Liver cancer

Liver cancer is a cancer that starts in the liver. You may also hear it called primary liver cancer.

In the UK, primary liver cancer is rare, but more people are developing it each year. It's more common in men than in women.

About 6,600 people in the UK are diagnosed with primary liver cancer each year. In other parts of the world, such as parts of Africa and Asia, it is one of the most common cancers.

When a cancer starts somewhere else in the body and spreads to the liver, it is called secondary liver cancer.

In this video, liver surgeon Aamir Khan talks about primary liver cancer. He explains the symptoms, how it is diagnosed, the possible causes and the treatments.

Hepatocellular carcinoma (HCC) is the most common type of liver cancer. You may also hear it called hepatoma.

This information is about hepatocellular carcinoma. To keep things simple, it says HCC or just liver cancer.

Other types of cancer can also start in the liver. And some liver tumours are not cancerous (benign).

If you have symptoms that could point to liver cancer, speak to a doctor. The doctor will examine you, and they usually take blood samples and arrange tests such as an ultrasound.

If they think cancer could be causing your symptoms, they'll refer you to a specialist doctor, who will do more tests urgently.

If you have long-term liver disease, regular tests to check your liver may find liver cancer at an earlier stage.

You may be sent to a hepatologist straight away. That's a liver specialist. Or you may see a gastroenterologist, a doctor who specialises in the stomach and bowel.

They'll ask about your symptoms and your general health, and they'll check whether you have risk factors for liver disease. Then the doctor will examine you by feeling your tummy area (abdomen).

They may take some blood samples and explain which other tests you need. These may include different types of blood tests, biopsies and scans.

If you have liver cancer, you'll have blood tests to check how well certain organs are working. The tests also look at the levels of different blood cells in your blood.

You may need other blood tests to check how well your liver is working and to help diagnose liver cancer. The tests are listed below.

You'll have blood tests called liver function tests (LFTs), which check how well your liver is working. They show 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 clots slowly

Your doctor may ask for blood tests to check for hepatitis B virus (HBV) and hepatitis C virus (HCV). Both of these infections raise the risk of developing liver cancer.

You'll also have a blood test to check for a protein called alpha-fetoprotein (AFP).

AFP is called a tumour marker for HCC. Its level is sometimes higher in people with hepatocellular carcinoma (HCC). But AFP levels can also be higher if you have hepatitis B or hepatitis C, or other inflammation of the liver.

Doctors may also check the AFP level after treatment. They do this to see how well the treatment has worked, or to look for signs of the cancer coming back. If the same cancer comes back, it's called a recurrence.

A liver ultrasound scan for liver cancer uses sound waves to build up a picture of your liver. Doctors use it to find out the size and location of any tumours. It also shows how healthy the liver is.

A CT scan gives a detailed picture of the inside of your body. The scanner takes a series of x-rays, and these are put together to build up the picture.

An MRI scan uses magnetism to build up a detailed picture of areas of the body.

Doctors may take a small piece of tissue from your liver and look at it under a microscope. This test is called a liver biopsy, and it's used in liver cancer. Not everyone needs one.

Test results help doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.

Knowing the stage will support you and your doctors when you decide on the best treatment for you.

Several systems are used to stage hepatocellular carcinoma (HCC). Doctors often use the Barcelona Clinic Liver Cancer (BCLC) staging system. It includes checking how well your liver is working, using the Child-Pugh classification system.

A team of specialists will meet to discuss the best treatment for you. This is called a multidisciplinary team. Because liver cancer is part of the hepatobiliary system, you'll see specialists in this team who deal with that system.

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 is the most effective treatment for hepatocellular carcinoma (HCC), the most common type of liver cancer. But it isn't always possible, because the cancer may be too advanced or the liver may be too damaged.

Surgery can mean an operation to remove part of the liver (liver resection) or a liver transplant. Both are major operations, so you need to be well enough to cope with them.

Some people have tumour ablation. In this treatment, heat, electrical pulses or sometimes alcohol are applied directly to the cancer cells to destroy the tumour. The main ablation treatments are microwave ablation and radiofrequency ablation.

Ablation may be used to treat small tumours instead of surgery. It can also be used together with other treatments.

Macmillan Cancer Support has more information about tumour ablation for liver cancer.

Targeted therapy drugs find and attack cancer cells. Immunotherapy drugs work differently, because they help your immune system fight the cancer cells.

Doctors may use these drugs for liver cancer if it is advanced in the liver or has spread outside it.

You might be given a combination of the immunotherapy drug atezolizumab and a targeted therapy drug called bevacizumab. Some people may have a targeted therapy drug called sorafenib (Nexavar®) instead, or a drug called lenvatinib.

Some people with liver cancer have a type of high-dose radiotherapy that closely targets the tumours in the liver. It's called stereotactic ablative radiotherapy (SABR), and doctors use it to try to control areas of cancer in the liver.

Radiotherapy can also ease symptoms like pain if the cancer has spread to an area like the bones.

Chemotherapy, given into a vein (intravenous) or taken as a tablet, might sometimes be used for liver cancer after other treatments have already been tried. It can be used to try to control the cancer or to reduce the symptoms.

You may have some treatments as part of a clinical trial.

Macmillan Cancer Support has information on getting organised before cancer treatment.

Some treatments are used to control the symptoms of liver cancer. You may hear this called palliative treatment or supportive care. You may be seen by a doctor or nurse who is an expert in controlling symptoms, and they will support you and your family.

It can take time to recover after treatment for liver cancer. Some days you'll feel better than others.

Looking after yourself can help speed up your recovery. Even small changes to how you live may improve your wellbeing and your health in the long run.

Check with your doctor before you drink any alcohol. Alcohol can damage the liver and make it work less well.

If you had cirrhosis before the liver cancer was found, carrying on with alcohol can make the cirrhosis even worse. You'll usually be advised to stop drinking completely.

Surgery and some other treatments also depend on how well the healthy parts of your liver are working.

Even if alcohol hasn't affected your liver, you might be asked to stop for a time before and after treatment, because your liver may not be able to cope with it.

Even if you already live a healthy life, you may choose to make some positive changes after treatment.