Liver cancer

Question 1

What is liver cancer?

Accepted Answer

Liver cancer is a cancer in the cells of the liver. It is the seventh leading cause of cancer deaths in Australia. The number of Australians with liver cancer is going up.  Your liver is the largest organ in your body. It sits under your ribs, on the right side of the abdomen. It has many important functions, including:  making and storing sugars and fat to be used for energy making bile to help digest your food making important proteins for use in the body breaking down harmful chemicals Liver cancer can be 'primary', which means the cancer started in the liver or 'secondary' (metastatic), which means the cancer has spread into the liver from another part of the body. Secondary liver cancer is more common than primary liver cancer in Australia.  Primary liver cancer Most people with primary liver cancer have hepatocellular carcinoma (HCC). This begins in the main type of liver cell, known as a hepatocyte.  Other types of primary liver cancer include:  cholangiocarcinoma — or bile duct cancer, which starts in the cells lining the bile ducts angiosarcoma — a rare liver cancer that starts in the blood vessels hepatoblastoma – a rare liver cancer that occurs in young children If primary liver cancer is not treated early or treatment is unsuccessful, it can spread (metastasise) to other parts of your body.  Secondary cancer in the liver Most cancers that affect the liver have spread from other parts of the body. These are known as secondary cancers (metastases). These secondary cancers are named after the part of the body in which they started. Colon, breast, ovarian, kidney, oesophageal, stomach and lung cancers, as well as melanomas, are all cancers that can spread to the liver.  Read the Cancer Council fact sheet about secondary liver cancer.

Question 2

What are the symptoms of liver cancer?

Accepted Answer

You may not have symptoms in the early stages of liver cancer.  If you do have symptoms, you may feel generally unwell and notice symptoms such as:  feeling weak and tired unexplained weight loss loss of appetite nausea and vomiting Symptoms may also be more specific to the function and location of the liver:  pain or swelling in your upper right abdomen pain below your right shoulder blade swelling of your abdomen due to fluid buildup (ascites) yellowing your skin and eyes (jaundice) dark urine pale, chalky bowel motions

Question 3

What causes liver cancer?

Accepted Answer

Doctors do not always know what causes primary liver cancer. The risk of getting primary liver cancer is increased if you already have scarring and liver damage called cirrhosis.  Cirrhosis of the liver can be caused by drinking excessive amounts of alcohol. Some types of liver disease also cause cirrhosis:  long-term hepatitis B or hepatitis C infection metabolic-associated fatty liver disease (MAFLD) haemochromatosis (having very high iron levels in the blood) People living with obesity or type 2 diabetes are more likely to develop MAFLD.  Some people develop liver cancer without first having cirrhosis. This can happen if you have a long-term hepatitis B infection or MAFLD.  If you regularly drink a lot of alcohol and also have diabetes or hepatitis, you are more likely to get HCC.  Other risk factors for primary liver cancer are:  smoking having a family history of hepatocellular carcinoma (HCC) being male being older than 60 years being Aboriginal and/or Torres Strait Islander

Question 4

How is liver cancer diagnosed?

Accepted Answer

Your doctor will start by examining you and asking about your symptoms.  If your doctor thinks you may have liver cancer, they will refer you for tests including:  blood tests imaging (such as magnetic resonance imaging (MRI) or computerised tomography (CT) scans, or a PET-CT scan) You may have a biopsy to remove a sample of liver tissue for testing. This is done using a thin needle under local anaesthetic.  If you have secondary liver cancer, you may have other tests to find out where the primary cancer is, if this isn't clear. This could involve blood tests, endoscopy and urine tests.  If liver cancer is confirmed, you are likely to be referred to a specialist doctor or a team of specialists which may include a gastroenterologist, surgeon or oncologist (cancer specialist).

Question 5

How is liver cancer treated?

