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  • What is liver cancer

    Contents

    The liver

    The liver is the largest organ inside the body. It is on the right side of the abdomen and is found just under the ribs.

    The liver is made up of two sections, the right and left liver. It performs several important functions including:

    • producing bile to help dissolve fat so it can be easily digested
    • converting sugar and fat into energy
    • storing nutrients
    • making proteins for the blood
    • helping the blood to clot
    • making other chemicals the body needs
    • breaking down harmful substances such as alcohol and drugs, and getting rid of waste products.

    Unlike other internal organs the liver can usually repair itself. It can function normally even if only a small part of it is working. After surgery or injury it can grow back to normal size in six to eight weeks.

    What is primary liver cancer?

    Primary liver cancer is cancer that starts in the liver. It is when a malignant tumour or tumours are found in the liver tissue. There are three different types of primary liver cancer:

    • Hepatocellular carcinoma (HCC) starts in the hepatocytes, the main cell type in the liver. HCC, also called hepatoma, is the most common type of primary liver cancer.
    • Cholangiocarcinoma starts in the cells lining the bile ducts which connect the liver to the bowel and gall bladder. It is also called bile duct cancer.
    • Angiosarcoma is a very rare type of liver cancer starting in the blood vessels. It usually occurs in people over 70.

    What is secondary liver cancer?

    Secondary cancer in the liver is cancer that started in another part of the body but has spread (metastasised) to the liver.

    Most cancers can spread to the liver but the most common ones start in the digestive system (large bowel, pancreas, oesophagus and stomach).

    Digestive cancers often spread to the liver because blood containing cancer cells from the digestive organs passes through the liver first and can lodge there.

    Melanoma and cancers of the breast, ovary, kidney and lung can also metastasise to the liver.

    Secondary cancer in the liver is sometimes found at the same time the primary cancer is diagnosed. However this is not always the case.

    It can be diagnosed soon after the primary cancer or it may be diagnosed months or years after someone has been treated for primary cancer.

    It may also be diagnosed before the primary cancer is found. If other tests don’t show what the primary cancer is, it is called cancer of unknown primary (CUP). This is uncommon.

    If you have secondary cancer in the liver, it may be useful to read information about the related primary cancer or about CUP if the primary cancer is unknown.

    Risk factors

    The exact cause of primary liver cancer is not known but the following factors may increase the risk:

    • infection with hepatitis B
    • liver scarring (cirrhosis) due to hepatitis B or C, inflammation, alcohol or genetic disorders such as haemochromatosis or alpha 1-antitrypsin deficiency
    • diabetes
    • drinking alcohol over a long period of time
    • smoking
    • high-fat diet
    • being overweight or obese.

    How common is it?

    Primary liver cancer is one of the less common cancers in Australia. About 1,400 people are diagnosed with it every year. It is more than twice as common in men, and in people aged over 65 years. Its incidence is increasing.

    Primary liver cancer - particularly hepatocellular carcinoma (HCC) – is common in Asia, Mediterranean countries and Africa due to the high rates of hepatitis B in people from those areas. In Australia it is more common in migrants from Vietnam, Hong Kong and Korea due to the link with hepatitis.

    Secondary cancer in the liver is much more common than primary liver cancer. It occurs about 20 times more often with about 28,000 people in Australia being diagnosed every year.

    Hepatitis B and liver cancer

    Infection with hepatitis B is the biggest known risk factor for developing primary liver cancer.

    The hepatitis B virus affects the liver cells (hepatocytes). This stimulates the immune system to attack the virus. However the immune response causes inflammation in the liver that can lead to ongoing damage. It isn’t the virus itself that causes damage.

    People with chronic hepatitis B often develop cirrhosis that increases the risk of liver cancer. However hepatitis B can also cause liver cancer before cirrhosis has occurred.

    Hepatitis B is spread through infected semen, blood or other body fluids entering the body of someone who is not infected. Spread can occur through sex with an infected partner, direct contact with the blood of an infected person or sharing items such as razors or toothbrushes with an infected person.

    People can spread hepatitis B without knowing they’re infected. To reduce the spread of hepatitis B and the incidence of primary liver cancer, it is recommended that all at-risk people receive a vaccination against the virus.

    This includes:

    • migrants from South-East Asia, Africa and the Pacific Islands
    • sexually active partners of infected individuals
    • people in the same household as someone with hepatitis B
    • recipients of blood products
    • all infants and children.

    If you are in one of these groups or are concerned about getting hepatitis B, contact your doctor or call Cancer Council 13 11 20 for more information.

    Symptoms

    Primary liver cancer doesn’t tend to cause symptoms in the early stages but they may appear as the cancer grows or becomes advanced. Secondary liver cancers may cause similar symptoms.

    These can include:

    • weakness and tiredness (fatigue)
    • pain in the upper right side of the abdomen, shoulder or upper back
    • loss of appetite or feeling sick (nausea)
    • unexplained weight loss
    • hard lump on the right side of the abdomen under the ribs
    • yellowing of the skin and eyes (jaundice)
    • swelling of the abdomen (ascites)
    • fever.

    This website page was last reviewed and updated July 2017.

    Information reviewed by: Dr Benjamin Thomson, Hepato-pancreato-biliary Surgeon, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, VIC; Joyce Bonello, Cancer Care Coordinator – GIT, Prince of Wales Hospital, NSW; Carol Cameron, Cancer Nurse Coordinator Upper GI, WA Cancer & Palliative Care Network; Karen Hall, Clinical Nurse Cancer Services Division, Flinders Medical Centre, and Cancer Council Helpline Nurse, SA; Robyn Hartley, Consumer; Mamta Porwal, Project Coordinator, B Positive Project, Cancer Council NSW; Chris Rivett, Clinical Nurse Oncology, Western Hospital, and Cancer Council Helpline Nurse, SA; and Dr Kellee Slater, Hepatobiliary, General and Liver Transplant Surgeon, Princess Alexandra Hospital, QLD.

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