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Liver cancer

Published by Bupa's health information team, February 2008.

This factsheet is for people with liver cancer or who would like information about it.

Cancer that starts in the liver (primary liver cancer) is rare in the UK. About 2,500 people each year are diagnosed with it and approximately twice as many men as women are affected. Cancers which spread to the liver (secondary liver cancer) are much more common. These occur when a cancer starts elsewhere in your body, such as your bowel, breast or lungs, and spreads to your liver.

How cancer develops

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The liver

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

Your liver carries out about 500 different jobs, including:

  • getting rid of toxins from your body
  • processing digested food
  • producing bile
  • repairing damage

In addition, it can repair itself and still function when much of it is damaged.

The liver and surrounding structures
The liver and surrounding structures

About primary liver cancer

A liver tumour is a lump created by an abnormal and uncontrolled growth of cells. It can either be malignant (cancerous) or benign. Most tumours in the liver are benign. Benign tumours are not cancerous. They don't spread to other parts of the body and don't invade surrounding tissue.

Cancerous tumours can grow through your liver and spread to other parts of your body (through the bloodstream or the lymph system) where they may grow and form secondary tumours. This spread of cancer is called a metastasis. Tumours may spread to the liver from other parts of the body - this is secondary liver cancer.

Types of primary 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 the liver called hepatocytes.

Cholangiocarcinoma starts in the cells that line your bile duct. The bile duct is a tube that connects your liver to your small bowel.

There are some other, much rarer types of liver cancer including:

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

Symptoms

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

  • weight loss
  • swollen abdomen
  • loss of appetite
  • sickness
  • fatigue
  • jaundice

Although not necessarily a result of liver cancer, if you have these symptoms you should visit your GP.

Causes

There are a number of things that mean you may be more at risk of developing hepatocellular carcinoma. These include the following.

  • In the UK, most people who get hepatocellular carcinoma do so as a result of cirrhosis. This is a condition where your liver has become scarred, possibly through an infection such as hepatitis B or hepatitis C. Drinking alcohol excessively can also cause cirrhosis. It damages how well your liver is able to function. However, only about three or four people out of every 100 who have cirrhosis will get liver cancer.
  • If you have been infected with hepatitis B or hepatitis C, you are more at risk of primary liver cancer even if you don't have cirrhosis.
  • If you have a condition called haemochromatosis, your body has too much iron and this can raise your risk of getting liver cancer.
  • In Africa and Asia, where liver cancer is much more common, a frequent cause is a substance called aflatoxin. This is found in mouldy peanuts and grain, and if eaten over a long period of time it can lead to liver cancer.
  • Primary liver cancer is twice as likely to occur in men as in women.

The exact reasons why you may develop cholangiocarcinoma are not fully understood at present. However, if you have an inflammatory bowel condition such as ulcerative colitis you may be slightly more at risk.

Diagnosis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history and possibly take a blood sample. Your GP may refer you to a specialist at a hospital where you are likely to have tests, including liver function tests. These check that your liver is working properly by looking at a sample of your blood. Some of the other tests your doctor may recommend include the following.

  • An ultrasound scan uses sound waves to produce an image of your liver.
  • A CT (computed tomography) scan uses X-rays to make a three-dimensional picture of your liver.
  • An MRI (magnetic resonance imaging) scan uses magnets and radiowaves to produce images of the inside of your body.
  • You may be advised to have a liver biopsy. A biopsy is a small sample of tissue. This is sent to a laboratory for testing. You will usually only have a local anaesthetic before this procedure but you may need to stay overnight in hospital.
  • A laparoscopy is a minor operation that allows surgeons to look inside your abdomen. A small cut is made in the skin of your abdomen and a thin tube is inserted. This contains a light and a camera so pictures can be taken of your liver. Your surgeon may do a liver biopsy at the same time. You will receive a general anaesthetic before having a laparoscopy.

Treatment

This will depend on how advanced your cancer is and also on your general state of health. Treatment will also vary according to where exactly the cancer is and whether or not it has spread to other parts of your body. All treatments can cause side-effects and it's important to talk to your doctor to get information and advice before going ahead with anything.

If you have secondary liver cancer, your treatment will depend on where the primary cancer has spread from.

Surgery

This is the best treatment for liver cancer and the only one that offers a possible cure. However, it's likely that you won't be able to have surgery because your cancer is too big or has spread elsewhere in your body. Fewer than one in three people who have hepatocellular carcinoma can have surgery to remove it.

There are a number of different types of surgery that can be used to treat liver cancer.

  • A liver resection is when the affected part of your liver is removed.
  • A lobectomy removes a whole lobe of your liver.
  • A liver transplant involves removing your entire liver and replacing it with one from somebody else. Only a very small number of people with liver cancer are suitable for this operation.

As much as 80 percent of your liver may be taken away if you have a liver resection or lobectomy. However, your liver is able to repair itself and can grow back to its original size within a few weeks.

Ethanol injections

If your cancer is small, you may be able to have it treated with injections of ethanol. Ethanol is an alcoholic liquid that destroys the cancer cells. In this procedure, it's injected through your skin straight into the affected area of your liver. The number of sessions you need will depend on whether you have more than one tumour and how big they are. In each session you may have one or two injections.

Radiofrequency ablation

This treatment uses heat from radiowaves to kill cancer cells. A thin needle is placed in the tumour and then radiowaves are passed down it - these heat up the tumour and destroy it.

Chemotherapy and chemoembolisation

Chemotherapy involves using medicines (usually given by injection into a vein or artery) such as doxorubicin which kill cancer cells. This treatment aims to shrink your cancer and reduce the symptoms it causes. Chemotherapy isn't very successful for treating liver cancer, but a procedure called chemoembolisation may be more effective. The chemotherapy medicines are mixed with an oily substance called lipiodol that helps them to stay in the 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 the tumour - without this the tumour can't survive.

Radiotherapy

This isn't usually used to treat hepatocellular carcinomas but may be a possibility if you have cholangiocarcinoma. It uses X-rays to kill cancer cells but can cause damage to healthy liver cells. It's occasionally given in combination with chemotherapy.

Related topics

Related Bupa products and services

Bupa offers Bupa Liver Health, an advanced liver assessment that can detect early signs of liver problems and disease, with advice to manage risks.

Further information

Sources

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.

Publication date: February 2008.

 

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