Accepted Answer

A team of medical specialists, nurses and other health professionals will be involved in your liver cancer treatment.  The type of treatment your doctor recommends will depend on:  the stage of your cancer your general health your medical history your age your personal preferences Often different therapies are used together. For HCC, your doctor may recommend treating your cancer with surgery or ablation (using heat or extreme cold to damage cells).  Your doctors may also recommend chemotherapy or radiotherapy to shrink the cancer, or destroy any cancer cells left after surgery.  Ask your doctor questions so that you understand your options. It is your choice to have treatment.  Surgery The aim of surgery is to remove the part of your liver that is affected by the cancer. Surgery is most suitable if your liver cancer has clear edges and your liver is otherwise working well.  Your doctor is more likely to recommend surgery if you don't have cirrhosis and the tumour hasn't spread to blood vessels. The type of surgery will depend on the size and location of the liver cancer.  Surgery to remove part of the liver is called partial hepatectomy or segmentectomy, depending on what part and how much is removed.  The liver can still work well even if most of it has been surgically removed. If your liver is working well before the surgery, your liver can recover and grow again after surgery. You will need to prepare for surgery and give informed consent.  Liver transplant If you only have one tumour or a few small tumours in the liver, you may be able to get a liver transplant. You must also meet other criteria to receive a liver transplant. It can take months or years for a suitable donor liver to become available. You will usually need to have other treatment such as tumour ablation or 'transarterial chemoembolisation' (TACE) while you wait.  Tumour ablation During tumour ablation, a specialist doctor will insert thin needles into the tumour and apply different methods to destroy cancer cells. In most cases, imaging (such as CT scans) is used to help your doctor place the needles in the right place.  Your doctor can apply a range of methods to ablate (destroy) a liver cancer, including:  high frequency radio waves and/or microwaves (radiofrequency) — more commonly used for small primary tumours pure alcohol heat liquid nitrogen (cryotherapy) Radiation therapy There are 2 types of radiation therapy (also known as radiotherapy) that can be used to treat liver cancer. This is usually done if surgery is not possible, or to shrink the tumour before surgery or while you wait for a liver transplant.  Selective internal radiation therapy (SIRT or radioembolisation) involves a specialist doctor inserting a thin tube into an artery, through which they release tiny radioactive beads (microspheres) into the liver. These beads block the blood supply to the tumour and deliver high-dose radiation.  Stereotactic body radiation therapy (SBRT) uses a machine to target beams of radiation to the tumour from outside.  Chemotherapy and TACE Chemotherapy uses medicines to destroy, shrink or slow the growth of cancer. If your liver cancer has spread or you have secondary cancer, your doctors may prescribe chemotherapy, which you will take through a vein (intravenous or IV) to treat your whole body.  If you have primary liver cancer, you may be offered 'transarterial chemoembolisation' (TACE), which is a more targeted form of chemotherapy. Your doctor inserts a tube into an artery supplying the liver to deliver a high dose of anti-tumour medicines. A substance is also used to partly block the artery, starving the cancer cells of their blood supply.  If you have secondary liver cancer which spread from your breast or prostate, you may have chemotherapy combined with hormone therapy.  Immunotherapy and targeted therapy Immunotherapy and targeted therapy are medicines that stop cancer cells growing or spreading, or help the body's own immune system to destroy them. These medicines can be used for both primary and secondary liver cancers. They must be prescribed by a specialist oncologist.  Palliative care Palliative care aims to help reduce your symptoms, relieve pain, control the spread of the cancer and improve your quality of life. If you have advanced or late-stage liver cancer, you may choose to have palliative care.  Radiotherapy, pain management, draining of fluid in your abdomen (ascites) can all be part of palliative care. If there is a build-up of bile in the liver, because the cancer is blocking a bile duct, a thin tube (stent) placed in the liver can help relieve the blockage and drain the bile.

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Need more information?

Liver cancer | Causes, Symptoms & Treatments | Cancer Council

Liver cancer | Cancer Australia

Liver cancer | Garvan Institute of Medical Research

Liver Cancer - Liver Foundation

Liver cancer | Cancer Institute NSW

Liver Cancer - Check Symptoms, Risk Factors & Health Professionals to See