Health A to Z
Primary liver cancer is an uncommon but serious type of cancer that begins in the liver.
This is a separate condition from secondary liver cancer, where the cancer developed in another part of the body and spread to the liver.
Read about secondary liver cancer on Macmillan Cancer Support.
This topic covers:
Symptoms of liver cancer are often vague and don't appear until the cancer is at an advanced stage. They can include:
Visit your GP if you notice any of the symptoms listed above. They're more likely to be the result of a more common condition, such as an infection, but it's best to have them checked.
The exact cause of liver cancer is unknown, but most cases are associated with damage and scarring of the liver known as cirrhosis.
Cirrhosis can have a number of different causes, including:
It's also believed obesity and an unhealthy diet can increase the risk of liver cancer because this can lead to non-alcoholic fatty liver disease.
You may be able to significantly reduce your chances of developing liver cancer by:
Although liver cancer is relatively uncommon in the UK, the chances of developing the condition are high for people with risk factors for the condition.
Over the past few decades, rates of liver cancer in the UK have risen considerably, possibly as a result of increased levels of alcohol consumption and obesity.
Liver cancer is usually diagnosed after a consultation with a GP and a referral to a hospital specialist for further tests, such as scans of your liver.
However, regular check-ups for liver cancer (known as surveillance) are often recommended for people known to have a high risk of developing the condition, such as those with cirrhosis.
Having regular check-ups helps ensure the condition is diagnosed early. The earlier liver cancer is diagnosed, the more effective treatment is likely to be.
Read about diagnosing liver cancer.
Treatment for liver cancer depends on the stage the condition is at. If diagnosed early, it may be possible to remove the cancer completely.
Treatment options in the early stages of liver cancer include:
However, only a small proportion of liver cancers are diagnosed at a stage where these treatments are suitable. Most people are diagnosed when the cancer has spread too far to be removed or completely destroyed.
In these cases, treatments such as chemotherapy are used to slow down the spread of the cancer and relieve symptoms such as pain and discomfort.
Read about treating liver cancer.
For many people, the first stage of diagnosing liver cancer is a consultation with a GP, although people at risk are usually tested regularly for the condition.
If you visit your GP, they'll ask about your symptoms, when they started, and when they're noticeable. They'll also examine you.
If they feel you need further tests, you'll be referred to a hospital specialist. Some of the tests you may have are described below.
If you're in a high-risk group for developing liver cancer, regular screening – known as surveillance – is often recommended. This is because the earlier the cancer is diagnosed, the greater the chance there is of curing it.
Surveillance is usually carried out every six months and often involves:
Surveillance is usually recommended if you have cirrhosis (scarring of the liver), although there are other factors that can also affect your risk of liver cancer.
The potential benefits of surveillance should be discussed with you before you enter any screening programme.
The tests above can also be used to look for liver cancer in people who aren't being routinely screened.
If these initial tests suggest there's a chance you could have liver cancer, one or more further tests will usually be recommended to confirm the diagnosis.
The further tests include:
After these tests have been carried out, it's usually possible to confirm a diagnosis of liver cancer and determine the condition's "stage".
Staging is a term used to describe how far a particular cancer has spread. There are a number of different systems used to stage liver cancer.
Many liver cancer specialists use combination staging systems that include features of both the cancer and the underlying liver function to stage a person's condition.
This is because the length of time a person lives and how well they tolerate potential treatments will be determined not only by how advanced their cancer is, but also by their level of health and how good their underlying liver function is.
One combination system for staging liver cancer is known as the Barcelona Clinic Liver Cancer (BCLC) staging system. The BCLC staging system consists of five stages. These are:
Read more about staging primary liver cancer on the Cancer Research UK website.
The treatment for liver cancer depends on the stage of the condition. Treatment can include surgery and medication.
Most hospitals use multidisciplinary teams (MDTs) to treat liver cancer. These are teams of specialists that work together to make decisions about the best way to proceed with your treatment.
Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
Your recommended treatment plan will depend on the stage your liver cancer is at (see diagnosing liver cancer for more information about staging).
If your cancer is at stage A when diagnosed, a complete cure may be possible. The three main ways this can be achieved are:
If your cancer is at stage B or C, a cure isn't usually possible. However, chemotherapy can slow the progression of the cancer, relieve symptoms, and prolong life for months or, in some cases, years. There's also a medication called sorafenib that can help prolong life.
If your cancer is at stage D when diagnosed, it's usually too late to slow down the spread of the cancer. Instead, treatment focuses on relieving any symptoms of pain and discomfort you may have.
