Primary liver cancer starts in the liver. The main type is hepatocellular carcinoma (HCC), which nearly always develops in a liver already damaged by cirrhosis or chronic hepatitis. A less common type, cholangiocarcinoma, starts in the bile ducts. Cancer that has spread to the liver from the bowel, breast or elsewhere is more common than either and is treated as the original cancer.
Treatment depends as much on how well the rest of the liver works as on the tumour. Options with curative intent are surgery, ablation and transplantation, and they are possible mainly when the cancer is found early, which is why people with cirrhosis are offered ultrasound every 6 months.
Symptoms
- No symptoms in early stages, with a nodule found on surveillance ultrasound
- Pain or discomfort under the right ribs or in the right shoulder
- Unexplained weight loss and poor appetite
- Yellowing of the skin and eyes, dark urine and itching
- Swelling of the abdomen from fluid, or swollen legs
- Increasing tiredness and weakness
- Sudden worsening in someone with previously stable cirrhosis
Causes and risk factors
The common thread is long-term liver injury. Chronic hepatitis B and hepatitis C infection, alcohol-related cirrhosis and fatty liver disease linked to obesity and diabetes account for most cases. Hepatitis B can lead to cancer even without cirrhosis. Other causes include haemochromatosis, primary biliary cholangitis, alpha-1 antitrypsin deficiency, and aflatoxin, a mould toxin found in poorly stored grain and nuts in some regions. Smoking adds to risk. Hepatitis B vaccination and hepatitis C treatment prevent many cases.
How it is diagnosed
- Ultrasound and AFP blood test: Used for 6-monthly surveillance in people at risk. AFP can be normal in liver cancer, so it is not relied on alone.
- Multiphase CT or MRI with contrast: In a cirrhotic liver, a nodule with a typical pattern of contrast uptake and washout is diagnostic of HCC without a biopsy.
- Liver biopsy: Reserved for nodules with an atypical appearance, tumours in a non-cirrhotic liver or suspected cholangiocarcinoma.
- Assessment of liver function: Blood tests, Child-Pugh and MELD scores and signs of portal hypertension determine which treatments the liver can tolerate.
- Staging scans: CT of the chest and sometimes a bone scan to check for spread.
Treatment options
- Surgical resection: Removal of the affected part of the liver, for people with a single tumour and well-preserved liver function.
- Ablation: Radiofrequency or microwave needles destroy tumours, typically those under 3 centimetres, under imaging guidance.
- Liver transplantation: Treats both the cancer and the cirrhosis for people within defined size and number criteria. In Türkiye this almost always means a living related donor with ethics committee approval.
- Chemoembolisation (TACE) and radioembolisation: Treatments delivered through the liver's artery for tumours that cannot be removed, to control growth or bridge to transplant.
- Systemic therapy: Immunotherapy combinations and targeted tablets for advanced disease.
- Treating the underlying liver disease: Antiviral therapy for hepatitis B or C and stopping alcohol improve liver function and widen the options.
When it is urgent
Go to the nearest emergency department if you vomit blood or pass black stools, become confused or very drowsy, develop a fever with abdominal pain and fluid in the abdomen, or have sudden severe abdominal pain with faintness, which can indicate a bleeding tumour. These are complications of liver disease that need immediate local treatment.
Travelling to Türkiye for treatment
A trip can make sense for a multidisciplinary opinion on imaging, for a planned resection or ablation, with 1 to 3 weeks' stay depending on the procedure, or for a defined TACE or radioembolisation session. Transplantation requires your own willing, medically suitable living relative as donor; donors are not arranged for patients, and both of you would stay for several weeks. Surveillance scans every 3 to 6 months, antiviral therapy and systemic drug treatment should be managed at home.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Do I need a biopsy?
Often not. In a cirrhotic liver, a characteristic appearance on contrast CT or MRI is accepted as proof of HCC.
Why can't the tumour simply be cut out?
A cirrhotic liver may not tolerate losing tissue. Surgeons must be confident that the remaining liver will cope, otherwise ablation or transplant is safer.
Am I eligible for a transplant?
Eligibility depends on tumour size and number, absence of spread, your general health and, in Türkiye, a suitable living related donor approved by an ethics committee.
I have hepatitis B but feel well. Should I be scanned?
Yes, if your doctor has placed you in a risk group. Six-monthly ultrasound is how small, treatable tumours are found.