Liver cancer

Tuesday 1 July, 2014

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On this page: The liver | What is primary liver cancer? | What are the risk factors?Can primary liver cancer spread? | What is secondary cancer in the liver?What are the symptoms? | How common is cancer in the liver?

The liver

The liver is the largest organ inside the body. It is on the right side of the tummy area (abdomen), next to the stomach. It is found under the ribs, just beneath the right lung and the diaphragm. The diaphragm is a sheet of muscle that separates the chest from the abdomen.

The liver is made up of two sections: the right and left lobes. Blood flows into the liver from the hepatic artery and the portal vein. Blood from the hepatic artery carries oxygen, while blood from the portal vein carries nutrients and waste products (toxins).

The liver 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 and chemicals the body needs
  • helping the blood to clot
  • breaking down 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 even if only a small part of it is working. After surgery or injury, a healthy liver can grow back to normal size in 6–8 weeks.

Bile is made in the liver and is stored in the gall bladder. When needed, bile is released into the bowel to help break down fats.

A diagram of the liver

What is primary liver cancer?

This is when a malignant tumour starts in the liver. There are 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 the gall bladder. It is also called bile duct cancer.

Angiosarcoma – a rare type of liver cancer starting in the blood vessels. It usually occurs in people over 70.

What are the risk factors?

The majority of liver cancer cases are related to long-term (chronic) infection caused by the hepatitis B or C viruses.

Other causes of liver cancer aren’t always known, but some factors that increase the risk include:

  • liver scarring (cirrhosis) due to: hepatitis B or C, alcohol, fatty liver disease or genetic disorders, such as haemochromatosis or alpha 1-antitrypsin deficiency
  • type 2 diabetes
  • high alcohol consumption
  • eating a high-fat diet and/or being overweight or obese
  • smoking tobacco
  • exposure to certain chemicals or substances (such as aflatoxins, vinyl chloride and arsenic).
The link between hepatitis and liver cancer

About eight in ten of HCC cases worldwide are attributable to chronic hepatitis infection. In Australia, hepatitis C and hepatitis B infections are the biggest known risk factors for primary liver cancer.

It’s estimated that more than a third of the world’s population has been infected with the hepatitis B virus. People can spread either type of hepatitis without knowing they’re infected. Hepatitis is spread by contact with infected blood, semen, or other body fluids. Spread can occur through sex with an infected partner or sharing personal items, such as razors or toothbrushes, with an infected person.

The most common way that hepatitis B is spread is during birth, from mother to baby. Although the infection usually goes away (is cleared) in adults, if hepatitis is acquired in infancy or early childhood, it can lead to chronic hepatitis infection.

Chronic infection with hepatitis B affects the liver cells (hepatocytes). This stimulates the body’s immune system to attack the virus. The immune response causes liver inflammation, which can lead to ongoing damage and can cause liver cancer.

People with chronic hepatitis infection often develop cirrhosis, which increases the risk of liver cancer. 

To reduce the spread of hepatitis B and the incidence of primary liver cancer, all at-risk people should be vaccinated against the virus. These include:

  • 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
  • infants and children (as part of Australia’s national immunisation program).

Vaccination is not effective if you are already infected with the virus. In this case, you need regular monitoring to ensure you don’t develop health problems, including liver cancer. If you are concerned about hepatitis, contact your doctor for more information.

For more details, see our hepatitis B and liver cancer page.

Can primary liver cancer spread?

If primary liver cancer isn’t found in its early stages, or if treatment is unsuccessful, it can spread. It typically spreads to other parts of the liver first, then the lungs, lymph nodes and bones.

The two most common ways that liver cancer spreads are through the bloodstream or the lymphatic system. The lymphatic system is part of the body’s defence system against infection and disease. It includes a network of thin lymph vessels, which carry a clear fluid called lymph to and from tissues, before emptying it into the bloodstream.

What is secondary cancer in the liver?

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. Cancers that start in the digestive system (including cancers of the oesophagus, stomach, pancreas and large bowel) are most likely to spread to the liver. This is because blood cells flow from the digestive organs through the liver, and cancerous blood cells can get stuck (lodge) in the liver.

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

Secondary cancer in the liver is sometimes found at the same time that the primary cancer is diagnosed. However, it can also be diagnosed soon after the primary cancer, or it may be diagnosed months or years after someone has been treated for primary cancer. It could also be diagnosed before the primary cancer is found. If other tests don’t show what the primary cancer is, this is called cancer of unknown primary (CUP).

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

Naming secondary cancers

A secondary cancer is named after the primary site where it began.

For example, bowel cancer that has spread to the liver is still called bowel cancer. To indicate that the cancer has spread, doctors may call it bowel cancer with liver secondaries, colorectal metastasis, metastatic bowel cancer or advanced bowel cancer. On this website, we use the term ‘secondary cancer in the liver’ to refer to any cancer type that has spread to the liver.

What are the 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.

Symptoms can include: 

  • weakness and tiredness (fatigue
  • pain in the upper right side of the abdomen 
  • severe abdominal pain
  • appetite loss and feeling sick (nausea)
  • weight loss
  • yellowing of the skin and eyes (jaundice)
  • pale bowel motions
  • swelling of the abdomen (ascites)
  • fever.

How common is cancer in the liver?

Primary liver cancer is one of the less common cancers in Australia. About 1400 people are diagnosed with it every year. It is more than twice as common in men, and the average age at diagnosis is 66.

The incidence of primary liver cancer is increasing, mainly because the rate of hepatitis infection is increasing, and more people are developing serious damage from fatty liver disease.

HCC, the most common type of primary liver cancer, is common in Asia, Mediterranean countries and Africa due to the high rates of chronic hepatitis B infection. In Australia, it is more common in migrants from Vietnam, Hong Kong and Korea – countries where hepatitis B infection is prevalent.

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 diagnosed every year.

Reviewed by: A/Prof Vincent Lam, Sydney Medical School Hepatobiliary, Pancreatic and Transplant Surgeon, Westmead Hospital, NSW; Prof Peter Angus, Medical Director, Director of Gastroenterology and Hepatology and Professorial Fellow, Austin Hospital and University of Melbourne, VIC; Jenny Berryman, Consumer; Ann Bullen, Cancer Care Coordinator, Royal Brisbane and Women’s Hospital, QLD; Prof Jonathan Fawcett, Director, Queensland Liver Transplant Service, Professor of Surgery, University of Queensland, QLD; Dr Dan Madigan, Interventional Radiologist, Royal Adelaide Hospital, SA; Dr Monica Robotin, Medical Director, Cancer Council NSW; and Dr Simon So, Interventional Radiologist, Westmead Hospital, NSW.

Updated: 01 Jul, 2014