What is the liver?
The liver is the largest organ in the body, it is situated in the upper abdomen and is protected from injury by the rib cage. The liver has many
important functions some of which include:
- The production of bile.
- Helps the body to digest
- Stores vitamins, iron and other essential
nutrients until the body needs them.
- Converts the food you
eat into energy needed for daily life.
- Aids in the removal of
toxic substances (e.g. drugs and alcohol)
from the bloodstream.
The liver can repair itself quite
easily and can usually function with only a small portion of it working.
What is liver cancer?
Liver cancer happens when cells begin to multiply at a faster rate than they should and the unwanted
cells form a growth. There are 2 main types of liver cancer and
- Primary cancer - this means the cancer started
in the liver. This type of cancer is quite rare in the U.K.
- Secondary cancer - this means the cancer
developed in another part of the body and has spread to the liver.
The most common cancers that may spread to the liver are cancers
of the stomach, lung, colon and breast.
There are 2 main types of primary liver cancer.
The most common type is known as a hepatoma, it starts in the cells,
which perform the major tasks of the liver, called hepatocytes.
The second type of cancer is known as cholangiocarcinomas and it
starts in the cells that line the bile
ducts of the liver.
What causes primary liver cancer?
Although nobody is exactly sure what causes
primary liver cancer, it does tend to arise in those people whose
liver has been severely damaged by a condition called cirrhosis (scarring of the liver). Any disease that causes cirrhosis of the
liver will increase the risk of you developing liver cancer. Cirrhosis
of the liver can be caused by infection with the hepatitis B or C virus and drinking excess alcohol. Hepatitis A does not cause
cirrhosis or primary liver cancer.
However, only a small minority of people with
cirrhosis of the liver will go on to develop primary liver cancer.
Primary liver cancer tends to affect the middle
aged and elderly, but very rarely it can affect children. It is
also a lot more common in men than it is in women.
What causes secondary liver cancer?
A primary cancer situated elsewhere in the body
always causes secondary liver cancer. If cancer cells from the primary
cancer escape into the bloodstream the liver is the most likely
place for them to embed and grow, as all blood in the body passes
through the liver.
What are the symptoms of liver cancer?
The symptoms for both primary and secondary
cancer are similar though in the early stages you may have no symptoms.
Secondary liver cancer tends to be found when the primary cancer
is diagnosed. When symptoms are present they may include any of
- Pain or discomfort in the upper abdomen.
- Loss of appetite.
- Weight loss.
- Nausea and occasionally vomiting.
- High temperature.
- Jaundice - a yellow colouring of the skin
and eyes, darkened urine and a pale colour to the stools.
These symptoms can be common to many other non-serious
conditions, so always have any symptoms you are experiencing checked
by your doctor.
Is there anything I can do to prevent liver
To avoid liver cancer you should stop smoking,
as this will greatly reduce your risk of developing lung and stomach
cancer. Try to maintain a healthy
balanced diet and reduce your consumption of alcohol
- a major cause of cirrhosis of the liver. Protect yourself against
the hepatitis virus by practicing safe sex and avoid sharing needles.
If you have cirrhosis of the liver your doctor
should regularly test you for the presence of a hepatoma.
The test may involve regular blood tests, which looks for the presence
of alpha-feta protein (A.F.P.), a substance found in abnormal amounts
in those with a hepatoma.
How is liver cancer diagnosed?
Your doctor may have a feel of your liver from a physical examination and may also carry out a urine test which among other things looks for bilirubin and urobilinogen, if these levels are raised this could indicate the liver is damaged. If these levels are raised and/or the liver feels larger or harder than it should then your doctor may recommend a LFT (Liver Function Test) for more detailed results and looks at the following:
- Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) - these are enzymes that help to process proteins and may be raised if your liver is inflamed or injured.
- Bilirubin - This is a chemical in bile, a damaged liver cannot process bilirubin and so levels can build causing the skin and/or eyes to look yellow (jaundice). An increase in bilirubin is suggestive of liver disease.
- Alkaline Phosphatase (ALP) and Gamma-Glutamyl Transferase- these are enzymes and might be raised when there is a blockage in your liver or bile duct.
- Albumin - This is a protein and may be low in some cancers or if you have been eating little and are malnourished.
A cancer of the liver might be suspected
when an abnormality is seen in liver blood tests. This
blood test detects there is something wrong in the liver but this
may not necessarily be because of cancer.
If the liver cancer type is a hepatoma it normally produces abnormal
amounts of a substance called alpha-feta protein, which can be detected
in the blood.
To diagnose liver cancer you will have a scan
of the liver with an ultrasound, CT
scan or a M.R.I.
(Magnetic Resonance Imaging). These tests build up a picture
of the liver and show the exact location of the tumour,
though they cannot usually tell, if it is a primary or secondary
cancer. For a final diagnosis you will usually have a biopsy,
which involves the doctor taking a small sample of liver cells,
for examination under a microscope. A biopsy will tell the doctor
what type of cell is causing the cancer to develop.
How is liver cancer treated?
The type of treatment available will depend
on the size and type of the cancer. The treatment of secondary liver
cancer depends on where the primary cancer is.
If you have a hepatoma there are a number of
treatments available. If the cancer is small it may be removed by
an operation. Even if you need to have the majority of the liver
removed, it will start to regrow very quickly and could be back
to normal size within a month.
If cirrhosis has seriously affected the liver,
a liver transplant may be considered. Chemotherapy may be used in the treatment of primary and secondary cancer but
it is unlikely that radiotherapy will be used.
If the cause of primary liver cancer is cholangiocarcinomas
then it can be very difficult to treat. The first stage of treating
this type of cancer is to relieve the jaundice,
caused by blocked bile
ducts (where this type of cancer forms). Once this has
been carried out, the doctor can assess the size and position of
the tumour and will hopefully be able to perform surgery. Radiotherapy
may also be used to treat this type of cancer.
Alcoholic Liver Disease
Cirrhosis of the Liver
Liver Function Test
What is the liver?