Cancer occurs when cells (the building blocks of tissue) develop in an uncontrolled way, continuously dividing and growing into a lump or tumour.
Primary liver cancer
It’s not yet known exactly what causes primary liver cancer, but it is pretty rare – about 3,500 cases are diagnosed in the UK every year (compared to, for example, around 40,000 cases of breast cancer).
What is known is that there are certain ‘risk factors’ – things that increase the chance of getting primary liver cancer. These include liver cirrhosis (scarring), long term infection with the Hepatitis B or Hepatitis C virus; diabetes; smoking; and a family history of the disease.
The most common type of primary liver cancer is known as Hepatocellular Carcinoma (HCC) or Hepatoma. This accounts for 85/100 primary liver cancers. It develops in the main liver cells (called hepatocytes) and usually occurs in patients with liver cirrhosis (scarring) – it’s more common in men, and is more likely to affect people as they get older.
Other primary liver cancers include:
- Cholangiocarcinoma. This may be intrahepatic (starts in the bile ducts inside the liver) in which case it’s treated as liver cancer or extrahepatic (if it starts in a section of the bile duct outside of the liver) when it’s treated as bile duct cancer
- Angiosarcoma/haemangiosarcoma, which is very rare (1/100 liver cancers)
- Hepatoblastoma, which is also a very rare form of cancer that affects young children
Symptoms - primary liver cancer
These can be vague in nature but can include:
- Unexplained weight loss
- Loss of appetite
- A bloated feeling
- A swollen tummy and associated pain
- A high temperature and sweating
- Jaundice (yellowing skin)
- Deteriorating health in a person with chronic hepatitis or liver cirrhosis (scarring)
- Feeling sick
Secondary liver cancer
In the UK nearly all cancer treated in the liver is secondary (metastatic). This means that the cancer cells have travelled there from a primary (original) site elsewhere in the body. The liver is one of the organs that cancer cells can spread to, because it filters all the body’s blood.
Symptoms - secondary liver cancer
Some people will not have any symptoms. These people will only discover their cancer from scans performed when doctors are investigating and diagnosing other health problems.
For other people either swelling of the tummy or jaundice may be the first signs that cancer has spread to the liver.
Your doctor will conduct an initial physical examination, in particular to see whether you experience any tenderness in the right-hand side of your rib-cage (ie, where the liver is). He/she will also take a sample of blood for testing. The examination and/or tests will also try to find signs of cancer elsewhere in your body if secondary liver cancer is suspected. However, it’s not always possible to find the primary site of the cancer.
In addition your doctor may also ask for a liver ultrasound, a CT scan of your tummy, an MRI scan, liver biopsy and look at your liver using a laparoscope (a tiny camera on the end of a fibre-optic tube).
Your doctor may not be able to give you a definitive diagnosis on the day and you may have to wait a couple of days for the diagnosis to be confirmed.
Treatment – primary liver cancer
Primary liver cancer has four main stages and treatment will depend on the stage reached when you are diagnosed.
Surgery is the most effective treatment for all forms of liver cancer. Although still considered ‘major’ surgery it has less than a two per cent mortality risk and an acceptable morbidity (ie, illness) risk when performed by experienced experts such as those at the Princess Grace Hospital.
However, liver surgery is a major operation that carries some major risks and complications – including excessive blood loss. These risks need to be balanced against the risks of not having the procedure.
Surgery is, however, the only treatment that offers a chance of curing the cancer – unfortunately it is not suitable for everyone: it will only be considered, for example, if the cancer has been contained within the liver (ie, it has not spread).
Partial liver resection may be combined with radio frequency ablation to treat unresectable liver tumours.
Non-surgical treatments for HCC - used when patients have inoperable HCC - include: injections of ethanol which dehydrates the cancer cells; radio frequency ablation that destroys cells by using heat; and embolisation and chemoembolisation (TACE ) which are chemotherapy treatments that reduce the side-effects of anti-cancer drugs in the blood.
Embolisation injects a substance into the liver creating a seal that cuts off the blood supply to the tumour to stop it growing. With chemoembolisation a drug is mixed with an oily dye and administered before the embolising substance. In this way the drug is sealed in to attack the tumour for a longer period of time. This procedure is performed during a hospital stay.
Cryotherapy can be used to treat primary liver cancer (HCC) that has not spread. Cyrotherapy makes use of extreme cold, created by liquid nitrogen or argon gas, to destroy abnormal tissue.
Treatment – secondary liver cancer
The main form of treatment used is chemotherapy although the choice of treatment depends on factors such as which parts of the liver are affected, where the primary cancer is (if known) and whether other parts of the body are also affected.
Surgery might be possible for some people – when the cancer has spread to the liver from the bowel. This involves removing part of the liver containing the tumour. Up to 70 per cent of healthy liver can be removed safely and the liver can regenerate back to normal after the operation. There are also techniques to grow the healthy liver before surgery to increase the residual volume – this is called ‘portal vein embolisation’. Surgery to remove secondary liver tumours is often combined with chemotherapy.
Prognosis/outlook – primary liver cancer
The outcome of the treatment for primary liver disease will broadly depend on what stage the cancer had reached when the treatment started.
About one in 10 people are diagnosed in the early stages of primary liver cancer. At this early stage surgery can help by removing the tumour. However, surgery is not usually possible for patients who also have liver cirrhosis (scarring).
Taking part in clinical trials has been shown to improve the outlook for some patients. If you would be interested in taking part you should discuss any possible options with your doctor.
Prognosis/outlook – secondary liver cancer
The prognosis of patients with secondary liver cancer is improving all the time with developments in chemotherapy as well as an increase in those patients now regarded as suitable for surgery.
However, patients with secondary liver cancer will need to see their doctor regularly: the chemotherapy drugs and radiation therapy may help to relieve the symptoms and extend the life expectancy of patients but regular medical check-ups will be essential.
To arrange a consultation with a liver consultant please contact The Princess Grace Hospital, Liver, Bile Duct and Pancreas Unit