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Liver cancer

Cancer that starts in your liver is called primary liver cancer. About 1,800 people are diagnosed with liver cancer each year in HK.

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.  

Cancerous tumours can grow through your liver and spread to other areas of your body, through your bloodstream or your lymphatic system, where they may grow and form secondary tumours. Your lymphatic system is the tissues and organs, including your bone marrow, spleen, thymus and lymph nodes, that produce and store cells that fight infection and disease. This spread of cancer is called metastasis.

Tumours may also spread from other parts of your body, such as from your bowel, breast or lungs, to your liver - this is called secondary liver cancer. Secondary liver cancer is much more common than primary liver cancer.

This factsheet will concentrate on primary liver cancer.

Your liver is a large organ found in the top part of your abdomen (tummy), just under your ribcage. It's split into sections called lobes.

liver

Your liver carries out about 500 different jobs, including:

  • getting rid of toxins from your body
  • processing digested food
  • producing bile - a digestive fluid that helps to break down fatty food

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

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. For more information, see Related topics.

More rare types of liver cancer include:

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

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 GP.

 

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.

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

Your GP 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 chemoembolisation 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.

Question: Why are people with hepatitis B or hepatitis C more at risk of developing liver cancer, even if they don't have cirrhosis?

Answer: Hepatitis B and hepatitis C can cause a type of liver cancer called a hepatocellular carcinoma (HCC). It's thought that both types of hepatitis may trigger changes in your liver cells that can cause cancerous growths.

Explanation: Hepatitis is inflammation of your liver. Hepatitis B and C are caused by infection with a virus.

Both hepatitis B and hepatitis C cause your liver to become inflamed and damaged. This often results in cirrhosis. Cirrhosis is when your healthy liver tissue is replaced by scarring, meaning your liver is unable to function as well as it should. Cirrhosis can cause changes in your liver cells, making them grow in an abnormal and uncontrolled way, which can lead to the development of HCC.

However, cirrhosis isn't always present in the livers of those with HCC and hepatitis B or hepatitis C. This has led doctors to believe that within both types of hepatitis there is a trigger that alters your liver cells, causing them to grow into cancerous tumours (HCC). Exactly what the trigger is or how this happens isn't fully understood at present.

If you have any questions or concerns about liver cancer, hepatitis B or hepatitis C, talk to your GP.

Question: What is haemochromatosis and how does it increase the risk of developing liver cancer?

Answer: Haemochromatosis is a condition that causes your body to absorb too much iron. This extra iron is deposited in your liver, often causing cirrhosis - scarring of your liver. Cirrhosis in turn can develop into liver cancer, specifically hepatocellular carcinoma (HCC).

Explanation: Haemochromatosis is a long-term condition where your body absorbs more iron than it needs. You can be born with the condition (genetic haemochromatosis), or you can develop it later in life, usually as a result of long-term blood transfusions for a blood disorder.

You usually have about three to four grams of iron in your body, which is stored in small amounts in your liver and bone marrow. When your body absorbs more than five grams of iron, it starts depositing it in your organs in larger amounts than usual. This happens mainly in your liver, but iron may also be deposited in other organs such as your pancreas, heart and joints. This can result in damage that causes long-term health conditions.

One of the main complications is cirrhosis of the liver - where healthy liver tissue is replaced with scar tissue. Over time this can prevent your liver from working properly and may develop into liver cancer (HCC).

However, simply having haemochromatosis doesn't increase your risk of HCC. Your risk is only increased if you develop cirrhosis. Treatment for haemochromatosis is very simple and effective. It involves regularly removing blood from your body to help get rid of excess iron. If you're diagnosed and receive treatment early, damage to your liver and other organs can be prevented. This reduces your risk of developing serious health conditions such as liver cancer.

Question: How is a liver biopsy carried out? Are there any risks involved?

Answer: A liver biopsy is carried out using a needle, which is inserted through your skin and directly into your liver. As with all procedures, there are some risks involved. For a liver biopsy, the main complication is internal bleeding, but this is rare.

Explanation: A liver biopsy is when a small sample of tissue is taken from your liver and sent to a laboratory for testing. It's done using a hollow needle, which is inserted through your skin and directly into your liver, guided by an ultrasound or CT scan.

You will be asked to lie on your back or side. Your doctor will inject some local anaesthetic into the skin over your liver to numb the area, and you will stay awake during the procedure. You will be asked to hold your breath for five to 10 seconds while the needle is quickly pushed in and out of your skin. This is because your liver moves slightly when you breathe, so you will need to stay very still during the biopsy.

You may need to stay in hospital overnight after the procedure, because doctors need to monitor you closely for at least six hours afterwards. You may be given painkillers after the procedure if you're in any discomfort.

Liver biopsies are commonly performed and generally safe. Complications are when problems happen during or after the procedure. For a liver biopsy, they are rare. Occasionally, internal bleeding can occur. This is more likely if you have cirrhosis or liver cancer. Very rarely, bile can leak from your liver as a result of the procedure. There is also a small chance of infection. The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you.

 

Further information

Sources

  • Risks and causes of liver cancer. CancerHelp UK. www.cancerhelp.org.uk, accessed 10 November 2009
  • Causes of liver cancer. Macmillan Cancer Support. www.macmillan.org.uk, accessed 10 November 2009
  • Causes of liver cancer. CancerHelp UK. www.cancerhelp.org.uk,accessed 10 November 2009
  • Liver cancer. British Society of Gastroenterology. www.bsg.org.uk , accessed 10 November 2009
  • Diagnosing primary liver cancer. CancerHelp UK. www.cancerhelp.org.uk ,accessed 10 November 2009
  • Diagnosis of liver cancer. Macmillan Cancer Support. www.macmillan.org.uk ,accessed 10 November 2009
  • Liver cancer. The British Liver Trust. www.britishlivertrust.org.uk ,accessed 10 November 2009
  • Surgery for liver cancer. Macmillan Cancer Support. www.macmillian.org.uk ,accessed 10 November 2009
  • Which treatment for liver cancer? CancerHelp UK. www.cancerhelp.org.uk ,accessed 10 November 2009
  • Tumour ablation. Macmillan Cancer Support. www.macmillian.org.uk ,accessed 10 November 2009
  • Chemoembolisation. Macmillan Cancer Support. www.macmillian.org.uk ,accessed 10 November 2009
  • Radiotherapy for liver cancer. Macmillan Cancer Support. www.macmillian.org.uk ,accessed 10 November 2009
  • Guidelines on the diagnosis and treatment of HCC. British Society of Gastroenterology. www.bsg.org.uk ,accessed 10 November 2009
  • Souhami R, Tobias J. Cancer and its management. 5th ed. Oxford: Blackwell Publishing, 2005: 255
  • The link between hepatitis C and liver cancer. Hepatitis C Trust. www.hepctrust.org.uk ,accessed 11 November 2009
  • Haemochromatosis. The British Liver Trust. www.britishlivertrust.org.uk ,accessed 11 November 2009
  • Haemochromatosis. The Haemochromatosis Society. www.haemochromatosis.org.uk ,accessed 11 November 2009
  • Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology, 2004. www.bsg.org.uk
  • Biopsy (liver). GP Notebook. www.gpnotebook.co.uk ,accessed 11 November 2009

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