Liver cancer

Liver Cancer showing on upper GI body diagram

Facts and figures about liver cancer

Liver cancer is the 18th most common cancer in the UK. Primary liver cancer accounts for 1% of all cancers in the UK. Higher incidence in men with a male to female ratio of approximately 18:10. Age related with approximately 81% of cases diagnosed in those 65+ years.

Liver cancer incidence has increased since the mid 1970s and risks include heavy alcohol consumption, Hepatitis B and Hepatitis C infection. The majority of liver cell cancers are hepatocellular carcinomas. Many cases of liver cancer are metastatic or secondary tumours that have spread from primary tumours in other parts of the body such as colon, rectum, stomach or oesophagus.

Only a small number of primary liver tumours are diagnosed early.

Liver cancer symptoms

  • Jaundice.
  • Pain and/or swollen abdomen.
  • Weight loss.
  • Night sweats and/or fever.

Diagnosis of liver cancer

Investigations may include:

  • Physical examination.
  • Blood tests.
  • Ultrasound scan.
  • CT scan.
  • MRI scan.
  • Needle biopsy – local anaesthetic is used, tissue sample is acquired by putting needle through the skin into the liver using ultrasound to guide the needle.
  • Laparoscopy – tissue samples may be taken for biopsy.

Liver cancer treatment

Depends on several factors:

  • The type of liver cancer.
  • The position of the tumour in the liver.
  • The stage of the cancer.
  • Liver function.
  • General health.

Surgery

Surgery may be used in early stage. This can either be by removing the liver and proceeding with a liver transplant or removing the affected part of the liver (resection). Surgery is only considered if the cancer is contained within the liver.

Radiofrequency ablation (RFA)

This uses radio waves to heat up the cancer cells until they are destroyed. Under local or general anaesthetic, a needle is put through the skin (guided by ultrasound or CT scan) and then radio waves are sent down the needle to the tumour site. Only appropriate for small tumours that are not close to major blood vessels.

Microwave ablation

This is a newer treatment to RFA, using the same technique but using slightly different energy waves i.e. microwaves. May not be an option if tumour is too close to another organ.

Percutaneous ethanol injection

This involves injecting alcohol through the skin directly into the liver tumour during an ultrasound scan. The alcohol destroys the tumour by dehydrating the tissue and stopping its blood supply.

Chemoembolisation (Trans arterial chemoembolisation TACE)

Chemotherapy is administered directly into the liver using tiny plastic beads (microspheres) that give off a chemotherapy drug or through a catheter directly into the artery and then plugging up the artery. These block the blood vessels to the tumour site in the liver, reducing the supply of oxygen and nutrients to the tumour and may make it shrink.

It can be used in conjunction with other treatments such as surgery of RFA. This may help to control the disease but it is unlikely to cure.

Radioembolisation

A new treatment that is now being used, similar to TACE, but using radioactive isotopes instead of chemotherapy.

Chemotherapy

Chemotherapy is rarely used in liver cancer but may be suggested for advanced disease to help control the symptoms and slow the growth of the tumour. There are limited benefits for hepatocellular cancer (HCC) and a risk of more severe side effects in patients with cirrhosis.

Radiotherapy

Radiotherapy is not routinely used in liver cancer as it can damage healthy liver cells. However, if the disease has spread, it may be used to control symptoms such as pain. Clinical trials are researching the use of radiotherapy in primary liver cancer.

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