There are four main types of primary liver cancer:

• hepatocellular carcinoma (HCC) – the most common type of liver cancer
• cholangiocarcinoma – cancer that starts in the bile ducts
• angiosarcoma – extremely rare with only around 10 cases diagnosed each year
• hepatoblastoma – another rare form of liver cancer, most commonly diagnosed in very young children.

Hepatocellular carcinoma is the most common type of primary liver cancer. It’s most common in people whose liver is damaged due to cirrhosis. Cirrhosis means that the liver is scarred from previous damage, possibly due to an infection such as hepatitis B or C, long-term alcohol abuse and some inherited diseases. This type of cancer is more likely to affect men and the risk increases with age.

A rarer subtype of hepatocellular carcinoma is called fibrolamellar carcinoma. This type of liver cancer is more common in young people.

The exact cause of liver cancer isn’t understood, but there are a number of factors that can put you at risk including:²

• cirrhosis – the scarring of your liver, usually due to damage caused by a virus, alcohol or a hereditary disease
• smoking
• hepatitis B or C infection
• regularly drinking more than 5 units of alcohol each day
• non-alcoholic fatty liver disease (NAFLD)
• low immunity
• a family history of liver cancer
• diabetes
• gallbladder removal
• obesity.

² Cancer Research UK, Causes and risk factors http://www.nhs.uk/Conditions/Cancer-of-the-liver/Pages/Causes.aspx

Symptoms of liver cancer can be vague and don’t usually appear until the disease is at an advanced stage. They can include:

• unexplained weight loss
• poor appetite for over a week
• feeling very full after eating even small amounts
• feeling sick or vomiting
• a swollen tummy (abdomen)
• jaundice, which means your skin and eyes look yellow
• itchy skin
• feeling weak and tired.

Most people who notice these symptoms don’t have liver cancer. But you should get them looked into by a doctor so you can treat any problems early.

Diagnosing liver cancer
Your doctor will want to examine you, and ask questions about your health and symptoms. If they think you need further tests, you’ll need to see a liver specialist.

At BMI Healthcare, our consultants and liver specialists may want to run some further tests.

• Blood tests to check your general health and how well your liver is working
• An ultrasound scan lets your consultant see inside your liver
• A CT scan that looks for signs of cancer in your liver and other parts of your body
• An MRI scan helps detect cancer in your liver or elsewhere in your body
• Biopsy removes a sample of tissue so it can be looked at under a microscope. It’s the only way to clearly tell between a cancerous or non-cancerous growth
• Laparoscopy is a small operation that lets your consultant surgeon look at your liver using a thin, flexible tube with a camera on the end called a laparoscope.

Stages of liver cancer
After the tests have been carried out to diagnose your cancer, your consultant specialist will see you with the results. They will be able to tell you what stage your liver cancer is at. This will influence the type of treatment you are offered.

• Stage 1: The cancer is small and hasn’t spread
• Stage 2 or 3: The cancer has spread into nearby areas
• Stage 4: The cancer has spread to other parts of your body. This is called metastatic or secondary liver cancer.³

³ Macmillan, Staging of primary liver cancer http://www.macmillan.org.uk/Cancerinformation/Cancertypes/
Liver/Symptomsdiagnosis/Staging.aspx

The type of treatment you’re offered depends on the type and stage of your liver cancer. Some people might need one type of treatment, whereas others might need a few different ones.

Surgery
Surgery is the most effective treatment for primary liver cancer that hasn’t spread. This involves a liver transplant or a liver resection and means removing the cancer from your liver. The liver has the ability to repair itself. Even if up to 80% of the liver is removed it will start to regrow in a short space of time.

Radiofrequency ablation (RFA)
This treatment uses radio waves to heat up and attack cancer cells. This procedure can be carried out under local or general anaesthetic.

Microwave ablation
This is a recent treatment. It’s similar to radiofrequency ablation but it uses microwaves instead of radio waves to heat up the cancer cells and attack them. This treatment may not be possible if your tumour is too close to another organ such as the bowel.

Percutaneous ethanol injection (PEI)
By injecting alcohol (ethanol) into the cancer in your liver the tissue is dehydrated, which stops the blood supply to the cancer. It’s most suitable for people who only have a few small tumours. This is most often carried out under a local anaesthetic and you will often have more than one session of treatment. The number of sessions will depend on the size of your tumour.

Chemoembolisation
Sometimes called transarterial chemoembolisation (TACE), this treatment gives chemotherapy directly to your liver. The consultant specialist will also inject a substance into the blood vessel to cut off the blood supply to the tumour (embolisation). This reduces the supply of oxygen and food to the tumour and can help to shrink it.

Chemoembolisation generally helps to manage the symptoms of liver cancer rather than cure it.

Radioembolisation
Radioembolisation is another recent treatment. It’s similar to chemoembolisation but uses radiation to attack the cancer cells. Like chemoembolisation, this treatment is generally used to manage symptoms rather than cure. This treatment may also be called selective internal radiation therapy (SIRT).

Biological therapy
Biological therapies, sometimes known as targeted therapies, are treatments that act on processes in the cells. They can interfere with the growth of some types of cancer cells. They can also slow the growth of new blood vessels to the tumour.

Chemotherapy
Depending on the type and size of your tumour your consultant specialist might recommend chemotherapy. Chemotherapy drugs can be given intravenously (injected into a vein), by taking tablets, or by injecting the drugs directly into the liver. Chemotherapy can help to slow down the cancer’s growth and control your symptoms.

Radiotherapy
Radiotherapy is only occasionally used to treat liver cancer. This is because radiation can damage healthy liver cells. It’s sometimes used if the cancer has spread to other areas of the body to help treat the area and control symptoms like pain.

After treatment
You’ll have regular check-ups following your liver cancer treatment. How often and for how long depends on the kind of treatment that you had.

At follow-up appointments, your doctor will ask how you’re feeling and examine you. You might also need blood tests, a CT or MRI scan, an ultrasound scan or a combination of these.

If you’re worried or spot any new symptoms between appointments, you should tell your doctor as soon as you can.

Paying for your treatment 
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.

Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.

If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.

Want to know more?
If you’d like to read more about liver cancer, treatment or living with liver cancer, please visit cancerresearchuk.org.uk.