What is the liver?

The liver is in the upper right part of the abdomen. It has many functions which include:

• Storing glycogen (fuel for the body) which is made from sugars. When required, glycogen is broken down into glucose which is released into the bloodstream.
• Helping to process fats and proteins from digested food.
• Making proteins that are essential for blood to clot (clotting factors).
• Helping to process and/or remove alcohol, many types of medicines, toxins, and poisons from the body.
• Making bile which passes from the liver to the gut down the bile duct. Bile helps to digest fats.

What is cancer?

Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply 'out of control'.

A malignant tumour is a 'lump' or 'growth' of tissue made up from cancer cells which continue to multiply. As they grow, malignant tumours invade into nearby tissues and organs which can cause damage.

Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form 'secondary' tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again.

Some cancers are more serious than others, some are more easily treated than others (particularly if diagnosed at an early stage), some have a better outlook (prognosis) than others.

So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become, and whether it has spread. This will enable you to get reliable information on treatment options and outlook.

See separate leaflet called 'What are Cancer and Tumours' for further details about cancer in general.

What is primary liver cancer?

Cancer of the liver can be divided into primary liver cancer and secondary liver cancer

• Primary liver cancer means that the cancer started (originated) in the liver. In the UK, primary liver cancer is uncommon. However, worldwide, it is one of the most common cancers.
• Secondary (metastatic) liver cancer means that a cancer which started in another part of the body has spread to the liver. Many types of cancer can spread to the liver. Most commonly, cancers of the bowel, pancreas, stomach, lung or breast. The behaviour, treatment and outlook of secondary liver cancers is often quite different to primary liver cancer.

More about primary liver cancer
There are different types of primary liver cancer which include:

• Hepatoma. This is the most common type (about 9 in 10 cases). It is sometimes called hepatocellular carcinoma (HCC). This type of cancer originates from a liver cell (hepatocyte) which becomes cancerous. (The bulk of the liver is made up from hepatocytes). A hepatoma most commonly develops as a complication of liver diseases such as cirrhosis (scarring of the liver) or types of hepatitis (liver inflammation).
• Fibrolamellar hepatoma is a rare sub-type of hepatoma. It typically develops in a liver which was previously healthy.
• Cholangiocarcinoma. This is uncommon. It develops from cells which line the bile duct.
• Hepatoblastoma. This is a very rare cancer which occurs in some young children.
• Angiosarcoma. This is very rare. It develops from cells of blood vessels within the liver.

The rest of this leaflet is only about primary liver cancer. In particular it is about hepatoma, the most common type of primary liver cancer.

What causes primary liver cancer?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply 'out of control'. (See separate leaflet called 'What Causes Cancer' for more details.)

Most people who develop a primary liver cancer have one or more of the following 'risk factors' which seem to make liver cells more prone to becoming cancerous.

• Cirrhosis. This is a condition which causes 'scarring' of the liver. It tends to progress slowly. In the UK, the common causes of cirrhosis are heavy alcohol drinking, and infection with hepatitis C. However, there are various other causes of cirrhosis. Note: most people with cirrhosis do not develop liver cancer - it occurs in only a small number of people with cirrhosis.
• Long-term infection with the hepatitis B or C virus. It typically takes 20-30 years after first becoming infected to develop primary liver cancer. Infection with these viruses is not common in the UK, but it is becoming more common. However, these are common infections worldwide, particularly in Asia and Africa. Many young children in these areas are infected with the hepatitis B virus. This is why primary liver cancer is a common cancer in young adults in these areas of the world (developing 20-30 years after first being infected).
• Ingesting some poisons or toxins. For example, a known risk factor is a poison called aflatoxin which contaminates some foods, mainly in developing countries.
• Some conditions which cause persistent inflammation of the gut increase the risk slightly for developing a cholangiocarcinoma (an uncommon type of primary liver cancer). For example, ulcerative colitis.
• A parasite infection (liver fluke) which mainly occurs in Africa and Asia increases the risk of developing a cholangiocarcinoma.

What are the symptoms of primary liver cancer?

There may be no symptoms in the early stage of the disease. As the cancer grows, the first symptoms to develop may be quite vague and 'non-specific'. For example, feeling generally unwell, feeling sick (nausea), off food, weight loss, and tiredness. Many people who develop primary liver cancer will already have symptoms associated with cirrhosis. If you already have cirrhosis and your health becomes worse quite quickly, the cause may be a liver cancer which has developed.

As the cancer develops further, more specific symptoms which may also develop include:

• Abdominal pain over the liver area.
• Jaundice. Jaundice is when you 'go yellow'. You tend to first notice it when the whites of the eyes become yellow. It is due to a build up of the chemical bilirubin which is made in the liver. This occurs if the bile duct becomes blocked by the cancer. Bile and bilirubin cannot drain out from the liver and so leak into the bloodstream.
• Itch (caused by the jaundice).
• Swelling of the abdomen. This can be due to
  • the growing cancer itself, and/or 
  • ascites. This is fluid that builds up in the abdomen. Ascites is a symptom of various liver disorders including liver cancer.

How is cancer of the liver diagnosed and assessed?

Initial assessment
If a doctor suspects that you may have liver cancer, you are likely to have a number of tests. These aim to:

• Confirm that you have a cancer in the liver. Also, that the cancer is a primary liver cancer and not a secondary liver cancer.
• Assess the stage of the cancer. That is, how much of the liver is affected and whether the cancer has spread to other parts of the body. 医学全在.线提供
• Assess the state of your liver function and your general health.

Therefore, a range of tests are usually needed. They may include:

• Scans such as ultrasound scan, CT scan or MRI scan. These can help to show the exact location and extent of the cancer.
• A liver biopsy. This is usually done to confirm the type of cancer. A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells.
• Blood tests help to assess the liver function and your general health.
• Other tests may be done if the above do not clarify the situation. For example, a laparoscopy is sometimes done. This is a small operation to 'look inside' the abdomen with a flexible telescope.

There are separate leaflets which describe each of these tests in more detail.

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