Liver cancer

Liver cancer is a cancer that's found anywhere in the liver.

What is liver cancer?

• Liver cancer is a cancer that's found anywhere in the liver.
• The liver is a large organ at the top right side of your tummy.
• It helps you digest your food and removes toxins.
• Liver cancer can sometimes start in your liver (primary) or spread from another organ (secondary).
• How serious liver cancer is depends on where it is in the liver, how big it is, if it has spread, if it's primary or secondary and your general health.

Symptoms of liver cancer

Main symptoms of liver cancer

Liver cancer may not have any symptoms, or they might be hard to spot.

The symptoms are the same if the liver cancer starts in the liver (primary liver cancer) or spreads from another part of the body (secondary liver cancer).

Symptoms of liver cancer can include:

• the whites of your eyes turning yellow or your skin turning yellow, which may be less obvious on brown or black skin (jaundice) – you may also have itchy skin, darker pee and paler poo than usual
• loss of appetite or losing weight without trying to
• feeling tired or having no energy
• feeling generally unwell or having symptoms like flu
• a lump in the right side of your tummy

Other symptoms can affect your digestion, such as:

• feeling or being sick
• pain at the top right side of your tummy or in your right shoulder
• symptoms of indigestion, such as feeling full very quickly when eating
• a very swollen tummy that is not related to when you eat

See a GP if you have:

• a lump in your tummy
• lost a lot of weight without trying
• symptoms of liver cancer that get worse or do not get better after 2 weeks

Important

Many of these symptoms are very common and can be caused by different conditions.

Having them does not definitely mean you have liver cancer. But it's important to get them checked by a GP.

This is because if they're caused by cancer, finding it early may mean it's easier to treat.

What happens at the GP appointment

The GP may feel your tummy. They may also listen to your chest.

Referral to a specialist

You may get an urgent referral for more tests or to see a specialist in hospital if the GP thinks you have symptoms that could be cancer. This does not definitely mean you have cancer.

Causes of liver cancer

Who is more likely to get liver cancer

Anyone can get primary liver cancer. It's not always clear what causes it.

You might be more likely to get it if you:

• are over 60 – it's most common in people over 85
• are a man
• have certain medical conditions, such as hepatitis, liver cirrhosis, gallstones, diabetes, a parasite in the liver (liver flukes) or HIV
• have a brother, sister or parent who had primary liver cancer

Secondary liver cancer is caused by cancer cells from a cancer somewhere else in the body spreading to the liver.

Many liver cancers are also linked to your lifestyle.

How to reduce your chances of getting primary liver cancer

You cannot always prevent liver cancer. But making healthy changes can lower your chances of getting it.

Do

• try to lose weight if you're overweight

• wear protective clothes and masks if you work in a job where you're exposed to harmful chemicals

• try to cut down on alcohol – avoid drinking more than 14 units a week

• try to quit smoking

It's important to get any symptoms of liver cancer checked by a GP.

Anyone can get liver cancer, even if you do not think you have a higher chance of getting it.

Tests and next steps for liver cancer

Main tests for liver cancer

You will need tests and scans to check for liver cancer if the GP refers you to a specialist.

These tests can include:

• blood tests
• scans, like an ultrasound scan, CT scan or MRI scan
• collecting a small sample of cells from the liver (called a biopsy), to be checked for cancer

You may not have all these tests.

If you've already had another kind of cancer and the specialist thinks it might have spread to your liver (secondary liver cancer) you may also have a PET scan.

These tests can also help find problems in your bile ducts, pancreas or gallbladder.

Getting your results

It can take several weeks to get the results of your tests.

Try not to worry if your results are taking a long time to get to you. It does not mean anything is definitely wrong.

You can call the hospital or GP if you are worried. They should be able to update you.

A specialist will explain what the results mean and what will happen next. You may want to bring someone with you for support.

If you're told you have liver cancer

Being told you have liver cancer can feel overwhelming. You may be feeling anxious about what will happen next.

It can help to bring someone with you to any appointments you have.

A group of specialists will look after you throughout your diagnosis, treatment and beyond.

Your team will include a clinical nurse specialist who will be your main point of contact during and after treatment.

You can ask them any questions you have.

Treatment for liver cancer

Main treatments for liver cancer

Liver cancer is often treatable, but it can be difficult to treat.

The treatment you have will depend on:

• if the cancer started in the liver (primary) or spread from somewhere else (secondary), but treatments for primary and secondary liver cancer are similar
• the size and type of liver cancer you have
• where it is
• if it has spread
• your general health

It may include surgery, chemotherapy, using heat to destroy the cancer (thermal ablation), targeted medicines, and radiotherapy.

The specialist care team looking after you will:

• explain the treatments, benefits and side effects
• work with you to create a treatment plan that is best for you
• help you manage any side effects, including changes to your diet to help you digest your food

You'll have regular check-ups during and after any treatments. You may also have tests and scans.

If you have any symptoms or side effects that you are worried about, talk to your specialists. You do not need to wait for your next check-up.

Surgery

If liver cancer is found early, is small and it has not spread, you may be able to have surgery to remove it.

Surgery will remove part or all of your liver. If it's all removed you will need a liver transplant to replace your liver with a donated one.

Recovery from surgery to treat liver cancer can take a long time. The specialist team looking after you will discuss all the benefits and side effects.

Chemotherapy

Chemotherapy uses medicines to kill cancer cells.

For liver cancer, the chemotherapy medicine is usually given into the blood vessels of the cancer. It aims to stop the cancer growing. This is called chemoembolisation.

You'll usually have chemoembolisation to help make the cancer smaller, or to control and improve the symptoms.

This is done if you are not able to have surgery because you are very unwell, or the cancer cannot be removed by surgery.

Using heat to destroy the cancer (thermal ablation)

Thermal ablation uses an electric current or microwaves to destroy the cancer.

You may have thermal ablation to treat liver cancer if you're not able to have surgery because you are very unwell, or the cancer cannot be removed by surgery.

Targeted medicines

Targeted cancer medicines aim to stop the cancer from growing.

You may have treatment with targeted medicines for liver cancer if:

• you cannot have surgery because you are very unwell, or the cancer cannot be removed by surgery
• the cancer has spread to another part of the body

Radiotherapy

Radiotherapy is where radiation is used to kill cancer cells.

A type of radiotherapy called selective internal radiation therapy (SIRT) is sometimes used to treat liver cancer. This is where radioactive beads are injected into your liver's blood supply to stop the cancer growing.

You may have SIRT for liver cancer if you're an adult and:

• your liver has not been too badly damaged
• the cancer cannot be removed by surgery

What happens if you’ve been told your cancer cannot be cured

If you have advanced liver cancer it might be very hard to treat. It may not be possible to cure the cancer.

If this is the case, the aim of your treatment will be to limit the cancer and its symptoms, and help you live longer.

Finding out the cancer cannot be cured can be very hard news to take in.

You will be referred to a special team of doctors and nurses called the palliative care team or symptom control team.

They will work with you to help manage your symptoms and make you feel more comfortable.

The clinical nurse specialist or palliative care team can also help you and your loved ones get any support you need.