Liver cancer

A. Definition of liver cancer
Liver cancer or hepatic cancer (from the Greek hēpar, meaning liver) is a cancer that originates in the liver. Liver tumors are discovered on medical imaging equipment (often by accident) or present themselves symptomatically as an abdominal mass, abdominal pain, yellow skin, nausea or liver dysfunction.

Liver cancer can be a primary cancer (starts in the liver) or a secondary cancer (starts in another part of the body and spreads to the liver). Liver cancer usually has no symptoms in its early stages. Later symptoms can include pain in the abdomen, fever, yellowing of the skin and eyes (jaundice), and weight loss. Treatment may include surgery, chemotherapy and radiotherapy.

Liver cancer can be a primary cancer, meaning it starts in the liver, or a secondary cancer, meaning it starts in another part of the body and spreads to the liver. Secondary liver cancers are more common than primary liver cancers. Primary liver cancer is one of the less common cancers in Victoria. Liver cancer usually has no symptoms in the early stages.The liver is the largest organ inside the body. It is located on the right side of the abdomen and protected by the ribcage. The liver will function normally with only a small portion of it in working order.
The liver’s functions include:

• destroying harmful substances, such as alcohol, and getting rid of waste products
• converting food containing fats and sugars to energy that is used by the body
• producing bile to help with the digestion of food.

The leading cause of liver cancer is viral infection with hepatitis B virus or hepatitis C virus. The cancer usually forms secondary to cirrhosis caused by these viruses. For this reason, the highest rates of liver cancer occur where these viruses are endemic, including East-Asia and sub-Saharan Africa Liver cancers should not be confused with liver metastases, also known as secondary liver cancer, which are cancers that originate from organs elsewhere in the body and migrate to the liver. They are formed from either the liver itself or from structures within the liver, including blood vessels or the bile duct. Five year survival rates are 17% in the United States.

B. Primary liver cancers

Primary liver cancer is one of the less common cancers in Victoria, with about 380 people diagnosed each year. It is more common in men and people aged over 65 years. Most primary liver cancers start in liver cells (these are called hepatocellular carcinoma), while others start in a bile duct and are referred to as cholangiocarcinoma.
In Western cultures, most people who develop primary liver cancer also have cirrhosis of the liver. This is scarring of the liver due to causes such as heavy alcohol drinking over a long period of time. However, only a small number of people who have cirrhosis of the liver develop primary liver cancer. Infection with hepatitis B, C or D can also increase the risk of cirrhosis and, later, primary liver cancer.

C. Secondary liver cancers

Secondary liver cancer is the most common liver cancer. A secondary liver cancer starts somewhere else in the body and spreads (metastasises) to the liver.
Most cancers can spread to the liver. The most common types that do this are breast, stomach and bowel cancers. These liver cancers are named after the primary cancer, for example, breast cancer that has spread to the liver is called metastatic breast cancer. Sometimes, the liver cancer is discovered first, which leads to diagnosis of the primary cancer.

D. Causes of liver cancer

Liver cancer is often caused by damage to the liver due to:

• cirrhosis – scarring of the liver tissue from alcohol
• long-term infection with a hepatitis virus – hepatitis B, C or D
• some chemicals – (for example, arsenic) that are now rarely used
• smoking – hepatitis B or C infection increases the risk of liver cancer in people who smoke
• diabetes – people with diabetes have a risk of liver cancer that is two or three times higher than people who do not have diabetes.
• Certain types of inherited liver disease such as hemochromatosis, which results in accumulation of too much iron in the liver, as well as alpha-1 antitrypsin deficiency, and tyrosinemia can lead to the development of liver cancer later in life.
• Obesity increases the risk of liver cancer in those patients in whom it causes liver disease. 
• Anabolic steroids: long-term use of anabolic steroids can increase the risk of liver cancer.

The causes of secondary liver cancer are very different to those of a primary liver cancer. This is because secondary liver cancers means the cancer began elsewhere in the body (where the primary cancer is). The causes of secondary liver cancer will be the same as for the primary cancer type.
.
E. Symptoms of liver cancer

 Symptoms often don't appear in the early stages of liver cancer. There are few nerves through the liver, so someone with this type of cancer does not feel pain. Symptoms are the same for both primary and secondary liver cancer.
In later stages, liver cancer can cause an ache in the upper abdomen or back. Rather than feeling pain in the liver, it is felt in the surrounding area due to distension (swelling), irritation or inflammation of the liver.
Other symptoms include loss of appetite, weakness and loss of weight (particularly loss of muscle in the arms and legs), nausea, fever and jaundice (yellowing of the skin and whites of the eyes). The abdomen may also be swollen.
If you have one of these symptoms, remember that liver cancer is rare, and your symptom is likely to be due to something else. However, see your doctor if you have any symptom that persists for more than two weeks. Do not delay seeing a doctor if you have any signs of jaundice or unexplained loss of muscle in your arms and legs.

F. Treatment for liver cancer

Treatment for liver cancer will depend on whether it is a primary or secondary cancer. Treatment options may include:

• surgery – to remove the cancer and damaged tissue. This is the main treatment for primary liver cancer. Surgery is only useful for secondary liver cancer if the cancer cells only affect one area of the liver.
• tumour ablation – usually uses radio waves or microwaves to heat and destroy cancer cells. It may be used if there are one or two small tumours present and surgery is not an option. It is mainly used for primary liver cancer. It is rarely used for secondary liver cancer.
• chemotherapy – the use of tablets or injections of anti-cancer drugs. Sometimes, they are introduced into the veins via a drip, or injected directly into the artery that feeds the cancer in the liver. Chemotherapy is the main treatment for secondary liver cancer and it is also sometimes used for primary liver cancer.
• radiotherapy – x-rays are used to target and kill cancer cells. Radiotherapy may help in treating some types of primary liver cancers, and may be used to relieve symptoms of pain and discomfort from secondary liver cancer.
• complementary and alternative therapies – when used alongside your conventional cancer treatment, some of these therapies can make you feel better and improve your quality of life. Others may not be so helpful and in some cases may be harmful. The Cancer Council Victoria booklet called Understanding complementary therapies can be a useful resource. All treatments can have side effects. Your medical team will discuss these with you before you begin any type of treatment.