Liver cancer
Liver cancer
What is liver cancer?
Liver cancer is cancer that starts in the liver itself. Doctors sometimes call this primary liver cancer.
Primary liver cancer is rare in the UK, though more people are being diagnosed with it these days. It shows up more often in men than in women.
Each year, around 6,600 people in the UK learn they have primary liver cancer. In other parts of the world, such as parts of Africa and Asia, it is one of the most common cancers people face.
When a cancer starts somewhere else in the body and later spreads to the liver, that is called secondary liver cancer, a different condition from the one covered here.
In this video, liver surgeon Aamir Khan talks about primary liver cancer. He explains the symptoms to watch for, how doctors go about diagnosing liver cancer, what may cause it, and the treatments available.
Types of liver cancer
Hepatocellular carcinoma, known as HCC, is the most common type of liver cancer. You may also hear it called a hepatoma.
This information focuses on hepatocellular carcinoma (HCC). To keep things simple, we refer to it here as HCC, or simply liver cancer.
There are other, less common types of cancer that can start in the liver too. Some growths found in the liver are not cancerous at all (benign), so it helps to understand which kind you are dealing with.
If you are trying to make sense of a diagnosis, it can also help to read further on staying informed about the stages of liver cancer, what treatment for liver cancer usually involves, and what life can look like after liver cancer treatment.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
What causes liver cancer?
Doctors don't know exactly why hepatocellular carcinoma (HCC) develops. But certain things, known as risk factors, can raise your chance of getting it.
One of the main risk factors is a condition called cirrhosis, which damages the liver.
Long-term infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) is also a risk factor, because these infections increase the risk of cirrhosis.
Other things, such as drinking heavily over a long period of time, can also lead to cirrhosis.
Several other conditions can raise the risk of liver cancer as well.
Macmillan Cancer Support has more information about risk factors for HCC.
Diagnosis
If you notice any symptoms, the right first step is to talk to your GP.
Your GP will examine you, and they will usually take blood samples and arrange tests such as an ultrasound.
If they feel your symptoms could be caused by cancer, they will refer you to a specialist doctor, who will carry out further tests urgently.
If you already live with long term liver disease, having regular check up tests on your liver can help catch liver cancer at an earlier, more treatable stage.
Tests at the hospital
You may be seen straight away by a hepatologist, which is simply the name for a liver specialist, or by a gastroenterologist, a doctor who specialises in the stomach and bowel.
They will ask you about your symptoms and your general health, and they will check whether you have any risk factors for liver disease. The doctor will also examine you by gently feeling your tummy area (abdomen).
They may take some blood samples and explain which other tests you may need. This could include a mix of blood tests, biopsies and scans.
Blood tests
You will have blood tests to check how well certain organs are working. These tests also look at the levels of different blood cells in your blood.
Other tests
You may need further blood tests to see how well your liver is working and to help diagnose liver cancer. These include the tests described below.
Liver blood tests
You will have blood tests called liver function tests (LFTs) to check how well your liver is working. These measure whether:
- you have too much of a waste product called bilirubin in your blood
- you have a low level of a protein called albumin in your blood
- your blood is clotting more slowly than it should
Tests for hepatitis
You may have blood tests to check for hepatitis B virus (HBV) and hepatitis C virus (HCV), since both can increase the risk of developing liver cancer.
AFP tumour marker test
You will also have a blood test to check for a protein called alpha fetoprotein (AFP).
AFP is known as a tumour marker for HCC. Its level is sometimes higher in people with hepatocellular carcinoma (HCC), though it can also rise if you have hepatitis B, hepatitis C, or other liver inflammation.
Doctors may also check your AFP level after treatment, to see how well the treatment has worked or to watch for early signs of the cancer returning. When the same cancer comes back, this is called a recurrence.
Liver ultrasound scan
A liver ultrasound scan uses sound waves to build up a picture of the liver. It helps find the size and location of any tumours and also shows how healthy the rest of the liver is.
CT scan
A CT scan builds a detailed picture of the inside of the body, using a series of x-rays taken by the CT scanner.
MRI scan
An MRI scan uses magnetism to build up a detailed picture of areas of the body.
Liver biopsy
You may have a small piece of tissue taken from the liver to look at under a microscope. This is called a liver biopsy, though not everyone needs one.
PET or PET CT scan
A PET scan uses a low dose of radiation to check how active the cells are in different parts of the body. Sometimes a PET scan is done together with a CT scan, and this combined test is called a PET CT scan.
Waiting for test results can be a difficult and anxious time. Macmillan Cancer Support have more information that can help, and they also have guidance for anyone who has just been diagnosed with cancer.
Stages of liver cancer
Test results help doctors understand more about the size and position of the cancer, and whether it has spread. This process is called staging.
Knowing the stage helps you and your doctors decide on the best treatment for you.
There are different systems used to stage hepatocellular carcinoma (HCC). Doctors often use the Barcelona Clinic Liver Cancer (BCLC) staging system, which includes assessing how well your liver is working using the Child Pugh classification system.
