About primary liver cancer

What is primary liver cancer?

Primary liver cancer is a malignant (cancerous) tumour that starts in the liver. The most common type of primary liver cancer in adults is hepatocellular carcinoma (HCC). HCC starts in the hepatocytes, the main type of liver cell.

Less common types of primary liver cancer include:

• cholangiocarcinoma or bile duct cancer - starts in the cells lining the bile ducts
• angiosarcoma and hemangiosarcoma - rare types of liver cancer that start in the blood vessels
• hepatoblastoma - a rare type of liver cancer that affects only young children.

Cancers in the liver can be either a primary or secondary cancer. The two types of cancer are different. Secondary liver cancer is cancer that has started in another part of the body and spread to the liver. It is more common than primary liver cancer in Australia.

If you are unsure if you have primary or secondary liver cancer, check with your doctor.

How common is liver cancer?

In Australia, more than 3000 people are diagnosed with primary liver cancer each year, with almost three times more men than women affected. The rate of primary liver cancer has almost doubled since 2002, which is possibly due to increasing rates of obesity, type 2 diabetes, hepatitis B and C infections, drinking too much alcohol, and an ageing population. About 80% of cases occur in people aged 60 and over.

About the liver

The largest organ inside the body, the liver is about the size of a football. It is part of the digestive system, working with the gallbladder and pancreas to help break down food and turn it into energy.

The liver has many important jobs, including:

• storing sugars and fats, so they can be used for energy
• producing bile which helps dissolve fat so it can be easily digested
• making proteins to help blood clot and to balance fluid in the body
• breaking down harmful substances, such as drugs and alcohol.

The liver is found on the right side of the abdomen (belly) sitting just above the stomach and under the rib cage. The two main sections of the liver are the right and left lobes.

How the liver works

Blood flows into the liver from the hepatic artery and the portal vein. The hepatic artery carries blood from the heart. The portal vein carries blood from the digestive organs to the liver.

Bile is carried between the liver, the gallbladder and the first part of the small bowel (the duodenum) by a series of tubes called bile ducts. The common bile duct carries bile from the liver and the gallbladder to the bowel, where the bile helps to break down and absorb fats and other nutrients from food.

The liver can continue to work when only a small part is healthy. A healthy liver may be able to repair itself if it is injured or part of it is surgically removed during cancer treatment.

Which health professionals will I see?

Your general practitioner (GP) will arrange the first tests to assess your symptoms or to follow up abnormal results from ultrasound or blood tests that have been done to check for liver cancer. If these tests show that you have liver cancer - or there is concern about possible cancer - you will usually be referred to a specialist. This is likely to be a hepatobiliary surgeon, gastroenterologist or hepatologist. The specialist will arrange further tests.

If liver cancer is diagnosed, the specialist will consider treatment options. Often these will be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting.

During and after treatment, you will see a range of health professionals who specialise in different aspects of your care. Primary liver cancer is challenging to treat and it is recommended that you are treated in a specialist treatment centre if possible.

Health professionals you may see

• hepatobiliary surgeon: operates on the liver, gallbladder, pancreas and surrounding organs
• gastroenterologist: diagnoses and treats disorders of the digestive system, including liver cancer; may treat liver cancer with drug therapies
• hepatologist: a gastroenterologist specialising in liver disease
• interventional radiologist: analyses x-rays and scans, may also perform a biopsy under ultrasound or CT and deliver some treatments
• medical oncologist: treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy (systemic treatment)
• radiation oncologist: treats cancer by prescribing and overseeing a course of radiation therapy
• cancer care coordinator: coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment; care may also be coordinated by a clinical nurse consultant (CNC) or clinical nurse specialist (CNS)
• nurse, hepatology nurse: administer drugs and provide care, information and support; a hepatology nurse specialises in liver cancer
• occupational therapist: assists in adapting your living and working environment to help you resume usual activities after treatment
• physiotherapist, exercise physiologist: help restore movement and mobility, and improve fitness and wellbeing
• social worker: links you to support services and helps you with emotional, practical and financial issues
• psychiatrist, counsellor, psychologist: help you manage your emotional response to diagnosis and treatment
• dietitian: helps with nutrition concerns and recommends changes to diet during treatment and recovery
• palliative care team: works closely with your GP and cancer team to help control symptoms and maintain quality of life; includes palliative care specialists and nurses, as well as other health professionals