Liver cancer can be a primary cancer, meaning it starts in the liver, or a secondary cancer, meaning it starts in another part of the body and spreads to the liver. Secondary liver cancers are more common than primary liver cancers. Primary liver cancer is one of the less common cancers in word. Liver cancer usually has no symptoms in the early stages.
Functions of the liver
The liver is the largest organ inside the body. It is located on the right side of the abdomen and protected by the ribcage. The liver will function normally with only a small portion of it in working order.
Its functions include:
- destroying harmful substances, such as alcohol, and getting rid of waste products
- converting food containing fats and sugars to energy that is used by the body
- producing bile to help with the digestion of food.
Primary liver cancers
Primary liver cancer is one of the less common cancers in word, Most primary liver cancers start in liver cells (these are called hepatocellular carcinoma), while others start in a bile duct and are referred to as cholangiocarcinoma.
In Western cultures, most people who develop primary liver cancer also have cirrhosis of the liver. This is scarring of the liver due to causes such as heavy alcohol drinking over a long period of time. However, only a small number of people who have cirrhosis of the liver develop primary liver cancer. Infection with hepatitis B, C or D can also increase the risk of cirrhosis and, later, primary liver cancer.
Secondary liver cancers
Secondary liver cancer is the most common liver cancer. A secondary liver cancer starts somewhere else in the body and spreads (metastasises) to the liver.
Most cancers can spread to the liver. The most common types that do this are breast, stomach and bowel cancers. These liver cancers are named after the primary cancer (for example, breast cancer that has spread to the liver is called metastatic breast cancer). Sometimes, the liver cancer is discovered first, which leads to diagnosis of the primary cancer.
Causes of liver cancer
Liver cancer is often caused by damage to the liver due to:
- cirrhosis – scarring of the liver tissue from alcohol
- long-term infection with a hepatitis virus – hepatitis B, C or D
- some chemicals – (for example, arsenic) that are now rarely used
- smoking – hepatitis B or C infection increases the risk of liver cancer in people who smoke
- diabetes – people with diabetes have a risk of liver cancer that is two or three times higher than people who do not have diabetes.
The causes of secondary liver cancer are very different to those of a primary liver cancer. This is because secondary liver cancers means the cancer began elsewhere in the body (where the primary cancer is). The causes of secondary liver cancer will be the same as for the primary cancer type.
Symptoms of liver cancer
Symptoms often don’t appear in the early stages of liver cancer. There are few nerves through the liver, so someone with this type of cancer does not feel pain. Symptoms are the same for both primary and secondary liver cancer. In later stages, liver cancer can cause an ache in the upper abdomen or back. Rather than feeling pain in the liver, it is felt in the surrounding area due to distension (swelling), irritation or inflammation of the liver.
Other symptoms include loss of appetite, weakness and loss of weight (particularly loss of muscle in the arms and legs),nausea ever and jaundice (yellowing of the skin and whites of the eyes). The abdomen may also be swollen. If you have one of these symptoms, remember that liver cancer is rare, and your symptom is likely to be due to something else. However, see your doctor if you have any symptom that persists for more than two weeks. Do not delay seeing a doctor if you have any signs of jaundice unexplained loss of muscle in your arms and legs.
Diagnosis of liver cancer
Liver cancer is usually diagnosed with a number of different tests, which may include:
- blood tests – to check your general health and check for a chemical usually found in increased levels in people with primary liver cancer
- ultrasound – a picture of the liver is taken using sound waves
- computed tomography (CT) scan – a specialised x-ray taken from many different angles to build a three-dimensional (3-D) picture of the body
- magnetic resonance imaging (MRI) – similar to a CT scan, but uses a powerful magnet and magnetic field instead of x-rays to build an image of the body
- liver biopsy – a small piece of liver tissue is removed with a needle and examined for cancer cells
- laparoscopy – a small cut in the lower abdomen is made and this allows a thin mini-telescope (laparoscope) to be inserted to look at the liver and take a sample of liver tissue.
If the tests show that you have secondary liver cancer, you may need further tests to find out where the primary cancer is located.
Treatment for liver cancer
Treatment for liver cancer will depend on whether it is a primary or secondary cancer. Treatment options may include:
Surgery – to remove the cancer and damaged tissue. This is the main treatment for primary liver cancer. Surgery is only useful for secondary liver cancer if the cancer cells only affect one area of the liver.
Two types of surgery are used to treat HCC:
A Hepatectomy. When a portion of the liver is removed, the surgery is called a hepatectomy. A hepatectomy can be done only if the cancer is in one part of the liver and the liver is working well. The remaining section of liver takes over the functions of the entire liver. The liver may grow back to its normal size within a few weeks. A hepatectomy may not be possible if the patient has advanced cirrhosis, even if the tumor is small. The side effects of a hepatectomy may include pain, weakness, fatigue, and temporary liver failure. The health care team will watch for signs of bleeding, infection, liver failure, or other problems that need immediate treatment.
B Liver transplantation. Sometimes, a liver transplantation can be done. This procedure is possible only when the cancer has not spread outside the liver, a suitable donor is found, and very specific criteria are met in terms of tumor size and number. These criteria usually are a single tumor 5 cm or smaller or 3 or fewer tumors, all of which are smaller than 3 cm. It is important to understand that the number of donor livers available is very limited, so transplantation is not always an option. After a transplant, the patient will be watched closely for signs that the body might be rejecting the new liver or that the tumor has come back. The patient must take medication to prevent rejection. These drugs can cause side effects, such as puffiness in the face, high blood pressure, or increased body hair.
Liver transplantation is a particularly effective treatment for people with a small tumor because transplantation removes the tumor and the damaged liver. However, there are few donors, and people waiting for a liver transplant may have to wait for a long time before a liver becomes available. During this time, the disease may get worse. The transplant centre will advise you on how long the wait is likely to be and what rules are used to prioritize people on the waiting list.
- Tumour ablation – usually uses radio waves or microwaves to heat and destroy cancer cells. It may be used if there are one or two small tumours present and surgery is not an option. It is mainly used for primary liver cancer. It is rarely used for secondary liver cancer.
- Chemotherapy – the use of tablets or injections of anti-cancer drugs. Sometimes, they are introduced into the veins via a drip, or injected directly into the artery that feeds the cancer in the liver. Chemotherapy is the main treatment for secondary liver cancer and it is also sometimes used for primary liver cancer.
- Radiotherapy – x-rays are used to target and kill cancer cells. Radiotherapy may help in treating some types of primary liver cancers, and may be used to relieve symptoms of pain and discomfort from secondary liver cancer.
- Complementary and alternative therapies – when used alongside your conventional cancer treatment, some of these therapies can make you feel better and improve your quality of life.