What is liver cancer?
Primary liver cancer is a malignant tumour that begins in the liver. There are different types:
- hepatocellular carcinoma (HCC) or hepatoma, is the most common type of primary liver cancer and it starts in the main cell type in the liver, the hepatocytes
- cholangiocarcinoma, or bile duct cancer, starts in the cells lining the bile ducts (which connect the liver to the bowel and gall bladder)
- angiosarcoma, which starts in the blood vessels. This is a rare type of liver cancer that is more likely to occur in people over 70.
Men are three times as likely to be diagnosed as women.
Secondary cancer in the liver has a far higher incidence than primary liver cancer, with approximately 28,000 people in South Africa diagnosed each year. It is cancer that started in another part of the body but has spread to the liver. If you have secondary cancer in the liver, it may be useful to read information about the primary cancer in conjunction with this information.
A secondary cancer is named after the primary site where it began, for example bowel cancer with liver secondaries. In this information, we use the term ‘secondary cancer in the liver’ to refer to any cancer type that has spread to the liver.
Liver cancer symptoms
Liver cancer symptoms are more likely to appear as the cancer grows or becomes advanced. Symptoms may include:
- weakness and tiredness
- pain in the upper right side of the abdomen
- severe pain and/or swelling of the abdomen
- appetite loss and feeling sick
- weight loss
- yellowing skin and eyes
- pale bowel motions
- fever.
Causes of liver cancer
Hepatitis B or C viruses which result in long term (chronic) infection can cause liver cancer. This is the biggest known risk factor for primary liver cancer in Australia.
There are other factors that can increase the risk of developing liver cancer, such as:
- liver scarring
- fatty liver disease or genetic disorders including haemochromatosis, or alpha 1-antitrypsin deficiency
- type 2 diabetes
- high alcohol consumption
- obesity
- smoking tobacco
- exposure to certain chemicals.
Screening for liver cancer
There is currently no screening for liver cancer available.
Diagnosis for liver cancer
A number of tests are used to diagnose liver cancer, or secondary cancer of the liver, including:
Blood test
Blood tests can check how well the liver is working; and how well your blood clots; as well as checking certain chemicals known as tumour markers; whether you have hepatitis B or C; and any genetic problems.
Ultrasound
The most commonly used method to look for primary liver cancer, an ultrasound produces pictures of the organ, and can show the size and location of abnormal tissue in your liver.
CT scan
CT scans produce three-dimensional pictures of several organs at the same time, and can help doctors help doctors plan the surgery. It can also see if the cancer has spread.
MRI scan
An MRI scan produces detailed cross-sectional pictures of the body, and can show the extent of a tumor and whether it is affecting the main blood vessels around the liver.
PET-CT scan
More commonly used for secondary cancers in the liver, PET-CT scans produce three-dimensional colour images that show where any cancers are in the body.
Biopsy
A biopsy is when a small amount of tissue is removed for examination under a microscope.
A biopsy is done by either: fine needle aspiration, which involves a local anaesthetic, and a thin needle which removes the cells; or laparoscopy (keyhole surgery), which is done under general anaesthetic and allows the doctor to look at the liver and surrounding organs, as well as take tissue samples using a laparoscope.
Other tests
If you have secondary cancer in the liver, you may have further tests to find out where the primary cancer started, if this is not already known.
Treatment for liver cancer
The most common treatments for primary liver cancer are tumour ablation and chemotherapy delivered directly into the cancer.
The most common treatments for secondary cancer in the liver are chemotherapy or a combination of surgery and chemotherapy.
Surgery
Surgery can involve removing part of the liver, or a liver transplant, where the whole liver is replaced by a donor liver.
Surgery is suitable for a small number of people with liver cancer, and it will depend on the size, number and position of the tumours.
Surgery to remove part of the liver is called a partial hepatectomy. Following surgery, the remaining part of the liver can usually repair itself if it is not damaged, and grow back to normal size over a few months. If there are tumours in both sides of the liver, surgery may be conducted over two stages, to allow the liver to regrow following the first operation.
For some people, it is not possible to remove part of the liver, and they may be considered for a transplant. A number of factors are considered before someone is eligible for a liver transplant, including the person’s overall health. A liver transplantation may be possible, however, waiting for a suitable donor liver may take a long time. During this time, most people have other treatment to control the cancer.
Tumour ablation
Tumour ablation is used most commonly for small primary liver cancers. It is rarely used for secondary cancer in the liver.
The most common types of tumour ablation treatments use radio waves and microwaves to heat and destroy cancer cells. This treatment is administered by either a needle inserted through the skin (percutaneous ablation) or a surgical cut (ablation with surgery).
Less common types of ablation treatment include alcohol injection, where pure alcohol is inserted into the tumour to destroy cancer cells; and cryotherapy, which is surgery that freezes and kills cancer cells.
Chemotherapy
Depending on the type of liver cancer you have, you may receive chemotherapy drugs to kill, shrink or slow the growth of the tumours.
Chemotherapy can be given systemically, via tablets or intravenously (through a drip), which means it goes throughout the whole body. This may be given following other treatment, such as surgery or cryotherapy, to get rid of any remaining cancer cells. It is not usually used to treat primary liver cancer unless the cancer has spread to other parts of the body.
Systemic chemotherapy can also be used as palliative treatment to slow down the cancer growth and reduce pain.
Chemotherapy can also be given directly into the tumour, which is called chemoembolisation (or TACE). As it is targeting the tumour directly, stronger drugs can be used. TACE is more commonly used for primary liver cancer.
Biological therapy
A range of treatments that work against the cancer cells by either stopping their growth or function, or by helping the body’s immune system destroy them. Used for both primary and secondary cancers in the liver, it can be used in conjunction with, or after other treatments for cancer.
Selective internal radiation therapy (SIRT)
Also known as radioembolisation, this treatment targets liver tumours directly with high doses of internal radiation in tiny beads. It is used for both primary and secondary cancers in the liver when the tumours can’t be removed with surgery. It is not available in all areas, so talk to your doctor about availability and costs involved.
Endoscopic stent placement
If the cancer in the liver has obstructed the bile duct and bile has then built up in the liver, it may be recommended that a stent (thin tube) is placed in your liver to drain the bile and ease symptoms.
Palliative treatment
Although it is most often used by people with advanced cancer, palliative treatment can be used at any stage of cancer treatment. It is intended to improve a person’s quality of life by alleviating the symptoms of cancer, without trying to cure the disease. It can include pain relief, and the management of other physical and emotional symptoms.
Treatment team
Depending on your treatment, your treatment team may consist of a number of different specialist staff, such as:
- hepatobiliary surgeon, who specialises in surgery of the liver and its surrounding organs
- gastroenterologist, who specialises in diseases of the digestive system, including the liver
- hepatologist, a gastroenterologist who specialises in diseases of the liver
- medical oncologist, who prescribes and coordinates the chemotherapy
- radiologist and nuclear medicine specialists, who help diagnose and deliver some of the cancer treatments
- a cancer nurse.
Other allied health professionals, such as a dietician, palliative care team or social worker.
Prognosis of liver cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of liver cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Preventing liver cancer
Hepatitis C and B infections are the biggest known risk factors for primary liver cancer. There are prevention strategies to reduce the spread of hepatitis B and the incidence of primary liver cancer, including vaccinating all at-risk people against the virus, and monitoring the health of people already infected with the virus.