Patient Information Leaflet

Primary Liver Cancer


What is cancer?

  • Cancer is a disease of the cells in the body. The cancer cells are abnormal and multiply out of control.
  • They may spread to other parts of the body to form secondary tumours (metastases) in one or more parts of the body.

What is liver cancer?

Cancer of the liver can be divided into primary liver cancer and secondary liver cancer:

  • Primary liver cancer means that the cancer started (originated) in the liver. It occurs most commonly in people aged over 65 years. However, worldwide, it is one of the most common cancers.
  • Secondary (metastatic) liver cancer means that a cancer originating from other part of the body has spread to the liver. Most commonly, cancers of the bowel, pancreas, stomach, lung or breast metastasise to the liver.

Primary liver cancer

There are different types of primary liver cancer which include:

Hepatocellular cancer (HCC) or Hepatoma

This is the commonest type. It originates from a liver cell (hepatocyte). It generally develops on a background of cirrhosis. However, patients with a normal liver can also develop a primary HCC.

Cholangiocarcinoma

This is uncommon. It develops from cells which line the bile duct.

Hepatoblastoma

This is a rare cancer which occurs in some young children.

What causes primary liver cancer?

Most people who develop a primary liver cancer may have one or more of the following risk factors

  • Cirrhosis : This is a condition which causes scarring of the liver. It tends to progress slowly. The common causes of cirrhosis are heavy alcohol drinking, infection with hepatitis B or C, non alcoholic fatty liver disease
  • Long-term infection with the hepatitis B or hepatitis C virus. It typically takes 20-30 years after first becoming infected to develop primary liver cancer.

What are the symptoms of primary liver cancer?

There may be no symptoms in the early stage of the disease. As the cancer grows, the first symptoms to develop may be quite vague and nonspecific. For example, feeling generally unwell, feeling sick (nausea), loss of appetite, weight loss and tiredness.

As the cancer develops further, more specific symptoms which may also develop include:

  • Abdominal pain over the liver area.
  • Jaundice.
  • Itch (caused by the jaundice).
  • Collection of fluid in the body.

How is cancer of the liver diagnosed & assessed?

Initial assessment

If liver cancer is suspected, you are likely to have a number of tests. These aim to:

  • Confirm that you have a cancer in the liver.
  • Assess the stage of the cancer. That is – to detect if the cancer has spread to other parts of the body.
  • Assess the state of your liver function and your general health.

Therefore, a range of tests are usually needed. They may include:

  • Scans such as ultrasound scan, CT scan or MRI scan. These can help to show the exact location and extent of the cancer.
  • Tumour markers ( blood tests) like S. AFP levels that help in the detection of cancer.
  • Blood tests help to assess the liver function and your general health.

Screening

  • Screening using ultrasound/ CT scan, and AFP level, at 6-to 12-month intervals, is recommended for people at high risk of liver cancer.
  • Detects liver cancer at an earlier stage and therefore improve the chance of successful treatment.

What are the treatment options for primary liver cancer?

The treatment advised depends on various factors such as:

  • The exact site of the primary tumour in the liver.
  • The stage of the cancer.
  • Your general health. In particular, the general state of your liver and liver function.

Surgery

Surgery is the only curative option

  • Healthy liver tissue will regrow to its full size within a few weeks after the surgery
  • When a part of the liver cannot be removed ( since the liver function tests are not appropriate) and the tumour is only confined to the liver; then a liver transplant can be considered . However, it is an option in only a minority of the cases

Other treatments

Various other treatment techniques are sometimes used. For example:

Radiofrequency ablation

For this treatment, a needle is inserted into the tumour. Highintensity radio waves are then passed through the needle. This can be done trans-cutaneously ( through the skin) or laparoscopically ( key hole surgery) or via open surgery

Chemoembolisation

Chemotherapy medicines are injected into branches of the liver artery that supply the tumour.