Types of Liver cancer:

1. Primary liver cancer
2. Secondary liver cancer – (liver metastases)

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What is the liver and what does it do?

The liver is one of the largest organs of the human body. It is located just under your rib cage on the right side, on top of your stomach. The liver performs many tasks which are essential for the normal functioning of the body such as purifying the blood, processing nutrients, making blood clotting factors, and preventing infection.

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How common is primary liver cancer? 

Primary liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide***. Cancer that spreads to the liver from elsewhere in the body (metastatic cancer) is more common than primary liver cancer.

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What causes primary liver cancer?

Liver cancer occurs when liver cells develop mutations in their DNA leading to an uncontrolled and disordered division of cells to form a mass or tumour. In some cases the cause of liver cancer is known, such as with chronic hepatitis infections. But liver cancer can occur with no clear cause underlying disease. Some factors which appear to increase the risk of liver cancer have been identified. These include:

• Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV)
• Liver Cirrhosis –  scarring of liver tissue due to liver disease
• Certain inherited liver diseases such as haemochromatosis and Wilson’s disease.
• Diabetes
• Nonalcoholic fatty liver disease – accumulation of fat in the liver
• Exposure to aflatoxins that grow on crops such as grains and nuts that are stored poorly.
• Excessive alcohol consumption.

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These tests are usually performed if a patient has symptoms of liver cancer, although blood tests and abdominal ultrasound they may be recommended to screen those with a higher risk of liver cancer. If your doctor confirms a diagnosis of liver cancer, additional tests may be required to determine the extent (stage) of the cancer and develop the most appropriate treatment plan.

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How is liver cancer treated? 

Treatment options depend on the type, location and stage of the cancer. Options may include surgery, chemotherapy, radiation therapy or a combination of these. In general, the earlier a cancer is detected, the better the prognosis. Surgical options to treat liver cancer include:

• Removal of the tumour and a small portion of healthy liver tissue that surrounds it may be an option for small tumours where liver function is good. In suitable cases, minimally invasive laparoscopic surgery can significantly reduce recovery time. Laparoscopic surgery is done through a thin, lighted tube with a camera on its tip (a laparoscope) which is inserted through a tiny abdominal incision.
• Liver transplant surgery to remove the diseased liver and replace it with a healthy liver from a donor may be an option in otherwise healthy people whose liver cancer hasn’t spread beyond the liver.

Localised treatments for liver cancer are administered directly to the cancer cells or the area surrounding the cancer cells. Some treatments use image-guided techniques (interventional radiology). Localised treatments may be recommended for people who can’t undergo surgery:

• Radiofrequency ablation – uses an electric current to heat and destroy cancer cells. Thin needles are inserted into small incisions in the abdomen, using an imaging test as a guide.
• Cryoablation – uses extreme cold to destroy cancer cells. An instrument (cryoprobe) containing liquid nitrogen is placed directly onto the liver tumours, guided by ultrasound images.
• Alcohol injection –  pure alcohol is injected directly into tumours causing the tumour cells to die.
• Chemoembolization – chemotherapy (anti-cancer) drugs are injected directly to the liver.
• Radioembolization – tiny glass spheres containing radiation are injected directly into the liver.

Radiation therapy – uses high-energy beams to destroy cancer cells. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue. Chemotherapy drugs may be either injected or taken orally to help kill cancer cells. Radiation therapy or chemotherapy may be used when surgery is not an option to help control symptoms. They may also be used before surgery to help shrink a tumor, or after surgery to reduce the risk of recurrence. Targeted drug therapies – target specific weaknesses present within cancer cells, causing the cancer cells to die. Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Immunotherapy uses your immune system to fight cancer by interfering with proteins produced by cancer cells which prevent them from being attacked by the body’s immune system. Immunotherapy treatments are generally reserved for people with advanced liver cancer.

Supportive (palliative) care

For advanced liver cancer that is not amenable to surgery, chemotherapy or radiotherapy, treatment may focus on symptom relief and improving quality of life. Palliative care may also be provided to complement other treatments.

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I have been diagnosed with liver cancer, what next?  Finding out about a cancer diagnosis can cause stress and worry. Here are some ways that may help you cope and get the right treatment and support: ● Educate yourself about your cancer to help you make decisions about your care. Share any questions or concerns with your specialist doctor, who will be able to advise you about the details of your cancer and your treatment options. They will also be able to recommend trusted sources of further information. ● Build a support network of trusted friends and family who can help you with practical tasks or provide a listening ear. If stress, anxiety or depression are causing significant problems in your daily life, talk to your doctor who may recommend professional counselling. ● Consider joining a support group specifically for liver cancer to connect with others who are going through similar experiences. Ask your doctor for information on liver cancer support groups in your area or online.

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