Liver cancer

The most common type of primary liver cancer is hepatocellular carcinoma (HCC) which starts in the main cells of the liver. It’s also called hepatoma and occurs in nine in 10 cases of primary liver cancer.

Primary liver cancer is uncommon in the UK. It’s more common to have secondary (metastatic) liver cancer – where cancerous cells have broken away from a tumour elsewhere in your body and travelled through the blood or lymphatic system to your liver. The treatment for secondary liver cancer depends on where the cancer originally started.

This information is about primary liver cancer and HCC.

Primary liver cancer can be difficult to diagnose in the early stages because it doesn’t have many specific signs or symptoms. It’s often diagnosed when it’s more advanced which makes it difficult to treat.

Liver cancer symptoms include:

• Fatigue
• Loss of appetite
• Malaise – feeling generally unwell
• Nausea
• Unexplained weight loss

Symptoms of more advanced liver cancer include:

• Abdominal pain and/or swelling
• Jaundice – yellowing of the skin and eyes
• Itch – caused by jaundice

If you have a high risk of developing liver cancer, you should have regular screenings which may include ultrasound scans and blood tests. These tests are also used if you have symptoms and your doctor suspects liver cancer.

To confirm a diagnosis or assess how advanced liver cancer is, further tests include:

• CT scans
• MRI scans
• Biopsy – where a small tissue sample is taken and analysed in a laboratory
• Laparoscopy - a long, thin instrument with a camera on the end is inserted into your stomach through a small cut in your abdomen to see your liver

The main cause of primary liver cancer is scarring due to previous damage (liver cirrhosis). This can be caused by:

• Hepatitis B or C
• Drinking too much alcohol
• Haemochromatosis – an inherited condition that causes iron build-up in the body
• Primary biliary cirrhosis – an autoimmune disease where your immune system mistakenly attacks the small bile ducts in your liver
• Non-alcohol related fatty liver disease (NAFLD) – where fat builds up in your liver causing damage

Other risk factors of primary liver cancer include:

• Aging – it’s more common in people over 60
• Being overweight
• Diabetes
• Family history of liver cancer
• Smoking

Treatment for liver cancer depends on the stage (how far it’s advanced) and your general health.

Liver cancer is easier to cure if it’s diagnosed and treated early. Treatments include:

• Surgery to remove the tumour and part of your liver
• Liver transplant
• Microwave or radiofrequency ablation – using heat to kill cancerous cells
• Targeted drug therapy

For more advanced cases of liver cancer, a multi-disciplinary team can recommend treatment to improve symptoms and slow the progress of the disease. This includes:

• Chemotherapy – to kill cancer cells or stop them from multiplying
• Transarterial chemoembolisation (TACE) – drugs to destroy cancer cells and reduce blood supply to the tumour are fed directly into the affected site using a long, flexible tube (catheter) inserted through an artery in your leg
• Radiotherapy – high energy radiation is directed at a tumour to kill cancerous cells or stop them from multiplying