Liver Cancer

The liver is one of the largest organs in the body. It is situated in the upper abdomen under the ribcage and has a number of functions that make it essential to life. These include:

Regulating sugars and fats so they can be used for energy
Storing glucose and vitamins so that they can be released into the bloodstream when needed
Producing proteins which are essential for blood clotting and prevent excessive bleeding while other proteins help regulate fluid levels in the body
Producing bile which is released into the intestine to break down the fats in food so they can be absorbed in the bowel
Processing substances including alcohol, drugs and by-products of normal metabolism so they can be passed out of the body or broken down into harmless substances

Secondary cancer in the liver occurs when a cancer develops elsewhere in the body and spreads to the liver via the bloodstream. This is the most common type of cancer in the liver. Primary liver cancer occurs when the cancer arises from the liver cells. The most common type is called hepatocellular carcinoma (HCC). HCC usually arises in people who have had underlying liver disease for many years resulting in liver scarring (cirrhosis). In New Zealand, the most common causes of the underlying liver disease are hepatitis B, hepatitis C, and alcohol abuse. A rarer sub-type of HCC that is unrelated to liver disease is called fibrolamellar HCC. This usually occurs in younger women. There are other rarer types of liver cancer, including hepatoblastoma, which affects very young children. Cancer in the liver is usually diagnosed using special radiology tests, such as ultrasound, CT scan and MRI, and if there is no known primary cancer, a biopsy is required. For primary liver cancer, a blood test is often used to help the diagnosis (alpha-fetoprotein).

Treatment

The treatment of primary liver cancer depends on how far the cancer has spread and whether there is underlying liver disease. Treatments include surgery to remove part of the liver (liver resection) or removal of the whole liver (liver transplantation), ablation, chemotherapy given into the blood vessels supplying the tumour (chemoembolisation), and biological agents (drugs that interfere with the signalling pathways in cancer cells). The treatment of cancer which has spread secondarily to the liver depends on the primary cancer type. Some are treated with chemotherapy and some may be suitable for surgical removal. Ablation is a way of destroying the cancer cells without having to remove that part of the liver surgically, and this is also sometimes used. The prognosis for liver cancer depends on many factors, including whether it is primary or secondary, the stage of disease (how advanced it is at the time of diagnosis), and whether it is possible to remove all of the cancer with surgery. In the best circumstances, cure can be possible for both primary and other cancers that have spread to the liver.

Symptoms

Cancer in the liver does not usually cause symptoms until it has reached a more advanced stage. It is important to realize that these symptoms can also arise in other conditions, including liver disease without cancer:

Abdominal swelling
Tiredness
Weight loss
Loss of appetite
Pain
Jaundice (yellowing of the skin and eyes)

NZ statistics

Around 440 people are diagnosed with liver and bile duct cancer in New Zealand each year. Liver cancer arises from liver cells that have become malignant. Secondary liver cancer originates from cancers in other organs such as the colon or rectum spreading (metastasising) to the liver. This will occur in about 40% of people with advanced bowel cancer.