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 cancers, which spread to your liver from other organs.

Key points

  1. Primary liver cancer is the sixth most common cancer in the world and the second most common cause of death from cancer. 
  2. Most cases (70–80%) of primary liver cancer in New Zealand are caused by chronic hepatitis B and hepatitis C.
  3. Most people (90%) with primary liver cancer have had cirrhosis (scarring of your liver) from underlying liver disease. However, some people with chronic hepatitis B or with certain types of fatty liver disease may develop primary liver cancer without having cirrhosis.
  4. You can significantly reduce your risk of getting primary liver cancer by getting a diagnosis and treatment for underlying liver diseases, in particular chronic hepatitis B and 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?

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. Common causes of cirrhosis are:

  • chronic hepatitis B – infection usually occurs at birth but cirrhosis usually develops in your 40s and cancer in your 50s
  • chronic hepatitis C – infection usually occurs in your 20s but cirrhosis usually develops in your 50s and cancer in your 60s
  • heavy drinking – having more than 2 alcoholic drinks a day for many years raises your risk: the more you drink, the higher your risk
  • obesity and diabetes – these can lead to non-alcoholic fatty liver disease, which in turn can cause cirrhosis
  • haemochromatosis – an inherited condition where you store too much iron in your liver. 

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)
  • bloating or swelling in your abdomen (tummy)
  • weakness or deep fatigue
  • nausea and vomiting
  • yellow skin and eyes
  • not wanting to eat and feelings of fullness
  • weight loss
  • nausea and vomiting
  • pale, chalky faeces (poos) and dark urine (wee)
  • fever

How is primary liver cancer diagnosed?

Primary liver cancer is diagnosed using a number of tests. These include blood tests 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 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?

  • Do not 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. It's important to 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.
  • 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 prevents cirrhosis worsening 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

Support for primary liver cancer

HCC support group meets once a month at the Domain Lodge in Auckland (contact: OonaghL@adhb.govt.nz). 
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

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.

References

  1. Villanueva A. Hepatocellular carcinoma N Engl J Med 2019 April 11; 380:1450-1462.
  2. Liver cancer Mayo Clinic, US 
Credits: Health Navigator Editorial Team . Reviewed By: Oonagh Lithgow, hepatocellular carcinoma clinical nurse specialist/coordinator, Auckland DHB Last reviewed: 26 Aug 2019