Overview
Although rare, the number of cases of primary liver cancers is increasing. In the West, liver cancer is a disease of middle aged and older people and is more common in men than women. However, the pattern of incidence varies across Europe. In men, the highest incidence is in Southern Europe. In women the highest incidence is in Northern Europe and lowest in Eastern Europe.
In tropical Africa and parts of Asia liver cancer is much more common.
In addition to primary liver cancers, the liver is a common site for metastases from cancers of the bowel, stomach, pancreas, breast, and ovary (amongst others).
The presence of any form of tumour in the liver that interferes with the liver’s essential functions can have severe adverse effects on the rest of the body.
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Key Figures
| Total number of new cancer cases in Europe (2006) |
3.2 million |
| Total number of cancer deaths in Europe (2006) |
1.7 million |
| Number of new primary liver cancer cases (2006) |
50,000 |
|
48,700 (EEA) |
|
38,000 (EU25) |
| Number of liver cancer deaths (2006) |
43,300 (EEA) |
|
42,700 (EU25) |
7 men and 2 women per 100,000 develop liver cancer each year. Overall liver cancer accounts for about 2% of all cancers or 50,000 new cases a year across Europe.
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Cancer Types
- Hepatocellular carcinoma (HCC) spreads to form secondary tumours within the liver and the surrounding lymph nodes.
- Fibrolamellar hepatoma is rare and typically occurs in younger people. It is not linked to cirrhosis of the liver or other liver disease.
- Bile duct cancer (or cholangiocarcinoma) starts in the cells of the bile ducts and is more common in women.
- Childhood liver tumours are very rare but are more common in boys than girls and may be hepatoblastomas in younger children or hepatocellular carcinoma (HCC) in older children.
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Causes of Liver Cancer
There are a number of groups who are particularly at risk of developing liver cancer. These are patients who have:
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Prevention of Liver Cancer
By the time that risk factors for liver cancer become apparent the risk is in practical terms irreversible.
Moderating alcohol intake is a sensible measure for everyone as excess alcohol intake is associated with a wide range of cancers and other diseases. Additionally, it is obviously sensible to take precautions to prevent contracting hepatitis.
Patients who are at risk can be screened on a regular 6 monthly basis using ultrasound examinations which are relatively cheap and non-invasive. Earlier diagnosis of liver cancer results in more effective treatment.
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Common Symptoms
Often there are no symptoms in the early stages.
Symptoms when they do occur include:
- pain or discomfort in the upper part of the abdomen - especially on the right side
- poor appetite
- weight loss
- nausea and sometimes vomiting
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Diagnostic Tests
Ultrasound, CT and MRI (Magnetic Resonance Imaging) scans can all be used to confirm a tumour is present, to differentiate solid from cystic lesions and to determine the tumour’s precise size and location in the liver.
To confirm the type of tumour present, a liver biopsy is required.
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Treatment
Treatment for primary liver cancer depends on the size and type of the cancer.
Surgery
For hepatoma, surgical removal is the best treatment. A healthy liver is able to regrow even after a large part of it has been removed.
If cirrhosis has seriously affected the liver, a liver transplant may be the only surgical option.
Stereotactic radiotherapy
Stereotactic radiotherapy (SRT) is a sophisticated form of radiotherapy where treatment is given from a large number of different angles so that large doses of radiotherapy can be delivered to a precise area of the liver with minimal effect to surrounding normal tissue.
By using imaging equipment any change in the tumour position due to breathing is detected. The machine then compensates by re-targeting the tumour before administering the radiation dose. Continuously checking and correcting ensures accurate radiation targeting throughout treatment.
Chemotherapy
Chemotherapy may also be used in the treatment of primary liver cancer (before or after surgery) or to relieve symptoms caused by a tumour pressing on the rest of the liver.
Chemoembolisation
Chemoembolisation is a type of treatment that combines giving chemotherapy directly to the cancer in the liver with a gel or small particles that block the blood vessels which are feeding the area containing the cancer. The drugs are introduced through a tube (catheter) placed in the artery in the groin and fed up to the blood vessels in the liver.
Biological Therapies – Monoclonal Antibodies
Monoclonal antibodies are used in the treatment of many forms of cancer. They target specific proteins necessary to the progression of the cancer and cause very few side effects. In liver cancer, proteins on the cancer cells can be targeted by monoclonal antibodies. Treatment with monoclonal antibodies can be combined with radiotherapy.
Cholangiocarcinomas can be difficult to treat. Both surgery and radiotherapy can be used to treat this form of cancer. However, the first priority is usually to treat the jaundice by bypassing the blockage to the bile duct.
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Prognosis
Many factors affect prognosis. These include the stage of the liver cancer, the patient’s age, general health and their individual response to treatment (which will vary). For this reason, statistics can only be considered as a general guide as they are produced by grouping together patients in whom these factors are similar but not identical. These figures are historical, often covering a long period, and so do not reflect improvements in survival through more modern treatment.
Survival rates indicate the percentage of people who survive the disease for a specific period of time after their diagnosis – usually five or ten years. They will also include patients who are free of the disease or still undergoing treatment.
Overall, liver cancer in adults has a poor prognosis if diagnosed late. By the time someone has symptoms the cancer is usually in the advanced stages. Only 30% are diagnosed in the early stages (eg. by using an ultrasound scan) when the patient is eligible for surgery and the prognosis is much better.
Globally, 7% of people diagnosed with liver cancer live 5 years, however, this includes patients in countries where it may be difficult to get treatment.
For those who have surgery to remove the cancer:
- 75% live for at least 1 year
- 50% live for at least 3 years
- 30% live for at least 5 years
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Key Trends
Non-surgical treatments are increasingly important in treatment. 10 years ago the only treatment was surgery but now radiotherapy and biological agents are available giving longer life expectancy.
Treatment is now available for primary and secondary liver tumours.
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Important Research Areas
Improving treatments by developing new treatment options and combining existing types of treatment.
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