Liver Cancer can be a primary cancer (starts in the liver) or a secondary cancer (starts in another part of the body and spreads to the liver).
Primary liver Cancers
- The most common type of liver cancer starts in the main cells of the liver and this is called hepato-cellular cancer (HCC). Most people who develop hepato-cellular cancer also have cirrhosis of the liver and this can be due to a variety of causes, most commonly hepatitis or heavy alcohol drinking. However, only a small proportion of people who have cirrhosis develop HCC.
- Cholangiocarcinoma begins in the cells that line the bile duct. This type of cancer can involve the bile ducts outside of the liver but occasionally will be localised to the liver. In western countries, this type of cancer although still relatively uncommon is becoming more frequent.
Secondary liver Cancers
- Secondary liver cancer is the most common liver cancer in the western world. A secondary liver cancer is a cancer that starts somewhere else in the body and spreads (metastasises) to the liver. Most cancers can spread to the liver but the most common one is colorectal cancer. This can often be treated with a combination of chemotherapy and surgery. Sometimes the liver cancer is discovered first, which leads to the diagnosis of the primary cancer.
Liver cancer usually has no symptoms in the early stages. Symptoms can include:
- Pain in the upper right side of the abdomen
- Yellowing of the skin and eyes (jaundice)
- Weight loss
- Loss of appetite
- Swelling of the abdomen
Liver cancer is usually diagnosed with a number of different tests, which may include:
- Blood tests – to check your general health, liver function and to assess specific tumour markers.
- Ultrasound - a picture of the liver is taken using sound waves
- CT scan – a specialised x-ray taken from many different angles to build a three-dimensional picture of the body
- Magnetic resonance imaging (MRI) – similar to a CT scan but uses magnetism instead of x-rays to build a picture 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 allows a thin mini-telescope (laparoscope) to be inserted to look at the liver and take a sample of the liver tissue. If the tests show you have secondary liver cancer (and you did not know that you had a primary cancer), you may need further tests to find out where the primary cancer is located
Treatment for liver cancer will depend on whether it is a primary or secondary cancer. Treatment is usually provided by a team of health professionals, which may include surgeons, medical oncologists, radiotherapists, gastroenterologists and a range of allied health personnel (multidisciplinary team). Treatment options may include:
- Surgery - to remove the cancer. This may be indicated for primary and secondary liver metastases from colorectal cancer depending on the site and the extent of the cancer
- Chemotherapy - either tablets or injections of anti-cancer drugs. Sometimes they are injected directly into the artery that feeds the tumour in the liver
- Radiofrequency ablation (RFA) - this is where the tumour has a probe placed into it either at surgery or by the radiologists to microwave and destroy the tumour
- Radiological procedures - there are other procedures performed by the radiologists to selectively inject chemotherapy attached to beads and spheres directly into the tumour