Liver cancer

Wednesday 1 June, 2016

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On this page: The liver | What is primary liver cancer? | How is secondary cancer in the liver different? | How common is cancer in the liver? | What are the symptoms? | What are the risk factors? | Which health professionals will I see?

The liver

The liver is the largest organ in the body, and is part of the digestive system. It is found on the right side of the abdomen, next to the stomach. It is 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
  • storing and releasing glucose as needed
  • storing nutrients
  • making proteins needed for fluid balance and making protein to help 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 if injured. It can continue to function even when only a small part 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 stored in the gall bladder. It is carried by the bile duct to the bowel, where it helps to break down fats.

The digestive system

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 duct, which connects 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.

How is secondary cancer in the liver different?

This is a secondary cancer that started in another part of the body, but has now spread (metastasised) to the liver. Because it is a secondary cancer, it is considered advanced cancer.

Most cancers can spread to the liver. However, the most likely cancer to spread to the liver is bowel cancer. This is because the blood supply from the bowel is connected to the liver through the portal vein.

Although less common, melanoma and cancer in the breast, oesophagus, stomach, pancreas, ovary, kidney or lung can also spread to the liver.

Secondary cancer in the liver is sometimes found at the same time as the primary cancer. 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. Sometimes tests can’t find where the cancer started – 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. See types of cancer.

How common is cancer in the liver?

Primary liver cancer

This is one of the less common cancers in Australia. About 1600 people are diagnosed with it every year. It is more than twice as common in men, and the average age at diagnosis is 67.1

Primary liver cancer is becoming more common, mainly because the rate of hepatitis infection is increasing, and more people are developing serious damage from fatty liver disease. See below for an explanation of the link between hepatitis and liver cancer.

Hepatocellular carcinoma (HCC) is common in Asia, the Pacific Islands and Africa due to high rates of chronic hepatitis B infection. In Australia, HCC is more common in migrants from Vietnam, China, Taiwan, Hong Kong and Korea – countries where there is a higher rate of hepatitis B infection.

Secondary cancer in the liver

It is estimated that about 28,000 people are diagnosed in Australia every year.

What are the symptoms?

Primary liver cancer

This doesn’t tend to cause symptoms in the early stages, but they may appear as the cancer grows or becomes advanced.

Secondary cancer in the liver

The symptoms are similar to people with primary liver cancer. Symptoms can include:

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

What are the risk factors?

Primary liver cancer

In most cases, primary liver cancer is related to long-term (chronic) infection caused by the hepatitis B or C virus.

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

  • liver scarring (cirrhosis) – from hepatitis B or C, alcohol, fatty liver disease, or genetic disorders such as iron overload (haemochromatosis) or alpha-1 antitrypsin deficiency
  • type 2 diabetes
  • drinking too much alcohol
  • eating a high-fat diet and/or being overweight or obese
  • smoking tobacco
  • exposure to certain chemicals or substances (such as aflatoxins or vinyl chloride).
Secondary cancer in the liver

It’s not known why cancer spreads from where it started to other organs such as the liver.

What is cirrhosis?

This is a type of liver damage where healthy liver tissue is replaced with scar tissue. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.

Cirrhosis can develop over months or years.

Link between hepatitis and liver cancer

About 8 in 10 HCC cases worldwide can be linked to chronic hepatitis B infection.

Both hepatitis B and C are spread by contact with infected blood, semen or other body fluids. This can occur through sex with an infected partner or sharing personal items, such as razors, toothbrushes or needles, with an infected person.

The most common way that hepatitis B is spread is during birth, from mother to baby. 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 that can cause liver cancer.

Primary liver cancer is more common in people with high rates of infection with hepatitis B or C virus. 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).

If you are already infected with the virus, vaccination is not effective and you need regular tests to ensure you don’t develop health problems, including liver cancer. If you are concerned about hepatitis, talk to your doctor.

Which health professionals will I see?

Your general practitioner (GP) will usually arrange the first tests to assess your symptoms. If these tests don’t rule out cancer, you’ll be referred to a specialist, who will organise further tests and advise you about treatment options.

A range of health professionals will work as a multidisciplinary team (MDT) to treat you. The table below lists the health professionals in your MDT.

The health professionals you see will depend on whether you have primary liver cancer or secondary cancer in the liver.

If you live in a regional or rural area, you may need to travel for treatment. Every state and territory has a scheme that provides financial help to people who need to travel long distances to access specialist medical treatment not available in their local area. To apply, contact the relevant state or territory government department. For more details, talk to the hospital social worker or call Cancer Council 13 11 20.

Your GP can be kept up to date with all your test results and treatment. They can answer questions you have in between appointments with specialists.

"Calling 13 11 20 after I was diagnosed helped me take in the new information." - Luisa
Health professional Role
hepatobiliary surgeon* a doctor who specialises in surgery of the liver and its surrounding organs
gastroenterologist* diagnoses liver cancer and specialises in the digestive system and its disorders
hepatologist* a gastroenterologist who specialises in diseases of the liver
medical oncologist* prescribes and coordinates the course of chemotherapy
interventional radiologist* uses imaging scans to diagnose cancer, and delivers some treatments
cancer care coordinator or clinical nurse consultant (CNC) coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment
nurses administer drugs, including chemotherapy, and provide care, information and support throughout your treatment
dietitian recommends an eating plan to follow while you are in treatment and recovery
social worker links you to support services and helps you with emotional or practical issues
clinical psychiatrist*, counsellor, psychologist provide emotional support and help manage feelings of depression and anxiety
physiotherapist, occupational therapist assist with physical and practical problems
palliative care specialists* and nurses work closely with GP and oncologists to help control symptoms and manage quality of life when cancer is advanced

*Specialist doctor

1. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: Liver cancer, AIHW, Canberra, 2016. 

Reviewed by: Graham Starkey, Liver Surgeon, Austin Hospital, VIC; Dr Ken Chan, Interventional Radiologist, Dr Jones & Partners Medical Imaging and Royal Adelaide Hospital, SA; David Fry, Consumer; Caitriona Nienaber, Oncology Nurse, Council Council WA, WA; A/Prof Monica Robotin, University of Sydney and Medical Director, Cancer Council NSW, NSW; and Dr Manfred Spanger, Interventional Radiologist, Eastern Health, Knox Private Hospital and Epworth Eastern, VIC.

Primary liver cancer

Wednesday 1 June 2016

Secondary liver cancer

Wednesday 1 June 2016

After liver cancer surgery

Wednesday 1 June 2016

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