Primary liver cancer occurs when a malignant tumour begins in the liver. You can also get secondary liver cancers which start in another part of the body but have spread (metastasis) to the liver.
There are three main types of primary liver cancer depending on the starting location of the cancer:
Causes of liver cancer
The biggest risk factor for primary liver cancer is a chronic infection with viral hepatitis, with an estimated 71% of liver cancer cases globally thought to be caused by viral hepatitis infections. Vaccinating all at-risk people against hepatitis B virus and monitoring those already infected with hepatitis B or hepatitis C are important prevention strategies to reduce the incidence of primary liver cancer. Other liver issues such as fatty liver disease and liver scarring (cirrhosis) can also increase the risk of developing liver cancer; as well as genetic disorders including haemochromatosis (overload of iron) and alpha 1-antitrypsin deficiency. Type 2 diabetes has also been shown to increase the risk of developing liver cancer, as has lifestyle factors such as high alcohol consumption, obesity and smoking.
Who gets liver cancer?
The incidence of liver cancer has been increasing over the last 35 years, likely due in part to increased rates of hepatitis infection, more damage from fatty liver disease and lifestyle factors. An estimated 1 in 190 Australians under the age of 75 years are affected by liver cancer with men being 3 times more likely to develop liver cancer compared to women. The rate of liver cancer increases with age with 1 in 113 Australians estimated to be affected over the age of 85 years.
Symptoms of liver cancer
Primary liver cancer rarely causes symptoms in it's early stages but they are more likely to become apparent as the cancer grows or becomes more advanced. Symptoms may include:
- Severe pain and/or swelling of the abdomen, particularly in the upper right side
- Weakness and tiredness
- Loss of appetite and weight loss
- Nausea
- Jaundice (yellowing of the skin and eyes)
- Pale bowel motions
- Fever
Diagnosing liver cancer
There is no current screening for liver cancer in Australia, however there are a number of tests that may be performed in order to diagnose liver cancer including:
Ultrasound
- Detects the size and location of abnormal tissue in the liver.
Blood test
- Detects liver function, how well blood clots, checks for tumour markers and presence of hepatitis B or C.
Scans
- Various scans including CT scans (produce 3D pictures of organs to assist doctors in planning surgery and seeing whether cancer has spread), MRI scans (produce detailed cross-sectional pictures showing the extent of a tumour and whether it affects the main blood vessels around the liver) and PET-CT scans (produce 3D colour images to show any cancers in the body).
Biopsy
- Removal of a small sample of tissue for microscopic examination, rarely used as a diagnostic tool.
Stages of liver cancer
If the tests show a positive result for primary liver cancer a specialist will determine how far it has spread in a process known as 'staging'. Knowing what stage the cancer is at allows health care professionals to determine what would be the best treatment course.
The most common staging system used for primary liver cancer is the Barcelona Clinic Liver Cancer (BCLC) system. The BCLC system is based on a combination of performance status (how well the patient can perform daily tasks), tumour characteristics and the Child-Pugh score (assesses how well the liver is working by measuring the level of liver damage caused by cirrhosis).
The Child-Pugh score has 3 levels:
- Child-Pugh A – Liver works well, less advanced cirrhosis
- Child-Pugh B – Liver works moderately well
- Child-Pugh C – Liver is not working well, advanced cirrhosis
The BCLC staging system has 5 levels:
Treating primary liver cancer
There are many different treatment options for primary liver cancer, but the most common are tumour ablation (using radio waves and microwaves to heat and destroy cancer cells) and chemotherapy. Liver transplants or surgical resection to remove the diseased portion may also be used to treat the disease. Some treatments offer the chance of a cure whereas others are aimed at relieving symptoms and improving the quality of life. The treatment for primary liver cancer depends on the stage of liver cancer, the size and spread of the cancer, and whether there is cirrhosis.
Prognosis of liver cancer
An individual's prognosis (expected outcome) for liver cancer depends on many factors including the type and stage of the cancer, the test results, whether there is cirrhosis, the rate of tumour growth, their age, medical history and general health at diagnosis. Their doctor or specialist can consider all of these factors as well as statistics but cannot necessarily accurately predict the course or timeline of an individual's disease progression.
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