What is liver cancer?

Liver cancer can be separated into primary and secondary tumours. Primary liver tumours are cancers that start in your liver. Secondary liver tumours (also called liver metastases) are cancerous tumours that start in another part of your body and spread to your liver. 

The most common types of primary liver cancer are hepatocellular carcinoma (HCC), also known as hepatoma, and cholangiocarcinoma (also known as bile duct cancer). 

HCC develops from the main liver cells called hepatocytes. Cholangiocarcinoma is a cancer of the bile ducts, which are the tubes that connect the liver and gallbladder to the small bowel.

Non-cancerous (benign) tumours can also form in the liver.

What are the causes of liver cancer?

Anyone can be diagnosed with primary liver cancer. But the causes of liver cancer are not always clear. 

However, you may be more likely to develop liver cancer if you:

• Are over the age of 60, as it's most common in people aged over 85
• Are a man
• Have a close family member who has had primary liver cancer
• Have certain medical conditions, such as hepatitis, liver cirrhosis, gallstones, diabetes, a parasite in your liver (liver flukes) or HIV

All chronic liver diseases that cause cirrhosis can lead to the most common liver cancer, hepatocellular carcinoma (HCC). 

In particular, the illnesses chronic hepatitis B and hepatitis C, fatty liver disease and haemochromatosis (iron overload) are most commonly linked to the development of this type of cancer. 

Some people with cirrhosis will go on to develop liver cancer, so it’s important you’re screened at least every six months if you have cirrhosis.

Having these regular screening appointments with an ultrasound scan can help to detect HCC early. 

Sometimes, HCC can develop in people that don’t have cirrhosis, and particularly in people with chronic hepatitis B. Regular screening is also important for these people. 

Although rare, it’s also possible to develop HCC if you have no history of liver disease.

What are the signs and symptoms of liver cancer? 

Liver cancer may have no symptoms, or it may be hard to spot. This is why it’s so important that people at risk of liver cancer are regularly screened.

Signs and symptoms of liver cancer to look out for include:

• Pain in the liver area (the right upper part of the belly) 
• Feeling or being sick 
• Unexplained weight loss 
• Your skin or the whites of your eyes turning yellow (jaundice) 
• A swollen belly caused by fluid in your abdomen (ascites) 

How is liver cancer diagnosed? 

If you show signs of liver cancer, you’re likely to have an ultrasound scan first to help diagnose it. This provides images of your liver and helps to show if anything doesn’t look normal, such as an abnormal growth.

You may also have blood tests to check:

• How well your kidneys and liver are working
• Your numbers of blood cells
• The level of alpha-fetoprotein (AFP) in your body, which may be high if there is liver cancer

If these tests show you have liver cancer, you may need more tests to find out how big the cancer is and whether it’s spread to other parts of your body.

These tests are usually an MRI or CT scan. They can provide detailed images of your liver and cancer, which helps your consultant to create the best treatment plan for you.

Rarely, your consultant may decide a sample of tissue (biopsy) needs to be taken from your liver so it can be looked at under a microscope. 

This usually involves a special, thin needle passing through your skin and into your liver. A local anaesthetic is injected into the area over your liver to minimise discomfort.

How is liver cancer treated? 

Liver cancer can be treated in different ways, and your treatment will depend on:

• If your cancer started in your liver (primary) or spread from another part of your body (secondary)
• The type of liver cancer you have and the size of it
• Where the cancer is in your body
• If the liver cancer has spread to other areas
• Your general health 

Your world-class liver specialist at The London will consider all this information with a group of cancer specialists and a multidisciplinary team. 

Your consultant will then explain your treatment options in detail so you can reach the best decision for you and your family. 

Throughout your treatment, you’ll also receive exceptional personal support from clinical nurse specialists specialising in liver cancer and the rest of your care team.

Treatment for HCC: Surgery

If you’re diagnosed with early-stage hepatocellular carcinoma (HCC), you may have surgery to remove a part of or all of your liver. If all your liver is removed, you’ll need a liver transplant. 

A liver transplant may also be an option if your liver is not working very well, or if it’s not possible to perform surgery that only removes part of your liver. If you do require a liver transplant, we’ll refer you to a first-class centre for this type of procedure. 

At this centre, your transplant will be overseen by liver specialists who also work at The London Clinic.

Radiofrequency ablation and transarterial embolisation

If your HCC is at a more advanced stage and surgery is not possible, you may be offered the following treatments to control the cancer and help you live longer: 

Trans-arterial embolisation (TAE/TACE) 

Small particles are injected into the hepatic artery in the liver to block the blood supply to your tumour.

Radiofrequency ablation (RFA) 

An electric current or microwaves are used to destroy your cancer. If you undergo one of these treatments, you’ll usually have to stay at The London Clinic for a short time. 

Chemotherapy

Chemotherapy is usually used to make HCC smaller, or to control and improve symptoms.

Sorafenib is a targeted cancer drug that’s sometimes used to treat people with advanced HCC. Clinical trials are also taking place to find other drugs that are effective at treating and managing liver cancer.

Selective internal radiation therapy (SIRT)

At The London Clinic, our aim is to always offer you the very best and latest treatments. One of the newer treatments for liver cancer is called selective internal radiotherapy (SIRT).

It involves radioactive beads being injected into your bloodstream. These beads stick permanently to small blood vessels in and around your liver. The beads give off radiation to damage nearby cancer cells.

SIRT is mainly used to treat secondary liver tumours, but it may be used to treat primary liver tumours which can’t be removed with surgery.