Liver cancer

There are two main types of primary liver cancer - hepatocellular carcinoma and cholangiocarcinoma. Hepatocellular carcinoma (also known as hepatoma or HCC) is the most common type of liver cancer. It starts in the main cells of your liver called hepatocytes.

Cholangiocarcinoma starts in the cells that line your bile duct and is commonly known as cancer of the bile duct. Your bile duct is a tube that connects your liver to your small bowel.

More rare types of liver cancer include:

• angiosarcoma - this starts in the blood vessels of your liver
• hepatoblastoma - this usually affects young children

In the UK, most people get HCC because of cirrhosis - scarring of the liver. Cirrhosis affects how well your liver is able to function. The most common cause of cirrhosis in the UK is drinking too much alcohol. It can also be caused by infections such as hepatitis B and hepatitis C. About three or four people out of every 100 with cirrhosis will develop liver cancer.

Other factors that put you more at risk of developing HCC include:

• having haemochromatosis - a condition where your body has too much iron
• being male - liver cancer is twice as likely to occur in men as in women
• having diabetes

HCC is also more common as you get older - it's rare in people under 45.

In Africa and Asia, where liver cancer is more common, a frequent cause is a substance called aflatoxin that is found in mouldy peanuts and grain. If eaten over a long period of time it can lead to liver cancer.

Doctors don't yet understand why people develop cholangiocarcinoma. However, if you have an inflammatory bowel condition such as ulcerative colitis you may be slightly more at risk.

Everyone with liver cancer will be affected differently, but it's quite likely that at first you won't have any symptoms. Later, symptoms may include:

• weight loss
• swollen abdomen
• pain and discomfort in your liver area
• feeling full or bloated after eating
• loss of appetite
• sickness
• extreme tiredness
• jaundice (a yellowy tinge to your skin and the whites of your eyes)

These symptoms aren't always caused by liver cancer but if you have them, contact your doctor.

Your doctor will ask about your symptoms and examine you. He or she may also ask about your medical history.

Your doctor may refer you to a specialist at a hospital, where you're likely to have tests including liver function tests. These tests check whether your liver is working properly by looking at a sample of your blood.

Your doctor may also check for a particular cancer marker - a protein that shows up in higher amounts if you have HCC.

Other tests you may have include the following.

• An ultrasound scan, which uses sound waves to produce an image of your liver.
• A CT scan, which uses X-rays to make a three-dimensional picture of your liver.
• An MRI scan, which uses magnets and radiowaves to produce images of your liver.
• A biopsy, where a small sample of tissue is taken from your liver. This is sent to a laboratory for testing.
• A laparoscopy. This is a minor operation that allows a surgeon to look at your liver by inserting a thin tube containing a light and a camera through a small cut in your abdomen. Your surgeon may take a liver biopsy at the same time.
• A hepatic angiography, which is an X-ray of the blood vessels supplying your liver. This is usually done if there's doubt about your diagnosis after a CT and MRI scan.

Treatment depends on how advanced your cancer is and on your general health. It will also vary according to exactly where the cancer is and whether it has spread to other parts of your body.

Surgery

Surgery is the only treatment that offers a cure. However, fewer than one in three people who have HCC can have surgery to remove it. This may be because the tumour is too big, the cancer has spread to other areas or your liver is too badly damaged by cirrhosis.

Surgery options include:

• a liver resection, where the affected part of your liver is removed (this is the most common type of surgery for liver cancer)
• a lobectomy, where a lobe of your liver is removed
• a liver transplant, where your liver is replaced with a donor's liver, however only a small number of people are suitable for this type of surgery

A large part of your liver may be taken away if you have a liver resection or lobectomy. However, your liver can repair itself and grow back to its original size over time.

Non-surgical treatments

Ethanol injections
Ethanol (pure alcohol) injections can be used to treat small tumours. Ethanol is injected through your skin into the affected area during an ultrasound. It stops the blood supply to your tumour, killing the cancer cells.

Radiofrequency ablation 
During an ultrasound or CT scan, a thin needle is placed in your tumour and radiowaves are passed down the needle. The radiowaves heat up the tumour and destroy it.

Chemotherapy and chemoembolisation 
Chemotherapy involves using medicines to shrink the tumour and reduce your symptoms. Chemotherapy isn't very successful at treating liver cancer, but a procedure called chemoemboliation may be more effective. This means that chemotherapy medicines are mixed with an oily substance called lipiodol, which helps them to stay in your liver for longer and so have a greater effect. At the same time, tiny beads of gel are injected to block off the blood supply to your tumour. 

Cryosurgery 
Liquid nitrogen is placed on the tissue around the tumour to freeze and destroy the cancer.

Biological therapies 
These are medicines that use substances occurring naturally in your body to kill cancer.