Liver cancer is a type of cancer that develops in the largest organ in the body – the liver. The liver sits under the ribs on the upper right side of the abdomen, and is a component of the digestive system.
The liver has many important functions, such as filtering toxins and alcohol, producing bile to dissolve fat, aiding digestion, storing and releasing sugars and nutrients, protein production to help blood clot and regulating fluid balance in the body. It is the only organ in the body that is able to repair itself if it becomes injured or partially removed.
Liver cancer is more common in males, and is generally diagnosed after the age of 60. However, anyone can develop this disease.
Types of Liver Cancer
Liver cancers are often divided into primary (originating in the liver) or secondary (originating in another area and metastasising to the liver) liver cancers. Secondary liver cancers often have different treatments than primary liver cancers, as they have originated in a different part of the body. This page will mainly focus on primary liver cancers.
Liver cancers may also be classified by the age groups they affect.
Adult liver cancers
There are three primary liver cancers that affect adults: hepatocellular carcinoma, cholangiocarcinoma (bile duct cancer) and angiosarcoma.
Hepatocellular Carcinoma (HCC)
Hepatocellular carcinomas (HCCs) are the most common type of primary liver cancer in adults. HCCs develop from hepatocytes, which are the main cells found in the liver. This type of cancer usually occurs in people with pre-existing liver conditions, and is often aggressive.
Cholangiocarcinoma
Cholangiocarcinoma is a type of cancer that starts in the bile ducts, which are the tubes that that carry bile from the liver to the small intestine.
Angiosarcoma
Angiosarcoma is a rare cancer that develops in the inner lining of blood vessels and lymph vessels. It most commonly occurs in the skin, breast, liver, spleen, and deep tissue.
Childhood liver cancers
There are five types of liver cancer that affects children: hepatoblastoma, hepatocellular carcinomas (HCCs), undifferentiated embryonal sarcoma of the liver, infantile choriocarcinoma of the liver and vascular liver tumours.
Hepatoblastoma
Hepatoblastoma is the most common form of liver cancer in children, and is generally diagnosed before the age of three. There are three common subtypes, well-differentiated fetal, small cell undifferentiated and non-well-differentiated fetal, which are classified by their cellular appearance under the microscope. It is often low-grade rarely metastasises.
Hepatocellular Carcinoma (HCC)
HCC generally affects older children and adolescents. Much like HCC in adults, HCC in children develops from hepatocytes, and is usually found in people with pre-existing liver conditions. Unfortunately, this type of cancer is also aggressive in children.
Undifferentiated embryonal sarcoma of the liver
Undifferentiated embryonal sarcoma of the liver is a rare form of liver cancer that forms from connective tissues. It generally affects children between the ages of five and ten. This subtype is often aggressive and may have high metastasis rates.
Infantile Choriocarcinoma of the liver
Infantile Choriocarcinoma of the liver is a rare and aggressive tumour that generally affects newborns and fetuses. This is a secondary type of liver cancer, as it starts in the placenta and spreads to the liver.
Vascular tumours
Vascular tumours form from liver cells that make up blood vessels and lymph vessels. As it is so rare, there has been limited research into this disease.
Treatment
If liver cancer is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health. In adult patients, your tumour will be staged and graded to help determine the best treatment option for you.
The treatment options for adults and children may include:
- Surgery, potentially including:
- Hepatectomy (removal of part or all of the liver).
- Liver transplant (in extreme cases).
- Tumour ablation, potentially including:
- Thermal ablation.
- Alcohol injection.
- Cryotherapy.
- Radiation therapy, potentially including:
- Selective internal radiation therapy (SIRT).
- Stereotactic body radiation therapy (SBRT).
- Transarterial chemoembolisation (TACE).
- Targeted therapy.
- Clinical trials.
- Palliative care.
For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.
Risk factors
The risk factors for liver cancers include:
- Heavy alcohol consumption.
- Being exposed to alcohol as a fetus (having a mother who drank while pregnant).
- Liver conditions, such as:
- Cirrhosis.
- Hepatitis B or C.
- Type 2 diabetes.
- Non-alcoholic fatty liver disease.
- Glycogen storage disease.
- Obesity.
- Tobacco use.
- Being over 60 years old.
- Having a family history of liver cancer.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Early symptoms
Early-stage liver cancers may appear asymptomatic. As the tumour progresses, some of the following symptoms may appear:
- Abdominal pain, discomfort and/or swelling.
- Pain in the right shoulder/upper back.
- Fatigue.
- Unexplained weight loss/loss of appetite.
- Nausea and vomiting.
- Fatigue.
- Jaundice (yellowing of the skin and whites of the eyes).
- Dark urine.
- Pale or clay coloured stool.
- Itchy skin.
- Fever.
- A hard and potentially painful lump on the upper right side of the abdomen.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have liver cancer, they will order a variety of tests to confirm the diagnosis and refer you to a specialist for treatment.
Physical examination
Your doctor will collect your overall medical history, as well as your current symptoms. Following this, they may examine your body to check for any abnormalities.
Blood tests
Blood tests are used to assess overall health and detect any abnormalities. Some of these tests may include:
- General blood test to assess overall health.
- Full blood count, which measure the levels of red blood cells, white blood cells and platelets.
- Liver function test.
- Blood chemistry and/or blood hormone studies, which analyse the levels of certain hormones and other substances in the blood.
- Serum tumour marker test.
- Hepatitis assay.
Imaging tests
The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), ultrasound, x-ray and/or positron emission tomography (PET scan), depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and look for signs of metastasis.
Biopsy
Once the location(s) of the cancer has been identified, the doctor will perform a biopsy to remove a section of tissue using a needle. The tissue sample will then be analysed for cancer cells. This can be done by a fine needle aspiration (FNA) or a core needle biopsy (CNB).
Prognosis (Certain factors affect the prognosis and treatment options)
While it is not possible to predict the exact course of the disease, your doctor may be able to give you a general idea based on the rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage liver cancers have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis may not be as good and there may be a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis.
References
Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.