Primary liver cancer is cancer that originates in the liver. There are two main types: hepatocellular carcinoma (80%) and cholangiocarcinoma (20%).
Secondary liver cancer is cancer that originates outside the liver and metastasises to the liver. Metastasis to the liver can occur in almost any cancer that spreads. There is a poor prognosis of any cancer with liver metastasis. The first stage is to search for the primary (e.g. full body CT scan and thorough history and examination of the skin and breasts). It is not uncommon to have liver metastases of unknown primary.
The main risk factor for hepatocellular carcinoma (HCC) is liver cirrhosis due to:
- Viral hepatitis (B and C)
- Non alcoholic fatty liver disease
- Other chronic liver disease
Patients with chronic liver disease are screened for HCC.
Cholangiocarcinoma is associated with primary sclerosing cholangitis. However, only 10% of patients with cholangiocarcinoma had primary sclerosing cholangitis. Cholangiocarcinoma usually presents in patients > 50 years old unless related to primary sclerosing cholangitis.
Liver cancer often remains asymptomatic for a long time and then presents late making prognosis poor.
There are non specific symptoms associated with liver cancer:
- Weight loss
- Abdominal pain
- Nausea and vomiting
Cholangiocarcinoma often presents with painless jaundice in a similar way to pancreatic cancer.
- Alpha-fetoprotein is a tumour marker for hepatocellular carcinoma.
- CA19-9 is a tumour marker for cholangiocarcinoma.
- Liver ultrasound can identify tumours.
- CT and MRI scans are used for diagnosis and staging of the cancer.
- ERCP can be used to take biopsies or brushings to diagnose cholangiocarcinoma.
Treatment of Hepatocellular Carcinoma
HCC has a very poor prognosis unless diagnosed early. Resection of early disease in a resectable area of the liver can be curative. Liver transplant when the HCC is isolated to the liver can be curative.
There are several kinase inhibitors that are licensed as medical treatment for HCC. They work by inhibiting the proliferation of cancer cells. Some examples of these are sorafenib, regorafenib and lenvatinib. They can potentially extend life by months.
HCC is generally considered resistant to chemo and radiotherapy. In certain circumstances they are used as part of palliative treatment or clinical trials.
Treatment of Cholangiocarcinoma
Cholangiocarcinomas have a very poor prognosis unless diagnosed very early. Early disease can potentially be cured with surgical resection.
ERCP can be used to place a stent in the bile duct where the cholangiocarcinoma is compressing the duct. This allows for drainage of bile and usually improves symptoms.
Cholangiocarcinoma is also generally considered resistant to chemo and radiotherapy.
Haemangiomas are common benign tumours of the liver. They are often found incidentally. They cause no symptoms and have no potential to become cancerous. No treatment or monitoring is required.
Focal nodular hyperplasia
Focal nodular hyperplasia is a benign liver tumour made of fibrotic tissue. This is often found incidentally. It is usually asymptomatic and has no malignant potential. It is often related to oestrogen and is therefore more common in women and those on the oral contraceptive pill. No treatment of monitoring is required.
Last updated February 2019