Liver Cancer

Lesions in the liver can be benign or malignant. Benign lesions are often an incidental finding and rarely cause any clinical concern. However some may require monitoring and rarely surgery is required to remove them. Benign tumours of the liver explained in more detail

Malignant tumours, in the liver can be separated into primary and secondary cancers. Primary liver tumours are cancers that originate from within the liver, whereas secondary cancers, referred to as metastases, are tumours that originate from a cancer elsewhere in the body that then spread to the liver. Secondary (metastatic) liver cancers are usually looked after by oncologists (cancer specialists) and are not dealt with further in this section.

The two common primary cancers that can develop in the liver are hepatocellular carcinoma (HCC), also known as hepatoma, and cholangiocarcinoma. HCC is a cancer arising from liver cells and cholangiocarcinoma is a cancer arising from cells of the bile duct.

Hepatocellular Carcinoma (HCC)

Who is at risk of developing HCC?

HCC usually occurs in the context of chronic liver disease, most often in patients that already have cirrhosis. All chronic liver diseases that cause cirrhosis can lead to HCC, though certain ones like chronic hepatitis B and C, fatty liver disease, and haemochromatosis (iron overload) are more commonly associated. Only a minority of patients with cirrhosis will go on to develop liver cancer, however it is important that patients with cirrhosis are screened for HCC with a liver scan at least every six months so that cancers can be detectable at early treatable stages. Sometimes, HCC can develop in patients that do not have cirrhosis, particularly in patients with chronic hepatitis B. Regular screening is thus also important in these patients. Rarely, HCC occurs in patients with no history of liver disease at all.

What are the symptoms of HCC?

Frequently, HCC causes no symptoms whatsoever. As tumours grow or spread, or in the case of multiple liver cancers, patients may complain of pain in the liver area (right upper part of the abdomen) or experience nausea, vomiting and unexplained weight loss. Patients may also develop symptoms of worsening liver function such as jaundice, fluid in the abdomen (ascites) or internal bleeding.

It is well understood that individuals can have no symptoms even though the tumour has been there for many months. For this reason, it is vital that patients at risk of HCC undergo regular screening with an ultrasound scan of the liver.

How is HCC diagnosed?

The detection of a new lesion (focal area of abnormality) in the liver on an ultrasound, or an elevated blood test called alpha-fetoprotein (AFP), is usually the first suggestion that a patient may have an HCC. Your doctor will then complete a series of investigations that will provide information about the location, size and amount of tumour within the liver. This is known as staging. These tests will also establish how well your liver is functioning.

Either MRI or CT scanning augmented with an intravenous injection of a contrast agent will provide sufficient information to complete staging. Rarely your doctor may need to do a biopsy: this is usually performed if there is uncertainty regarding the diagnosis. This is performed by a radiologist under direct vision using scanning. You will receive a small amount of local anaesthetic to the area and a needle will be passed through the skin to obtain the tissue sample of the liver. There is usually some mild discomfort following the procedure that resolves quickly.

What are my treatment options?

Treatment options will be carefully weighed up by your liver specialist and are usually also considered by a group of cancer specialists at the London Clinic, called a multi-disciplinary team (MDT). The options will be explained to you in detail so that you can reach the most suitable and informed decision. Clinical nurse specialists in liver cancer are available to help advise and guide you through your treatment.

If an HCC is identified at an early stage then surgical removal of that part of the liver is sometimes possible with the intention of curing the cancer. If liver function is poor and a resection not possible, then occasionally liver transplantation is an option. You would be referred to another centre for this, and some of the liver specialists at the London Clinic also work in these units.

At more advanced stages, treatments are aimed at controlling the disease and prolonging life expectancy. These often involve treatments performed by interventional radiologist (X-ray specialists) to specifically block off the blood supply to the tumours (transarterial embolisation, TAE/TACE) or destroy the tumour tissue (radiofrequency ablation, RFA). This usually involves a short admission to hospital. Newer, advanced therapies are also available at the London Clinic. One of these is called selective internal radiotherapy or SIRT.

Chemotherapy has limited benefit in patients with HCC. Sorafenib is a drug that is sometimes used in advanced stage disease to increase survival and other drugs are in advanced stages of clinical trials.