Primary liver cancer

Also known as hepatocellular carcinoma, HCC or hepatoma

Primary liver cancer is cancer that started in your liver. It's different from secondary liver cancer, which spreads to your liver from other organs.

Key points about primary liver cancer

  1. Primary liver cancer is the fourth most common cancer in the world and the second most common cause of death from cancer in men in the Asia-Pacific region. 
  2. Most people with primary liver cancer have had cirrhosis (scarring of your liver). However, some people with chronic hepatitis B or fatty liver disease may also develop primary liver cancer.
  3. You may not have any symptoms at first. Symptoms usually appear in the later stages when the tumour is getting bigger or causing complications.
  4. Treatment depends on the size of the cancer, whether it is contained in one part of your liver without affecting major blood vessels and whether you have cirrhosis.
  5. You can significantly reduce your risk of primary liver cancer by getting a diagnosis and treatment for underlying liver diseases, in particular chronic hepatitis B and hepatitis C.

What is primary liver cancer?

The main type of primary liver cancer that can affect adults is hepatocellular carcinoma (HCC).

  • A less common type of liver cancer can start in the bile ducts that connect your liver to your bowel and gall bladder. This is known as cholangiocarcinoma or bile duct cancer.
  • A very rare type of liver cancer that starts in your blood vessels is known as angiosarcoma.
  • Hepatoblastoma is a form of liver cancer that affects only young children and is also very rare.
The information on this page focuses on hepatocellular carcinoma (HCC)

Who is at risk of primary liver cancer?

Primary liver cancer usually occurs in patients with risk factors. The following are the common risk factors for primary liver cancer:

  • Cirrhosis – most people (90%) with primary liver cancer have had cirrhosis of the liver from underlying liver disease. In cirrhosis, your liver cells are damaged and replaced with scar tissue. Cirrhosis can be caused by chronic hepatitis B and hepatitis C, heavy drinking, haemochromatosis or fatty liver disease. Read more about cirrhosis.
  • Hepatitis B infection – chronic hepatitis B can increase your risk of primary liver cancer without having cirrhosis. Read more about hepatitis B infection.
  • Non-alcoholic fatty liver disease – this is a category of fatty liver disease that is not caused by heavy alcohol use. It is usually due to obesity and type 2 diabetes.
  • Haemochromatosis – an inherited condition where too much iron is stored in your liver. Read more about haemochromatosis.

What are the symptoms of primary liver cancer?

Primary liver cancer may not cause any symptoms at first. Symptoms usually appear in the later stages of the condition.

Symptoms of primary liver cancer

  • pain in the upper right part of your abdomen (tummy)
  • a lump or feeling of heaviness in your upper abdomen (tummy)
  • right shoulder pain
  • back pain
  • bloating or swelling in your abdomen (tummy)
  • weakness or deep fatigue
  • nausea (feeling sick) and vomiting (being sick)
  • yellow skin and eyes (jaundice)
  • not wanting to eat and feelings of fullness
  • weight loss
  • bruising
  • skin itchiness
  • nausea and vomiting
  • pale, chalky faeces (poos) and dark urine (pee)
  • fever

How is primary liver cancer diagnosed?

Your doctor will ask you questions about your symptoms and examine you for signs of liver disease. Primary liver cancer and its causes can be diagnosed using a number of tests. These include blood tests such as a full blood count, liver function tests, alpha-fetoprotein, hepatitis screening and imaging scans such as ultrasound, CT and MRI. In some cases, a tissue sample (biopsy) may also be tested.    

How is primary liver cancer treated?

There are a few treatment options for primary liver cancer. Treatment depends on the size of the cancer, whether it is contained in one part of your liver with no major blood vessels affected and whether you have cirrhosis.

Your doctor will also consider your age, your general health and the options available at your hospital.

