Cancer involving the liver

Reviewed by Professor Alastair J Munro, professor of radiation oncology

How can cancer involve the liver?

There are two ways in which cancer can involve the liver. The cancer can arise from the liver itself (primary liver cancer) or it can spread to the liver from a primary tumour at another site (secondary, or metastatic, cancer).

In the UK, secondary liver cancer is about 28 times more common than primary liver cancer. Each year there are about 70,000 patients in the UK with secondary liver cancer and about 2,500 with primary liver cancer.

Primary liver cancer can arise from the liver cells themselves (hepatocellular carcinoma) or from the system of tubes that drains the bile from the liver (cholangiocarcinoma, gall bladder cancer).

Most patients with primary liver cancer have suffered previously from liver disease such as chronic hepatitis, cirrhosis or, in the less developed world, been exposed to poisons from plants (aflatoxins). Immunisation against hepatitis B might, particularly in the developing world, prevent many cases of primary liver cancer.

Secondary (metastatic) cancer reaches the liver by spreading through the blood system from a primary tumour at a separate site. In about 50 per cent of patients with metastatic liver cancer, the primary tumour is in the bowel (colon, rectum) or stomach. The other common primary sites are the breasts and lungs.

What are the symptoms of cancer involving the liver?

The symptoms of cancer involving the liver can include:

tiredness.

loss of appetite.

nausea.

a dragging sensation or heaviness felt up under the lower ribs on the right hand side of the body.

pain in the upper part of the belly.

In the later stages, the skin can develop a yellowish tinge (jaundice) together with fevers and drenching sweats, particularly at night.

How is liver cancer treated?

Primary liver cancer is difficult to treat. Surgical removal is the best option but these tumours are often too large and too extensive for surgery. Chemotherapy is occasionally used for inoperable tumours but any benefit is usually short lived. Unfortunately, survival rates for primary liver cancer are low.

The treatment of secondary (metastatic) liver cancer is determined by the site of origin of the original (primary) tumour. It is important to realise that the tumour, even though it has spread to the liver, will still behave according to its origin. A leopard does not change its spots: breast cancer involving the liver behaves like breast cancer, not like primary liver cancer. Consequently the outlook can be rather better for patients with secondary, as opposed to primary, liver cancer.

Surgery is increasingly being used for patients with secondary liver cancer. This can sometimes involve removing a segment of liver. Alternatively, keyhole techniques can be used to apply extreme cold or heat to localised areas of the liver.

The presence of secondary cancer within the liver implies that the primary tumour has spread via the bloodstream and as a result other organs may be at risk.

It is sensible, therefore, to consider using a treatment such as chemotherapy, which acts all over the body. The type of chemotherapy used will depend on the type of primary cancer.

Hormone treatment is an additional option for patients with cancers of the breast or prostate that have spread to the liver.

Conventional radiotherapy has little role to play in the management of liver cancer, whether primary or secondary.

Specialised techniques, involving the temporary placement of radioactive wires, can be used to treat certain primary cancers of the ducts within, or immediately adjacent to, the liver.

Liver transplantation is not usually a viable option for patients with cancer involving the liver - the cancer has often spread beyond the liver itself and the medicines used to suppress the immune system after the transplant can stimulate the growth of any remaining cancer cells.

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