the liver called hepatocytes. HCC is more common in men, however a rarer sub-type of HCC called fibrolamellar HCC, is more common in younger women.
This type of cancer starts in the cells that line the bile duct, connected to the liver and is sometimes called bile duct cancer. It is more common in women.
What causes liver cancer?
The exact cause of primary liver cancer isn’t known. We know, like other cancers, that it is not infectious, and can’t be passed on to other people.
There are factors that increase a person’s risk of developing primary liver cancer.These include:
Cirrhosis of the liver
This is scarring on the liver, due to infection or heavy alcohol drinking over a long period of time. This increases the risk of developing HCC, yet only a small number of people will develop primary liver cancer.
Inherited medical conditions
Primary liver cancer is not caused by an inherited faulty gene, however, people who have an inherited condition, such as haemochromatosis or tyrosinaemia, have a higher chance of developing cirrhosis and HCC.
This is a poison found mainly in Africa and Asia and can be found in the mould on peanuts, soya beans wheat and grain from these areas. This also increases the risk of developing HCC.
People who take anabolic steroids over a long period of time also have a slightly increased risk of developing primary liver cancer.
What are the symptoms?
For early stages of primary liver cancer there are often vague or no symptoms. They range from:
- Jaundice: Makes the skin and the whites of the eyes go yellow and may make the skin very itchy. Other signs include dark-coloured urine and pale stools (bowel motions).
- Ascites: A build up of fluid in the abdomen and causes swelling known as ascites. A tube can be put into the abdomen to drain the fluid away.
- Pain: In the upper abdomen sometimes also be felt in the right shoulder, known as referred pain.
- Loss of appetite.
- Weight loss.
- Feeling sick (nausea).
- Weakness and tiredness (lethargy).
TIP: If you have any of these symptoms you should have them checked by your doctor - but remember, they are common to many illnesses.
How is it diagnosed?
After visiting a GP you will probably be referred to a hospital for some tests. These may include:
- Abdominal CT (computerised tomography) scan: A CT scan takes a series of x-rays of the abdomen which build up a 3D picture of the inside of the body. It can be used to show the size and position of a cancer. The scan is painless and takes 10–30 minutes. Before the scan the patient will be asked to drink a special liquid which shows up on x-ray.
- Liver ultrasound: Uses sound waves to look at the liver.
- Blood test
- Liver biopsy: The doctor takes some cells or a small piece of tissue from the affected area to look at under a microscope. This is called a biopsy. After the area has been numbed using a local anaesthetic injection, a fine needle is passed into the tumour through the skin. CT or ultrasound may be used at the same time, to make sure that the biopsy is taken from the right place. The patient will need to stay in hospital for a couple of hours after a liver biopsy, and possibly overnight. This is because there is a risk of bleeding afterwards.
- MRI: Uses magnetic fields to build up a series of cross-sectional pictures of the body.
- Laparoscopy: While under anaesthetic, the doctor will make a small cut (incision) in the front of the abdomen and insert a thin tube containing a light and a camera (laparoscope). The doctor is able to look at the liver and can take a small sample (biopsy) for examination. During the operation, carbon dioxide gas is passed into the abdominal cavity and this can cause uncomfortable wind and/or shoulder pains for several days. The pain is eased by walking about or taking sips of peppermint water.
Waiting for results can be an anxious time. It can help to talk things over with a relative, friend or some who will understand.
If the results of the test show liver cancer, the patient will be referred to a doctor who specialises in the treatment of liver cancer.
The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site.
Primary liver cancer is divided into four stages:
- Small and localised (stage one).
- Spread into surrounding structures (stages two or three).
- Spread into other parts of the body (stage four).
How is it treated?
A team of doctors and other staff at the hospital will plan the treatment (called a multidisciplinary team). It will depend on the size of the tumour and where it is.
The multidisciplinary team may include: an oncologist (a doctor who specialises in treating cancer with chemotherapy) and a radiologist (a doctor who specialises in treating cancer with radiation) as well as nursing and social work staff who can offer support.
Treatment may involve:
Most people have chemotherapy to shrink to size of the tumour and to get rid of any cancer cells around the body. This is usually followed with surgery to remove the tumour. More chemotherapy and radiotherapy usually follows.
Chemotherapy for liver cancer
- While chemotherapy is not a cure for liver cancer the treatment is often given to shrink the tumour prior to surgery. Often chemo starts again after surgery to kill any remaining cancer cells and stop them from spreading. This is called adjunct chemotherapy.
- Another form of chemotherapy specifically used with liver cancer is chemoembolisation. Chemotherapy drugs are injected directly into the tumour in the liver. The drugs are mixed with a substance called lipiodol that helps the chemotherapy stay in the liver for longer. This safely blocks the blood supply (embolisation) thus starving the tumour of oxygen, and destroying it.
For more information about, go to our chemotherapy fact sheet.
Surgery for liver cancer
The aim of surgery is to remove the tumour, but with liver cancer, it can be difficult to reach the tumour and not damage the liver, which is a very important organ with in the body. Surgery takes two main forms:
- Liver resection: removing the affected area of the liver and leaving the healthy part of the liver alone.
- Liver transplant: It may be possible to remove the whole liver and replace it with a liver from another person, a donor.
Most people are able to go home 6–12 days after their operation and will need painkillers for the next few weeks. It may take up to six weeks to get back to normal.
For more information about surgery, go to our surgery fact sheet.
Radiotherapy for liver cancer
Radiotherapy is not often used to treat primary liver cancer because the liver can’t tolerate very high doses of radiotherapy. The liver, while being the biggest organ in the body, it is also one of the most sensitive.
For more information about, go to our radiotherapy fact sheet.