Liver Cancer

The liver is a large organ at the top right side of a person’s abdomen, just under the lower right ribs, which helps to digest food and removes toxins. Liver cancer is a cancer found anywhere in the liver and is referred to as ‘primary’ when it starts there (or secondary if it has spread from another organ). 

Primary liver cancer is much less common than secondary liver cancer. How serious liver cancer is depends on where it is in the liver, how big it is, if it has spread, if it’s primary or secondary and the patient’s general health.

Primary Liver Cancer is where cancer starts in the liver itself and is much less common than secondary liver cancer. There are four main types of primary liver cancer:

• Hepatocellular Carcinoma (HCC) – is quite common in China and Africa, but not particularly common in the UK. With around 6,500 new cases per year, it represents about 2% of all new cancer diagnoses in the UK each year. There are two subtypes of HCC:
  • Adenocarcinoma HCC – the commoner form of the disease affecting older people and often those with a history of liver disease
  • Fibromellar HCC – a rarer form of the disease which can affect young people
• Cholangiocarcinoma – is relatively rare in the UK with under 3,000 cases each year. This cancer arises in the drainage tubes which exit the liver, known as the bile ducts. The cancer can occur in the bile ducts within the liver (intrahepatic cholangiocarcinoma) or in the bile ducts outside of the liver (extrahepatic cholangiocarcinoma) or in the gallbladder.
• Gallbladder cancer – Cancer can also arise in the gallbladder itself, which is the source of bile, and quickly spread to the liver due to the close anatomical relationship between the two organs. This is known as gallbladder cancer, and there are about a thousand cases of this every year in the UK, so it is quite rare. 
• Secondary liver cancer – is where the cancer spreads to the liver from another primary site (linked to a diagnosis of another cancer somewhere else in the body). 

Generally speaking, the risk of most cancers increase with age and smoking increases the risk of many cancers due to the chemicals contained with cigarettes such as nicotine. Obesity is also driving the rise of almost all cancers in the UK. 

There are also specific risk factors for the different types of Liver Cancer:

• HCC is more commonly seen in those who have suffered from chronic liver disease (e.g. primary sclerosing cholangitis, autoimmune liver disease or Wilson’s Disease) or liver infection (Hepatitis B, Hepatitis C) that have caused liver damage, inflammation or scarring (cirrhosis) to the organ. High alcohol intake can also damage the liver to a similar extent and people who are obese or overweight accumulate fat in the liver (called fatty liver disease) which can increase the risk of liver cancer over time

• Cholangiocarcinoma is linked to rare diseases like primary sclerosing cholangitis (which scars the bile ducts) or Cystic Fibrosis, bile duct problems from birth (like choledochal cysts), having chronic liver disease or liver infections (like hepatitis viruses) and being type 1 or type 2 diabetic
• Gallbladder cancer is more common in women, people who have a history of gallstones and those who have had ‘porcelain gallbladder’ diagnosis (where calcium deposits in the organ)

As with many cancers, the earlier they detected the better the outcomes. If you have had one of the conditions mentioned above or many of the risk factors, you may be kept under surveillance and screening by your doctor for early evidence of liver cancer.

Most Liver Cancer symptoms only develop when the cancer is at an advanced stage. These include abdominal pain (especially right upper abdominal pain), swelling in the same place, jaundice (yellowing of the skin and whites of the eyes), dark urine, pale stools and itchy skin. People with liver cancer may also experience a reduced appetite, feeling full shortly after eating and unintended weight loss.