The main treatment options for liver cancer are discussed in more detail below.
If damage to your liver is minimal and the cancer is contained in a small part of your liver, it may be possible to remove the cancerous cells during surgery. This procedure is known as surgical resection.
As the liver can regenerate itself, it may be possible to remove a large section of it without seriously affecting your health. However, in the majority of people with liver cancer, their liver's regenerative ability may be significantly impaired and resection may be unsafe.
Whether or not a resection can be performed is often determined by assessing the severity of your cirrhosis (scarring of the liver).
If a liver resection is recommended, it will be carried out under a general anaesthetic, which means you'll be asleep during the procedure and won't feel any pain as it's carried out.
Most people are well enough to leave hospital within a week or two of having surgery. However, depending on how much of your liver was removed, it may take several months for you to fully recover.
Liver resection is a complicated surgery and can have a considerable impact on your body. There's a significant risk of complications occurring during and after surgery.
Possible complications of liver resection include:
Liver resection can also sometimes cause fatal complications, such as a heart attack. It is estimated that around 1 in every 30 people who have liver resection surgery will die during or shortly after the operation.
A liver transplant involves removing a cancerous liver and replacing it with a healthy one from a donor.
This is a major operation and there's a risk of potentially life-threatening complications. It's estimated around 1 in every 30 people will die during the procedure and up to 1 in 10 people will die at some point in the year after surgery.
A liver transplant may be suitable for you if:
If you have multiple tumours or a tumour larger than 5cm, the risk of the cancer returning is usually so high that a liver transplant will be of no benefit.
If you're suitable for a liver transplant, you'll normally need to be placed on a waiting list until a donor liver becomes available. The average waiting time for a liver transplant is 142 days for adults.
In some cases, a small part of the liver of a living relative can be used. This is known as a living donor liver transplant.
The advantage of using a living donor liver transplant is that the person receiving the transplant can plan the procedure with their medical team and relative, and won't usually have to wait very long.
Read more about liver transplants.
Microwave or radiofrequency ablation (RFA) may be recommended as an alternative to surgery to treat liver cancer at an early stage, ideally when the tumour or tumours are smaller than 5cm (50mm) in diameter.
They can also be used to treat tumours larger than this, but the treatment may need to be repeated in such cases.
These treatments involve heating the tumours with microwaves or radio waves produced by small, needle-like electrodes. This heat kills the cancer cells and causes the tumours to shrink.
Similar procedures using lasers or freezing can also achieve the same result.
There are three main ways microwave ablation or RFA can be carried out:
Microwave ablation or RFA can be carried out under general anaesthetic or local anaesthetic (where you're awake but the area being treated is numbed), depending on the technique used and the size of the area being treated.
How long it takes to carry out the treatment depends on the size and number of tumours being treated, but it usually takes between one and three hours in total. Most people need to stay overnight in hospital.
You may experience some minor discomfort and flu-like symptoms, such as chills and muscle pains, for a few days after the procedure.
The risk of complications occurring with microwave ablation or RFA is low, but possible problems can include bleeding, infection, minor burns and damage to nearby organs.
Chemotherapy uses powerful cancer-killing medications to slow the spread of liver cancer.
A type of chemotherapy called transcatheter arterial chemoembolisation (TACE) is usually recommended to treat cases of stage B and C liver cancer. In these cases, the treatment can prolong life, but cannot cure the cancer.
TACE may also be used to help prevent cancer spreading out of the liver in people waiting for a liver transplant.
It's not recommended for stage D liver cancer because it can make the symptoms of liver disease worse.
During TACE a fine tube called a catheter is inserted into the main blood vessel in your groin (femoral artery) and passed along the artery to the main blood vessel that carries blood to the liver (hepatic artery).
Chemotherapy medication is injected directly into the liver through the catheter and either a gel or small plastic beads are injected into the blood vessels supplying the tumours to help slow down the speed they grow at.
TACE usually takes one to two hours to complete. After the procedure, you will stay in hospital overnight before returning home.
This procedure can be completed several times if necessary.
Injecting chemotherapy medications directly into the liver, rather than into the blood, has the advantage of avoiding the wide range of side effects associated with conventional chemotherapy, such as hair loss and tiredness.
However, the procedure is not free of side effects and complications. The most common side effect is post-chemoembolisation syndrome, which can cause abdominal (tummy) pain and a high temperature (fever), as well as making you vomit or feel sick.
