Liver Cancer

Primary liver cancer is cancer that begins in the cells of the liver. The most common type in adults is hepatocellular carcinoma, which starts in the main liver cells (hepatocytes). A less common type, cholangiocarcinoma, starts in the bile ducts within or near the liver.

The liver is a large organ in the upper right part of the abdomen. It performs many vital jobs, including filtering the blood, breaking down toxins, helping with digestion, and making proteins that help blood to clot.

It is important to know the difference between primary liver cancer, which starts in the liver, and secondary (metastatic) cancer, which starts elsewhere in the body and spreads to the liver. The two are treated differently. This page is about primary liver cancer.

Early liver cancer often causes no symptoms, particularly in people who already have liver disease and may put changes down to their existing condition. As the cancer grows, symptoms can include unexplained weight loss, loss of appetite, feeling full after eating only a small amount, and pain or a lump in the upper right side of the abdomen.

Other symptoms may include yellowing of the skin and eyes (jaundice), itchy skin, feeling sick, tiredness and weakness, and a swollen abdomen caused by a build-up of fluid. Some people notice that they bruise or bleed more easily.

These symptoms can have many causes other than cancer. But anyone with existing liver disease who notices new or worsening symptoms, and anyone with persistent unexplained symptoms like these, should see a doctor so the cause can be found.

Most primary liver cancers develop in a liver that has been damaged over many years. Long-term infection with the hepatitis B or hepatitis C virus is a major cause worldwide, and cirrhosis (scarring of the liver) from any cause increases the risk.

Other risk factors include heavy, long-term alcohol use, non-alcoholic fatty liver disease linked to obesity and type 2 diabetes, and an inherited condition called haemochromatosis, in which too much iron builds up in the body. In some parts of the world, exposure to a mould toxin called aflatoxin in poorly stored food is also a risk.

Vaccination against hepatitis B, treatment of hepatitis B and C infections, limiting alcohol, and keeping to a healthy weight can all help reduce the risk. Having a risk factor does not mean a person will definitely develop liver cancer.

Liver cancer is often investigated with imaging. An ultrasound scan is commonly used first, followed by more detailed CT or MRI scans, which can often identify hepatocellular carcinoma by its appearance. A blood test for a protein called alpha-fetoprotein (AFP) may also be done.

A biopsy, taking a small sample of liver tissue, is sometimes needed to confirm the diagnosis, although in some cases the scans and blood tests give enough information without one. Tests are also done to check how well the liver is working, as this strongly affects which treatments are possible.

People at higher risk, such as those with cirrhosis or chronic hepatitis, may be offered regular surveillance with ultrasound and blood tests. This aims to find any cancer at an earlier, more treatable stage.

Treatment depends on the size, number and position of the tumours, how well the rest of the liver is working, and a person's general health. A team of specialists recommends a plan, which may combine treatments.

When the cancer is caught early and the liver is otherwise healthy enough, surgery to remove the affected part of the liver (resection) may be possible. For some people, a liver transplant can treat both the cancer and the underlying liver disease. Smaller tumours may be destroyed using ablation, which uses heat or other energy to kill cancer cells.

When surgery is not suitable, other options include transarterial chemoembolisation (TACE), which delivers chemotherapy directly to the tumour and blocks its blood supply, as well as targeted therapy and immunotherapy, which act on the cancer throughout the body. Radiotherapy may be used in selected cases.

Because liver cancer often occurs alongside liver disease, looking after the liver is an important part of care. This can include treating underlying hepatitis, avoiding alcohol, and managing complications such as fluid build-up in the abdomen.

Specialist nurses, dietitians and palliative care teams can help with symptoms, nutrition and emotional wellbeing. The aim is to keep a person as well and comfortable as possible, whatever stage their illness is at.

Many cases of primary liver cancer can be made less likely by protecting the liver. Being vaccinated against hepatitis B, getting tested and treated for hepatitis B and C, limiting alcohol, keeping to a healthy weight and managing diabetes all help lower the risk.

For people who already have cirrhosis or chronic viral hepatitis, regular monitoring is one of the most useful steps, because cancers found early are generally easier to treat.

The outlook depends on the stage of the cancer and on how well the liver is working. Because these two things vary a lot between people, the medical team is the best source of information about an individual situation.