Liver Cancer

Liver cancer develops when cancerous cells form and grow in the liver.

Primary liver cancer is when the cancer starts in the liver, although it may spread outside the liver in the advanced stages.  The 2 main types of primary liver cancer are hepatocellular carcinoma (HCC) and cholangiocarcinoma (bile duct cancer).

Secondary liver cancer is when the cancer starts in another place and spreads to the liver.

If it’s caught early, when the cancer is still very small, liver cancer can be cured. But if it grows and spreads into blood vessels or to other parts of the body, it’s much harder to cure, although treatments may slow it down.

Liver cancer is becoming more common in Australia. More than 3,000 people are diagnosed every year. It’s 3 times more common in men than in women.

Most people with liver cancer will already have underlying liver disease.  It’s important that the liver disease is managed alongside the cancer itself and that the function of the liver is kept as good as possible to allow for cancer treatment.

What are the different types of liver cancer?

Primary liver cancer

Primary liver cancer is cancer that starts in the liver. The type of cancer depends on which type of cells it grows in:

• The most common type of primary liver cancer is hepatocellular carcinoma (HCC). It begins in the liver’s main cells, called hepatocytes.
• The second most common type of primary liver cancer is cholangiocarcinoma (bile duct cancer). It begins in cells that line the bile ducts, the tubes that carry bile from the liver to the gallbladder and then to the intestines. Bile duct cancers can start as a lump in the liver, or can grow along the larger bile ducts within or outside the liver.

Other rare types of primary liver cancer are:

• Angiosarcoma (starts in the blood vessels in the liver; sometimes it’s called hemangiosarcoma)
• Fibrolamellar carcinoma (starts in healthy liver cells, mostly in adolescents and young adults)
• Hepatoblastoma (most commonly only affects children younger than 4 years old).

Secondary liver cancer

Secondary liver cancer is cancer that starts somewhere else in the body then spreads (metastasises) to the liver. It’s sometimes called liver metastases or metastatic liver disease. It’s much more common than primary liver cancer.

Bowel cancer is the cancer that’s most likely to spread to the liver. The cancer cells travel to the liver through a major vein called the portal vein.

Other cancers that can spread to the liver are breast, kidney, lung, melanoma, neuroendocrine, oesophageal, ovarian, pancreatic, and stomach.

Sometimes it’s not sure where in your body the cancer started. This is called ‘cancer of unknown primary’.

Benign liver lesions

It’s also possible to have growths in your liver that aren’t cancer. Read more about benign liver lesions.

Could I have liver cancer?

Most liver cancers don’t cause any symptoms in the early stages. By the time you notice symptoms, the cancer might have grown quite big or spread to other parts of the body.

Sometimes people have symptoms from their liver disease even when a liver cancer is very small and treatable.

Ideally liver cancer will be diagnosed while it is just a small lump in the liver, and before it causes symptoms. However, if the first indication of liver cancer is because you have developed symptoms, some of these symptoms might be:

• You have some pain or discomfort in the upper right side of your belly or in your upper right back, around your right shoulder blade
• There’s a hard lump in the right side of your belly, below your rib cage
• You have a swollen belly caused by a build-up of fluid (ascites)
• You lose weight without meaning to
• Your skin and the whites of your eyes go yellow (this could be jaundice)
• You feel extremely weak and tired (fatigue)
• You lose your appetite, or you feel sick
• You have a fever (high temperature).

All these symptoms could be from liver disease itself, not liver cancer. They could also be caused my many other conditions such as infection or heart problems. If you have any of these symptoms, it’s best to see your doctor.

Why did I get liver cancer?

Rare liver cancers and secondary liver cancers have their own risk factors. But for most primary liver cancer, you are at greater risk if you:

• Have cirrhosis
• Have hepatitis B or hepatitis C
• Drink more alcohol than is recommended
• Have other conditions including haemochromatosis, primary biliary cholangitis or primary sclerosing cholangitis
• Have a family history of liver cancer
• Are overweight or obese
• Have type 2 diabetes
• Smoke
• Are older
• Are male

How is liver cancer diagnosed?

If your doctor thinks you may have liver cancer, they will examine you and order some tests:

• Blood tests to see how well your liver is functioning, check for hepatitis, look at blood clotting, and look for other signs you might have cancer
• Scans including ultrasound, CT, MRI or PET scans to look at the tumour and see if it has spread
• A small procedure to take a tissue sample from the liver (biopsy), or to look inside your belly with a laparoscope (a thin tube with a light on the end).

How is liver cancer treated?

If you have liver cancer, you need to be treated both for the cancer and also for the underlying liver disease. Treatment depends on what type of cancer you have, where in the liver it is, how big it is, how far it’s spread, and how well your liver is working.

Some options are:

• Surgery to remove the tumour and part of the liver (called liver resection)
• Liver transplant
• Tumour ablation (using heat, alcohol or freezing to destroy the tumour)
• TACE (transarterial chemoembolisation, a type of chemotherapy delivered straight to the tumour through a catheter into the liver)
• SIRT treatment
• Radiation therapy
• Targeted therapy (special medications that just target the tumour and not other cells in your body)

If you have secondary liver cancer, the most common treatment is chemotherapy. The type of chemotherapy will depend on where the cancer started. For example, if the cancer spread from the breast, you will be treated with drugs for breast cancer. If it spread from the bowel, you’ll be treated with drugs for bowel cancer.

Secondary liver cancers may also be treated with surgery, tumour ablation, TACE, radiation therapy, hormone therapy, immunotherapy or targeted therapy. Very occasionally people with bowel cancer that has spread to the liver may be considered for liver transplantation.

Liver cancer is hard to treat if it’s advanced (grown large and/or spread).

More about different types of liver cancer