These symptoms may last for a few weeks after a TACE session.
Read more about chemotherapy.
If you only have a few small tumours, alcohol (ethanol) injections may be used as a treatment. A needle passes through the skin to inject alcohol into the cancerous cells. This dehydrates the cells and stops their blood supply.
In most cases, this is carried out under a local anaesthetic, meaning you'll be awake, but the affected area is numbed so you won't feel any pain.
Sorafenib is a medication given in tablet form that can disrupt the blood supply to liver tumours and slow down their growth.
It's sometimes used as a treatment for advanced cases of liver cancer, although it's not routinely available on the NHS because the National Institute for Health and Care Excellence (NICE) has said the cost of the medication is too high for the limited benefit it offers.
Whether or not you're eligible for sorafenib will be decided by your medical team, and depends on whether you're likely to significantly benefit from the medication.
For more information, see the NICE guidelines on sorafenib for the treatment of advanced hepatocellular carcinoma.
Treatment for advanced liver cancer focuses on relieving symptoms such as pain and discomfort, rather than attempting to slow down the progression of the cancer.
Some people with advanced liver cancer require strong painkillers, such as codeine or possibly morphine. Nausea and constipation are common side effects of these types of painkillers, so you may also be given an anti-sickness tablet and a laxative.
Read more about end of life care.
The exact cause of liver cancer is unknown, but many cases are linked to a problem with the liver called cirrhosis. This is where the tissue of the liver has become scarred and cannot perform many of its usual functions.
Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably, producing a lump of tissue known as a tumour.
In cases of liver cancer, it is uncertain why and how the cells of the liver are affected, but it appears that cirrhosis can increase a person's chances of developing the condition.
However, most cases of cirrhosis do not lead to liver cancer, and people without cirrhosis can also develop liver cancer.
The main causes of cirrhosis in the UK are outlined below.
The liver is a tough and resilient organ. It can endure a high level of damage that would destroy other organs and is capable of regenerating itself. But despite the liver's resilience, excessive alcohol intake over many years can damage it.
Every time you drink alcohol, your liver filters out the poisonous alcohol from your blood and some of the liver cells die. The liver can regenerate new cells, but if you drink heavily for many years, your liver will lose the ability to do this and it can become damaged and scarred over time.
Non-alcoholic fatty liver disease occurs when small deposits of fat build up inside the tissue of the liver. It's a common condition and causes no noticeable symptoms in most people.
However, in some people high levels of fat can make the liver inflamed. Over time, the inflammation can scar the liver.
A long-term infection of hepatitis C can cause inflammation and scarring of the liver.
Hepatitis C is spread by blood contact. The most common ways this happens worldwide include poor medical practice with the use of contaminated needles, or injected drug use, where any item of injecting equipment (not just needles) is shared.
If you smoke or regularly drink alcohol and have hepatitis C, your risk of developing liver cancer further increases.
Early treatment of long-term hepatitis C with antiviral medication can prevent the liver becoming scarred.
Less common causes of cirrhosis in the UK are described below.
Hepatitis B is a virus that can be spread through contaminated blood and other types of bodily fluids, such as saliva, semen and vaginal fluids.
Like hepatitis C, hepatitis B is spread through blood contact. It is most commonly spread from mother to child at birth or from child to child in early life (usually in areas outside the UK where the infection is very common), and very rarely sexually or through injecting drugs.
It affects about 1 in every 200 people in the UK. Most of those infected were born in parts of the world where the hepatitis B virus is very common.
As with hepatitis C, hepatitis B can also cause inflammation and scarring of the liver over time.
If you smoke or drink and have hepatitis B, your risk of developing liver cancer further increases.
Early treatment of long-term hepatitis B with antiviral medication is not always needed, but can substantially reduce the risk of the liver becoming scarred.
Haemochromatosis is a genetic condition where the body stores too much iron from food.
The excess levels of iron have a poisonous effect on the liver and cause scarring over time, although treatment can reduce the risk of the condition leading to liver cancer.
Primary biliary cirrhosis is a rare and poorly understood liver condition estimated to affect around 1 in every 3,000 people in England and Wales.
One of the main functions of the liver is to create a fluid called bile, used by the body to help break down fat. The bile is transported to the digestive system via a series of tubes called bile ducts.
For reasons that are unclear, in cases of primary biliary cirrhosis the bile ducts gradually become damaged. This eventually leads to a build-up of bile inside the liver, which damages the liver and causes cirrhosis.