Primary liver cancer most often develops in people with underlying liver disease, usually cirrhosis.
In cirrhosis, healthy liver cells are replaced by scar tissue, and benign nodules (non-cancerous lumps) form throughout the liver. As this gets worse (advanced cirrhosis), the liver stops working properly. Cirrhosis may be caused by:
A small but increasing number of people are developing liver cancer without cirrhosis. This may occur in people with long-term hepatitis B infection, or with liver disease related to obesity or type 2 diabetes.
Aboriginal and Torres Strait Islander peoples and migrants from countries with higher rates of hepatitis B infection (e.g. countries in the Asia-Pacific region and Sub-Saharan Africa) are also at greater risk of developing liver cancer.
Worldwide, up to 8 in 10 cases of liver cancer (HCC) can be linked to infection with the hepatitis B or C virus (viral hepatitis). This is changing as vaccinations and treatments for viral hepatitis are helping to reduce the rates of hepatitis-related liver cancer.
How hepatitis spreads
Hepatitis B and C spread through contact with infected blood, semen or other body fluids. The most common way hepatitis B spreads is from an infected mother to a baby during birth.
Hepatitis B can also be transmitted during unprotected sex with an infected partner, or by sharing personal items, such as razors or needles, with an infected person.
Hepatitis C is usually transmitted through the sharing of needles during illicit drug use, tattooing, sharing personal items, or contaminated medical equipment.
Viral hepatitis infects the liver cells (hepatocytes). When the body’s immune system attacks the virus, the liver becomes inflamed. Infection that lasts for more than six months may lead to cirrhosis, which increases the risk of primary liver cancer.
Importantly, people with cirrhosis should have long-term monitoring for liver cancer.
Preventing hepatitis
All babies in Australia are offered the hepatitis B vaccine at birth. To further prevent the spread of hepatitis B, at-risk people should also be vaccinated.
This includes: Aboriginal and Torres Strait Islander peoples; people from countries with higher rates of hepatitis B; people living with someone with hepatitis; people who are immunocompromised; and health care workers.
If you already have hepatitis B, vaccination won’t be helpful, but you will usually have regular tests to ensure you don’t develop cancer or other liver problems.
If you also have signs of liver damage, you may be offered antiviral medicines to help prevent further damage. There is no vaccine for hepatitis C infection, but effective medicines are available and the virus can often be cured.
While this treatment can lower the risk of primary liver cancer, it does not eliminate it.
Bile duct cancer (cholangiocarcinoma)
This uncommon form of primary liver cancer accounts for about 10–15% of all liver cancers worldwide.
Bile duct cancer (cholangiocarcinoma) starts in the cells lining the ducts that carry bile between the liver, gall bladder and bowel.
Most risk factors are similar to those of HCC, but exposure to certain chemicals in the print industry may also increase the risk of developing bile duct cancer.
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