Liver cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs 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 abdomenstomach, stomach area, belly, and is a component of the digestive systema group of organs and tissues responsible for breaking down food, absorbing nutrients, and eliminating waste.
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 bloodthe red bodily fluid that transports oxygen and other nutrients around the body 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 carcinomacancer arising from tissues that line organs, 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 cellsthe basic structural and functional unit of all living things found in the liver. This type of cancer usually occurs in people with pre-existing liver conditions, and is often aggressive.
Fibrolamellar Carcinoma
Fibrolamellar carcinoma (FLC), or fibrolamellar hepatocellular carcinoma (FL-HCC or FHCC), is a rare form of cancer that develops from the tissues lining the liver. It is considered to be a variant of HCC. For more information on FLC, please refer to the Rare Cancers Australia Fibrolamellar Carcinoma page.
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 intestinea section of the gastrointestinal tract that recieves food from the stomach and absorbs the nutrients from food, also called small bowel.
Angiosarcoma
Angiosarcoma is a rare cancer that develops in the inner lining of blood vessels and lymph vesselsa network/chain of thin tubes that moves lymph fluid around the body. It most commonly occurs in the skin, breast, liver, spleen, and deep tissuea group of cells that work together to perform a function.
Childhood liver cancers
There are five types of liver cancer that affects children: hepatoblastoma, hepatocellular carcinomas (HCCs), undifferentiated embryonal sarcomacancer arising from bones and/or soft tissue 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 metastasiswhen the cancer has spread to other parts of the body, also known as mets rates.
Infantile Choriocarcinoma of the liver
Infantile Choriocarcinoma of the liver is a rare and aggressive tumoura tissue mass that forms from groups of unhealthy cells 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.
Some of the information regarding types of liver cancer was obtained from the Liver and Bile Duct Cancer and Childhood Liver Cancer pages, which were published by the National Cancer Institute.
Treatment
If liver cancer is detected, it will be staged and graded based on size, metastasis, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas 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 (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- 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 localisedaffecting only one area of body 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 advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells 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 testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, 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:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Hepatectomycomplete or partial removal of the liver.
- Organ transplanta surgical procedure that involves removing a failing or damaged organ and replacing it with a healthy one from a donor (liver) (in extreme cases).
- Tumour ablation, potentially including:
- Ablation therapya minimally invasive procedure that uses extremely high or low temperatures to destroy (ablate) abnormal tissue and/or cancer cells.
- Alcohol injectiona procedure that involves injecting pure ethanol (alcohol) into the tumour to kill cancer cells.
- Cryotherapythe process of freezing off cancerous tumours and/or lesions using liquid nitrogen.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells, potentially including:
- Selective internal radiation therapy (SIRT).a type of radiation treatment that combines embolisation with internal radiation therapy
- Stereotactic ablative body radiation (SABR)a precise radiation therapy technique that delivers high doses of radiation to tumors while minimising damage to surrounding healthy tissues, may be given to patients who can't undergo surgery.
- Transarterial chemoembolisation (TACE)a minimally invasive procedure that involves injecting high doses of chemotherapy to restrict a tumours blood supply.
- Targeted therapymedication that targets specific molecular features of cancer cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
The riskthe possibility that something bad will happen 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.
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.
- Fatiguea state of extreme tiredness or exhaustion, can be physical or mental.
- Unexplained weight loss/loss of appetite.
- Nauseato feel sick or likely to vomit and vomiting.
- Jaundiceyellowing of the skin and the whites of the eyes.
- Dark urine.
- Pale or clay coloured stoolwaste product from the bowel sent to the anus for removal; also known as faeces or poo.
- 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
If your doctor suspects you have liver cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- Ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
- Blood teststesting done to measure the levels of certain substances in the blood.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
