Introduction
Cancers that develop from liver cells (primary liver cancers) are quite rare. However, the number of people developing these cancers is increasing in Europe. In some non-European countries, particularly in tropical Africa and parts of Asia, liver cancer is much more common.
In the Western world, liver cancer tends to be a disease of middle aged and older people and is more common in men than women. In Africa and Asia, liver cell cancer is also often a disease of younger people.
Seven men in every 100,000 develop the disease each year. The equivalent figure in women is just two per 100,000. Overall liver cancer accounts for about 2% of all cancers or 50,000 new cases a year across Europe.
The incidence of liver cancer varies across Europe. In men, the highest incidence is in Southern Europe, but in women the highest incidence is in Northern Europe and the lowest in Eastern Europe.
In addition to the cancer that develops from liver cells, cancers from other parts of the body frequently spread to the liver, forming secondary cancers or metastases. The most common cancers to spread to the liver are bowel, stomach, pancreas, breast, and ovarian cancers.
The presence of any form of cancer pressing on the normal parts of the liver and interfering with its essential functions can have severe adverse effects on the rest of the body.
Back to top
The Liver
At between 1.4 and 1.6 kilograms, the adult human liver is the largest internal organ in the body. The liver is surrounded by a fibrous capsule and is divided into sections called lobes. Protected by the lower ribs, it is located on the right side of the upper abdomen below the diaphragm, lying to the right of the stomach and above the gall bladder.
The liver is connected to the gall bladder and the duodenum (the first part of small bowel) by the bile duct. This duct takes the bile produced by the liver to the intestine.
The liver has a number of essential functions:
- production of blood clotting agents
- breaking down food containing carbohydrates (sugars) and fats
- producing bile, which breaks down the fatty foods in the gut so that they can be absorbed
- removing harmful substances such as alcohol
- breaking down old blood cells and substances no longer used by the body so that they can be excreted via the kidneys or bowels
- storing glucose and vitamins so that they can be used when needed
- energy production
Back to top
Liver Cancer
All cancers are uncontrolled growths of cells. When this occurs in the cells of the liver, it produces a type of cancer known as an adenocarcinoma.
There are two types of primary liver cancer. The first, HepatoCellular Carcinoma (HCC), a type of hepatoma, develops from liver cells (hepatocytes). HCC is more common in men and occurs mostly in people with cirrhosis of the liver. Although HCC does spread to form secondary tumours this is usually within the liver and the surrounding lymph nodes. It is rare for HCC to spread to more distant areas of the body.
A rarer type of liver cell cancer called fibrolamellar hepatoma typically occurs in younger people, and is not linked to cirrhosis of the liver or other liver disease.
The second, bile duct cancer (or cholangiocarcinoma), starts in the cells of the bile ducts, and is more common in women.
Back to top
Liver Cancer Risk Factors
There are a number of known risk factors - things which make you more likely to develop liver cancer:
- cirrhosis of the liver, which is usually caused by heavy alcohol consumption over a long period of time (only a minority of cirrhosis sufferers go on to develop primary liver cell cancer)
- liver infection with hepatitis B or C viruses
Liver cell cancers are also more common in patients suffering from two rare inherited conditions:
Back to top
Preventing Liver Cancer
There is no way to be certain of preventing liver cancer but moderating alcohol intake reduces the chances of developing cirrhosis of the liver and, by extension, liver cancer.
Avoiding or reducing obesity through a healthy balanced diet is generally advisable and will have a small statistical impact on the chances of developing liver cancer.
Back to top
Symptoms of Liver Cancer
There are often no symptoms in the early stages of primary or secondary liver cancer.
However, if symptoms do occur, they may include:
- pain or discomfort in the upper part of the abdomen, especially on the right side
- poor appetite
- weight loss
- nausea and sometimes vomiting
These symptoms may be due to a variety of conditions of which only one is cancer of the liver. However, anyone with these symptoms should seek medical advice.
Back to top
Screening for Liver Cancer
Patients at particular risk – patients who have had hepatitis B and C – can be screened on a regular (6 monthly) basis using ultrasound examinations.
Back to top
Diagnosing Liver Cancer
Ultrasound, CT and MRI (Magnetic Resonance Imaging) scans can all be used to show whether a tumour is present. MRI scans are also very helpful in staging liver cancer.
To discover what type of tumour is present, a biopsy is required. A needle is passed into the tumour through the skin, and guided to exactly the right spot using scanning equipment. A sample of tumour cells is taken for examination under a microscope.
Back to top
Treating Liver Cancer
Treatment for primary liver cancer depends on a number of factors including 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. But if cirrhosis has seriously affected the liver, its ability to regrow will be badly affected and so a liver transplant may be considered.
Stereotactic radiotherapy
This equipment consists of a linear accelerator (Linac), which generates the radiotherapy beam, a robot, capable of positioning the linear accelerator so that it can provide treatment from different angles, and imaging equipment that means any change in the tumour position is detected. The robot then compensates by re-targeting the linear accelerator before administering the radiation beam. 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 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, causing 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, but the first priority is usually treating the jaundice by bypassing the blockage to the bile duct.
Back to top
Looking after Yourself
Treatment for liver cancer, like all others, causes some side effects. Many of these can usually be treated effectively, so if you experience problems it is important to mention them to your doctor or nurse, so they can give you the treatment you need.
Radiotherapy to the liver can cause a feeling of sickness, vomiting and diarrhoea. These are common problems especially in patients treated with surgery. A number of medications will help these symptoms. Taking plenty of fluids is also important.
Radiotherapy can also cause tiredness, which tends to increase during treatment but gradually gets better over the weeks following treatment.
Whatever the problem, do not assume that nothing can be done about it – ask your doctor or nurse: do not just grin and bear it.
Back to top
Questions for your Doctor
Before making up your mind about the best treatment option for you, you will need information about your cancer, the treatments available in your area and what they will entail, what to expect from the treatment, what side effects you might experience and how these may change over time as well as what your doctors believe would be most effective in combating your cancer.
For different patients the answers will be different, so it is important to discuss all these issues with your doctor so that you are able to make the right choice for you.
You will have your own questions but some issues you might want to raise are:
- What does the treatment involve?
- What are the benefits I might get?
- How good are my chances of getting those benefits?
- Could having treatment make me feel worse? If so in what way?
- Are there alternative treatments?
- What are the risks of the treatment?
- Are the risks minor or serious? How likely are they to happen?
- What care will I need after treatment?
- What happens if something goes wrong?
- What may happen if I don’t have the treatment?
Back to top
Conclusion
Cancers that start in the liver are rare. People at risk benefit from regular screening and as for all cancer, early diagnosis results in more effective treatments. There is no one solution to the management of liver cancer, but for clinical and personal reasons particular treatments will suit some patients better than others. Patients, therefore, need comprehensive information so that they are able to make the right decision for them.
Back to top