Primary liver cancer

Primary liver cancer is a malignant tumour that starts in the liver. The most common type of primary liver cancer in adults is hepatocellular carcinoma (HCC). HCC starts in the hepatocytes, the main type of liver cell. Below we focus on HCC.

Less common types of primary liver cancer include:

• cholangiocarcinoma or bile duct cancer – starts in the bile ducts
• angiosarcoma – a very rare type of liver cancer that starts in the blood vessels
• hepatoblastoma – a very rare form of liver cancer that affects only young children.

Cancer that starts in another part of the body and spreads to the liver is known as secondary cancer in the liver.

Learn more about:

• The liver
• Who gets primary liver cancer?
• What causes primary liver cancer?
• Link between hepatitis and liver cancer

The liver

The liver is the largest organ inside the body. It is found above the stomach on the right side of the abdomen (belly) under the ribs. The gall bladder sits under the liver, and the pancreas sits under the stomach. These organs are all part of the digestive system. They work together to help the body break down food and turn it into energy.

The digestive system

How the liver works

The liver has two main sections: the right and left lobes. Blood flows into the liver from the hepatic artery and the portal vein. Blood in the hepatic artery comes from the heart and carries oxygen. Blood in the portal vein comes from the digestive organs and carries nutrients and substances such as medicines to the liver.

The liver does many important jobs. These include:

• breaking down drugs and alcohol, and getting rid of toxins
• producing bile to help dissolve fat so it can be easily digested
• storing and releasing sugars (glucose) as needed
• storing nutrients
• making proteins to help blood clot and to balance fluid in the body.

Unlike other internal organs, a healthy liver may be able to repair itself if it is injured. It can continue to function when only a small part is working and may grow back to its normal size in 6–8 weeks, even after a part is removed during surgery.

Who gets primary liver cancer?

In Australia, about 2100 people are diagnosed with primary liver cancer each year, with almost three times more men than women affected. The rate of primary liver cancer in Australia has doubled since 1999, which is possibly due to increasing rates of obesity, type 2 diabetes, hepatitis B and C infections, and an ageing population.

What causes primary liver cancer?

HCC most often develops in people with underlying liver disease (cirrhosis). In cirrhosis, healthy liver cells are replaced by scar tissue, which stops the liver working properly.

Causes of cirrhosis include long-term (chronic) infection with the hepatitis B or C virus, drinking too much alcohol, fatty liver disease due to obesity, type 2 diabetes, and having too much iron in the body (haemochromatosis). Cirrhosis may develop slowly over months or years.

It is increasingly common for patients to develop HCC without cirrhosis. This is often associated with non-alcoholic fatty liver disease, obesity, type 2 diabetes and hepatitis B infection. Other factors that increase the risk of HCC are smoking tobacco, being overweight or having a family history of HCC. People with several risk factors have an increased risk of developing HCC.

HCC is most common in Asia, the Pacific Islands and Africa due to high rates of hepatitis B infection. In Australia, HCC is more common in migrants from countries with a higher rate of hepatitis B infection.

Link between hepatitis and liver cancer

Worldwide, about 8 in 10 cases of HCC can be linked to infection with the hepatitis B or C virus.

Hepatitis B and C spread through contact with infected blood, semen or other body fluids. This can happen during unprotected sex with an infected partner, or by sharing personal items, such as razors, toothbrushes or needles, with an infected person. The most common way hepatitis B spreads is from mother to baby during birth.

Viral hepatitis infects the liver cells (hepatocytes). When the body’s immune system attacks the virus, the liver becomes inflamed. In some people, the virus is cleared by the immune system. If the infection lasts more than six months (chronic infection), this inflammation may lead to liver scarring (cirrhosis) that can increase the risk of developing primary liver cancer.

To limit the spread of hepatitis B and the rate of primary liver cancer, all at-risk people should be vaccinated against the virus.

At-risk people include:

• people from South-East Asia, Africa and the Pacific Islands
• sexually active partners of people with hepatitis B
• people living in a household with someone with hepatitis B
• people receiving blood transfusions
• people who inject drugs.

If you already have hepatitis B, vaccination won’t help, but you will usually have regular tests to ensure you don’t develop liver problems. If you do have signs of liver damage, you may be offered antiviral medicines to help manage the effects of the infection and prevent further damage.

There is no vaccine to prevent infection with the hepatitis C virus. New antiviral medicines can cure hepatitis C in most people. This lowers the risk of developing primary liver cancer but does not eliminate it.

Even after successful hepatitis treatment, people with cirrhosis need to manage their health and have regular check-ups.