Liver Cancer

Liver cancer begins when liver cells begin to multiply at a rapid rate. It can occur anywhere in the liver, and start within the liver itself (primary), or spread from another organ (secondary). Severity depends on the size and location of the cancer within the liver, if it has spread to other parts of the body, your level of health, and if it is primary or secondary cancer.

What is Liver Cancer?

Liver cancer is a cancer of the liver. It is categorized as primary or secondary cancer, dependent on if the cancer first occurred in the liver or initially developed elsewhere and spread to the liver. Cancer which began in the liver itself is called primary liver cancer. Cancer which developed elsewhere and spread to the liver is referred to as secondary liver cancer. This may also be referred to as metastatic liver cancer, and is more common than primary liver cancer types.

Types of Liver Cancer

Primary Liver Cancer

There are four types of primary liver cancer:

Hepatoma or Hepatocellular Carcinoma

Hepatoma is also known as hepatocellular carcinoma or HCC which begins in the hepatocyte cells of the liver. 75-90% of all cases of primary liver cancer are HCC. This type of cancer is especially common in people with cirrhosis of the liver. It is more common in men than women and risk can increase with age.

Fibrolamellar Carcinoma

Fibrolamellar carcinoma is a rare form of HCC which develops in younger people, often aged between 20-30, and is not linked to conditions such as hepatitis or cirrhosis.

Biliary Tree Cancer

Biliary tree cancer types include cholangiocarcinoma which is cancer of the bile ducts, and gall bladder cancer.

Cholangiocarcinoma is a rare form of cancer which is split into three groups, depending on where they first develop.

Intrahepatic region – within the liver, right and left hepatic ducts, and their branches.

Perihilar region – Outside the liver where the hepatic ducts meet.

Distal region – Bile ducts located through the pancreas to the small bowel.

Extrahepatic bile duct cancers are those which begin in the bile ducts outside of the liver itself.

Angiosarcoma or Haemangiosarcoma

Liver angiosarcoma is an extremely rare form of soft tissue cancer which mainly affects men over the age of 70. It accounts for less than 0.5% of liver diagnoses each year.

Secondary Liver Cancer

Secondary liver cancer, or metastatic liver cancer, is a cancer that began elsewhere in the body then spreads to the liver. It is made of the same cells as the primary cancer. For example, if the primary cancer began in the bowel, the cancerous area of the liver will be made up of bowel cells.

Causes of Liver Cancer

The exact cause of primary liver cancer is unknown. Factors which may contribute to an increased likelihood of developing primary liver cancer include:

Age – Primary liver cancer is most common in people over 85.

Gender – Men are more likely to be diagnosed with liver cancer than women.

Pre-existing medical conditions – People with cirrhosis of the liver, diabetes, gallstones, hepatitis and other related illnesses are more likely to develop liver cancer.

Family History – If a close relative has developed liver cancer you may be at a higher risk of developing it yourself.

Secondary liver cancer spreads to the liver from elsewhere in the body.

A combination of poor lifestyle and pre-existing conditions are likely to put individuals at the highest risk. Depending on your general health, age and other factors can influence the severity of liver cancer.

Signs and Symptoms of Liver Cancer

The liver is an exceptional organ, and you may not experience symptoms for some time. When symptoms do appear. they can present in the same way as other liver conditions such as cirrhosis.

Symptoms may include:

• Flu-like symptoms
• Jaundice – yellowing of the skin and eyes
• Unexplained weight loss
• Fatigue and lethargy
• Dark urine
• Symptoms of indigestion
• Pain in the right side of the tummy and shoulder

While many of these symptoms may seem quite generic, if you or a loved one are experiencing any suspected symptoms of liver cancer, it’s important to seek medical advice early on to ensure a correct diagnosis can be made and it can be treated at an early stage.

Diagnosis and Tests for Liver Cancer

If you think you or a friend or family member are experiencing the symptoms of liver cancer, the first step is to book an appointment with your doctor. They will discuss your symptoms with you and ask questions about your family history and lifestyle. They may carry out a blood test to look for abnormalities in liver function, and recommend imaging tests such as a CT scan, MRI scan, or ultrasound. If liver cancer is suspected, a liver biopsy may be taken in some cases, and the sample sent to a pathologist for confirmation of your condition.

Liver Cancer Staging and Grading

There are a number of staging systems for liver cancer, which help determine the size and spread of the cancer. This defines what treatment options are available to you. In many cases, people with liver cancer are too ill or the cancer is too advanced for surgery, however a number of treatments are available to help prolong life and maintain quality of life.

Doctors use a system called TNM to stage primary liver cancer. This stands for Tumour, Node, and Metastasis.

Tumour or T, describes the size of the tumour. There are four stages within the T stage:

T1 - T1 tumours are subdivided into T1a and T1b.

T1a – There is a single cancer is within the liver which measures 2cm or less. It may have grown into the blood vessels of the liver.

T1b – There is a single cancer is within the liver which measures 2cm or less. It has not grown into the blood vessels of the liver.

T2 – There is a single tumour larger than 2cm which has grown into the blood vessels, or there are several tumours all of which are smaller than 5cm.

T3 – There are several tumours in the liver, at least one of which measures over 5cm.

T4 – The cancer has grown into a major branch of one of the blood vessels, into organs near the liver, or through the lining around the abdominal internal organs.

Node or N, describes whether the cancer has spread into lymph nodes.

N0 – Cancer has not spread to lymph nodes.

N1 – Cancer has spread to lymph nodes.

M, or Metastases, describes whether the cancer has spread to other parts of the body.

M0 – Cancer has not spread to other parts of the body.

M1 – Cancer has spread to other parts of the body.

Stages of Liver Cancer

Doctors will also often use stages to describe liver cancer.

Stage 1- Stage 1 is divided into stages 1a and 1b.

1a – There is a single tumour of 2cm or less which may have grown into blood vessels.

1b - There is a single tumour of more than 2cm or less which has not grown into blood vessels.

Stage 2 – There is a single tumour which is more than 2cm and it has grown into the blood vessels of the liver.

Stage 3- Stage 3 is divided into stages 3a and 3b.

3a – There is more than one tumour. At least one of them measures more than 5cm. It has not spread to other parts of the body. 3b – The cancer has grown into a major branch of one of the blood vessels, into organs near the liver, or through the lining around the abdominal internal organs.

Support and Advice for Living with Liver Cancer

Receiving a liver cancer diagnosis can come as quite a shock, and may leave you feeling upset, and distressed. It is important to get the right information about the type of liver cancer that has been diagnosed, and look into all treatment options available to you. It can be overwhelming with a lot of information to process so it’s important that you take the time to assess your options in order to make an informed decision.

A wide range of support is available to you and your loved ones, to help you cope with your diagnosis and ensure you get the best treatment for you.

Treating Liver Cancer    

There are a number of treatment options for liver cancer and the treatment or combination of treatment you receive will depend on the stage of development, and a number of other factors such as your general health. It is important that you should be in control of your treatment and have access to all available options.

A team of doctors and specialists will discuss the best treatment for you, but the most common options are:

Surgery – including transplant and re-sectioning

Radiotherapy

Chemotherapy

Ablation – the use of heat to treat the tumour Targeted cancer drugs

Second Opinions for Liver Cancer  

It’s widely encouraged for patients to get a second opinion about their diagnosis and/or treatment options for any form of cancer.  You may seek confirmation or your diagnosis and want a deeper understanding of the stage of your liver cancer. Whatever the reason, Oncolomed can help facilitate second opinions with liver cancer specialists from leading hospitals globally. Find out more about obtaining a second opinion for liver cancer.

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