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Liver cancer

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What is the liver?

The liver is the largest organ in the body, it is situated in the upper abdomen and is protected from injury by the rib cage. The liver has many important functions some of which include:

  • The production of bile.
  • Helps the body to digest fats.
  • Stores vitamins, iron and other essential nutrients until the body needs them.
  • Converts the food you eat into energy needed for daily life.
  • Aids in the removal of toxic substances (e.g. drugs and alcohol) from the bloodstream.

The liver can repair itself quite easily and can usually function with only a small portion of it working.

What is liver cancer?

Liver cancer happens when cells begin to multiply at a faster rate than they should and the unwanted cells form a growth. There are 2 main types of liver cancer and these are:

There are 2 main types of primary liver cancer. The most common type is known as a hepatoma, it starts in the cells, which perform the major tasks of the liver, called hepatocytes. The second type of cancer is known as cholangiocarcinomas and it starts in the cells that line the bile ducts of the liver.

What causes primary liver cancer?

Although nobody is exactly sure what causes primary liver cancer, it does tend to arise in those people whose liver has been severely damaged by a condition called cirrhosis (scarring of the liver). Any disease that causes cirrhosis of the liver will increase the risk of you developing liver cancer. Cirrhosis of the liver can be caused by infection with the hepatitis B or C virus and drinking excess alcohol. Hepatitis A does not cause cirrhosis or primary liver cancer.

However, only a small minority of people with cirrhosis of the liver will go on to develop primary liver cancer.

Primary liver cancer tends to affect the middle aged and elderly, but very rarely it can affect children. It is also a lot more common in men than it is in women.

What causes secondary liver cancer?

A primary cancer situated elsewhere in the body always causes secondary liver cancer. If cancer cells from the primary cancer escape into the bloodstream the liver is the most likely place for them to embed and grow, as all blood in the body passes through the liver.

What are the symptoms of liver cancer?

The symptoms for both primary and secondary cancer are similar though in the early stages you may have no symptoms. Secondary liver cancer tends to be found when the primary cancer is diagnosed. When symptoms are present they may include any of the following:

  • Pain or discomfort in the upper abdomen.
  • Loss of appetite.
  • Weight loss.
  • Nausea and occasionally vomiting.
  • High temperature.
  • Jaundice – a yellow colouring of the skin and eyes, darkened urine and a pale colour to the stools.

These symptoms can be common to many other non-serious conditions, so always have any symptoms you are experiencing checked by your doctor.

Is there anything I can do to prevent liver cancer?

To avoid liver cancer you should stop smoking, as this will greatly reduce your risk of developing lung and stomach cancer. Try to maintain a healthy balanced diet and reduce your consumption of alcohol – a major cause of cirrhosis of the liver. Protect yourself against the hepatitis virus by practicing safe sex and avoid sharing needles.

If you have cirrhosis of the liver your doctor should regularly test you for the presence of a hepatoma. The test may involve regular blood tests, which looks for the presence of alpha-feta protein (A.F.P.), a substance found in abnormal amounts in those with a hepatoma.

How is liver cancer diagnosed?

Your doctor may have a feel of your liver from a physical examination and may also carry out a urine test which among other things looks for bilirubinand urobilinogen, if these levels are raised this could indicate the liver is damaged. If these levels are raised and/or the liver feels larger or harder than it should then your doctor may recommend a LFT (Liver Function Test) for more detailed results and looks at the following:

  • Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) – these are enzymes that help to process proteins and may be raised if your liver is inflamed or injured.
  • Bilirubin – This is a chemical in bile, a damaged liver cannot process bilirubin and so levels can build causing the skin and/or eyes to look yellow (jaundice). An increase in bilirubin is suggestive of liver disease.
  • Alkaline Phosphatase (ALP) and Gamma-Glutamyl Transferase- these are enzymes and might be raised when there is a blockage in your liver or bile duct.
  • Albumin – This is a protein and may be low in some cancers or if you have been eating little and are malnourished.

A cancer of the liver might be suspected when an abnormality is seen in ‘liver blood tests’. This blood test detects there is something wrong in the liver but this may not necessarily be because of cancer.
If the liver cancer type is a hepatoma it normally produces abnormal amounts of a substance called alpha-feta protein, which can be detected in the blood.

To diagnose liver cancer you will have a scan of the liver with an ultrasound, CT scan or a M.R.I. (Magnetic Resonance Imaging). These tests build up a picture of the liver and show the exact location of the tumour, though they cannot usually tell, if it is a primary or secondary cancer. For a final diagnosis you will usually have a biopsy, which involves the doctor taking a small sample of liver cells, for examination under a microscope. A biopsy will tell the doctor what type of cell is causing the cancer to develop.

How is liver cancer treated?

The type of treatment available will depend on the size and type of the cancer. The treatment of secondary liver cancer depends on where the primary cancer is.

If you have a hepatoma there are a number of treatments available. If the cancer is small it may be removed by an operation. Even if you need to have the majority of the liver removed, it will start to regrow very quickly and could be back to normal size within a month.

If cirrhosis has seriously affected the liver, a liver transplant may be considered. Chemotherapy may be used in the treatment of primary and secondary cancer but it is unlikely that radiotherapy will be used.

If the cause of primary liver cancer is cholangiocarcinomas then it can be very difficult to treat. The first stage of treating this type of cancer is to relieve the jaundice, caused by blocked bile ducts (where this type of cancer forms). Once this has been carried out, the doctor can assess the size and position of the tumour and will hopefully be able to perform surgery. Radiotherapy may also be used to treat this type of cancer.

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