Macmillan Cancer Support have detailed information about these on their stages of liver cancer page.
Treatment
Treatment for liver cancer
A team of specialists will meet to discuss the best treatment for you. This is called a multidisciplinary team.
As liver cancer is part of the hepatobiliary system you’ll see specialists in this team.
Your doctor, cancer specialist or nurse will explain the different treatments and their side effects. They’ll also talk to you about things to consider when making treatment decisions. You’ll need this information before you give your permission (consent) to have any treatment.
The treatment you have usually depends on:
- where the cancer is in the liver
- the size of the tumour or tumours
- how many tumours there are
- whether important blood vessels in the liver are affected
- whether the cancer has spread outside the liver (the stage of the cancer)
- how well your liver is working and your general health
- your preferences.
The following treatments may be used to treat liver cancer.
Surgery
Surgery is the most effective treatment for HCC. But it’s often possible because the cancer may be too advanced, or the liver is too damaged.
Surgery may involve an operation to remove part of the liver (liver resection) or a liver transplant. These are major operations, so you need to be well enough to cope with them.
Tumour ablation treatments
Some people have tumour ablation. This is when heat, electrical pulses or sometimes alcohol are applied directly to cancer cells to destroy the tumour.
The main ablation treatments include microwave ablation and radiofrequency ablation.
Ablation may be used to treat small tumours instead of surgery. It can also be used with other treatments.
Macmillan Cancer Support have more information about tumour ablation for liver cancer.
Embolisation treatments
Embolisation is a way of cutting off the blood supply to the tumour. It may be used on its own or along with:
- chemotherapy, called chemoembolisation
- radiation called selective internal radiation therapy (SIRT)
Some people might have a treatment called portal vein embolisation (PVE) before a liver resection.
Macmillan Cancer Support have more information about embolisation treatments for primary liver cancer.
Targeted therapy and immunotherapy drugs
Targeted therapy drugs find and attack cancer cells.
Immunotherapy drugs help the immune system to fight cancer cells.
Doctors may use targeted therapy drugs and immunotherapy drugs if the cancer is advanced in the liver or it has spread outside it.
You might have a combination of the immunotherapy drug atezolizumab, with a targeted therapy drug called bevacizumab.
Some people may have a targeted therapy drug called sorafenib (Nexavar®) or a drug called lenvatinib.
Radiotherapy
Some people have a type of high-dose radiotherapy that closely targets tumours in the liver. This is called stereotactic ablative radiotherapy (SABR). It’s used to try to control areas of cancer in the liver.
Radiotherapy can also be used to ease symptoms like pain if the cancer has spread to an area like the bones.
Chemotherapy
Chemotherapy into a vein (intravenous) or taken as a tablet might sometimes be used after other treatments have already been tried. It can be used to try to control the cancer or reduce the symptoms.
You may have some treatments as part of a clinical trial.
Macmillan Cancer Support have information on getting organised before cancer treatment.
After liver cancer treatment
You’ll have regular check-ups and blood tests during and after your treatment.
Depending on your treatment, you may have regular CT or MRI scans to check the tumour has not come back. This might mean having 3 monthly scans for the first 2 years.
If you had a liver transplant, you’ll have check-ups more often. You’ll have tests to make sure your body is not rejecting the new liver. Your doctor or nurse will tell you what to look out for.
Tell your doctor or specialist nurse as soon as possible if you have any problems or notice new symptoms between appointments.
Macmillan Cancer Support have more information about follow-up care after treatment.
Support after liver cancer
People often have many different feelings when they finish liver cancer treatment. You may feel relieved that treatment has finished, but worried about what will happen in the future.
It’s important to know where to get support or information from if you need it.
Ask your GP or someone from your cancer team for advice about support in your area.
Macmillan Cancer Support also has further information to support you. You can:
- phone the Macmillan Support Line on 0808 808 00 00
- chat to Macmillan specialists online
- use the Macmillan liver cancer forum – you can talk to others affected by liver cancer, ask questions and share your experience
- find local cancer support services
Other organisations who offer information and support include:
- British Liver Trust – provides information and support to people affected, including a helpline
- Guts UK – provides information and leaflets on digestive problems, including liver cancer
Complications
Recovery after liver cancer treatment can take time, and some days will feel better than others. Looking after yourself can help speed things up, and even small lifestyle changes may improve your wellbeing and long-term health.
Please check with your doctor before drinking any alcohol. Alcohol can damage the liver and reduce how well it works. If you had cirrhosis before your cancer diagnosis, continuing to drink can make it worse, so you'll usually be advised to stop completely.
Surgery and some other treatments also depend on how well the healthy parts of your liver are working. So even if alcohol hasn't affected your liver, you might be asked to stop for a while before and after treatment, since your liver may not be able to cope with it.
And even if your lifestyle is already healthy, you may still want to make some positive changes after treatment.