  • Surgery: Surgery to remove the cancer and a bit of healthy liver that surrounds it may be an option if you have early-stage liver cancer and normal liver function. This requires a general anaesthetic.
  • Liver transplant: Surgery to remove your entire liver and replace it with a liver from a donor may be an option if you are otherwise healthy and the liver cancer hasn't spread beyond your liver.
  • Thermal ablation: This involves destroying cancer cells using extreme heat or cold. It may be recommended for people who can't undergo surgery. The procedures include microwave ablation (heat) and cryoablation (cold). This requires a general anaesthetic. Read more about microwave ablation.
  • Irreversible electroporation (IRE): This procedure uses high-current electrical pulses to cause death in the liver cancer cells. This requires a general anaesthetic. Read more about IRE.
  • Transarterial chemoembolisation (TACE): This involves delivering chemotherapy directly to cancer cells using a catheter that's passed through your blood vessels and into your liver. This requires sedation. Read more about TACE.
  • Selective internal radiation therapy (SIRT): This delivers radiation directly to the cancer cells. By using a catheter that's passed through your blood vessels and into your liver, doctors can deliver tiny glass spheres containing radiation directly to the cancer cells. This treatment option is not funded but available privately. Read more about SIRT.
  • Targeted drug therapy: Using targeted medicines to attack specific weaknesses in the cancer cells may help slow the progression of the disease if you have advanced liver cancer. This treatment option is not funded but is available privately.
  • Clinical trials: Clinical trials give you a chance to try new liver cancer treatments. These include injections to make your own immune system fight the cancer and tablets that can block the cancer growth. These are free and travel and accommodation (if needed) is provided. Ask your doctor whether you're eligible to participate in a clinical trial.

What can I do to help myself with primary liver cancer?

  • Don’t drink alcohol as it will cause more liver damage.
  • Quit smoking if you smoke.
  • Ensure you are up to date with your vaccinations, such as vaccinations against hepatitis A, hepatitis B, pneumococcal disease and the flu. This protects you from severe illness. Get your vaccinations as early as possible, as your body's response becomes weaker as cirrhosis progresses.
  • Eat well to avoid loss of muscle mass and reduce the risk of complications. Most people with liver cancer need a high protein and high energy diet. Consider seeing a dietitian experienced in liver disease. Read more about the high protein/high fat diet.
  • If you have diabetes, make sure your diabetes is well controlled. Ask your GP or doctor if you are unsure.
  • If you have hepatitis B or hepatitis C and are prescribed antiviral medicines by your doctor, take the medicines as instructed.
  • If you are obese, losing weight and having regular exercise can help.
  • Before starting any new medicine, ask your doctor or pharmacist about its effect on your liver. 

How can primary liver cancer be prevented?

Vaccination: Vaccination against hepatitis B prevents hepatitis B infection, one of the more common causes of primary liver cancer. Read more about hepatitis B vaccination.

Antiviral medicines: If you have chronic hepatitis B or hepatitis C, antiviral therapies are recommended. There is very good evidence that they prevent progression to cirrhosis and possible development of liver cancer. If you have already developed cirrhosis, antiviral therapy is still helpful, as it stops cirrhosis getting worse and possible liver failure. Successful antiviral therapy reduces but does not remove the risk of liver cancer developing. Read more about hepatitis B and hepatitis C

Surveillance: If you have chronic hepatitis B and hepatitis C, cirrhosis or other risk factors of primary liver cancer, your doctor may recommend regular checking and monitoring of your liver to check if you have liver cancer. This can help prevent progression to cirrhosis or possible development of liver cancer.

Support for primary liver cancer

Cancer Society Cancer Information Helpline 0800 CANCER (226 237) or email information@akcansoc.org.nz.

Learn more

The following links have more information on primary liver cancer. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Liver cancer Cancer Council Victoria, Australia
What to expect – liver cancer Cancer Council Victoria, Australia
Primary liver cancer Patient Info, UK

References

  1. Liver cancer Auckland Regional HealthPathways, NZ, 2020
  2. Villanueva A. Hepatocellular carcinoma N Engl J Med 2019 April 11; 380:1450-1462.
  3. Liver cancer Mayo Clinic, US 

Reviewed by

Oonagh Lithgow is a hepatocellular carcinoma clinical nurse specialist/coordinator for Auckland DHB. She has worked with the liver service for six and a half years as a nurse specialist and is passionate about ensuring the best outcomes for people with primary liver cancer.

An HCC support group meets once a month at the Domain Lodge in Auckland. Contact: OonaghL@adhb.govt.nz 
Credits: Health Navigator Editorial Team . Reviewed By: Oonagh Lithgow, hepatocellular carcinoma clinical nurse specialist/coordinator, Auckland DHB Last reviewed: 05 Nov 2020