Liver cancer is an aggressive disease that is unfortunately increasing in prevalence. It develops when tumour cells form in the liver and divide uncontrollably, which can ultimately prevent the liver and other vital organs from functioning correctly.
The liver is the body's largest solid organ, situated beneath the right ribcage. It is pyramid-shaped and has two main sections, known as lobes. The liver receives blood from two sources: the hepatic artery, which supplies oxygen-rich blood, and the portal vein, which delivers nutrient-rich blood from the intestines.
The liver performs many critical processes, including:
Cancers that originate in the liver are known as primary liver cancers and are named according to the type of cell where the cancer first develops. These include:
This is the most common form of primary liver cancer, beginning in the liver's hepatocyte cells. It may start as a single tumour or, more commonly, in multiple spots (multifocal), particularly in patients with liver inflammation such as cirrhosis.
A rare subtype of HCC that typically occurs in younger patients without underlying liver inflammation or known risk factors. It often carries a higher chance of successful treatment than general HCC.
These are rare, fast-growing cancers that begin in the liver's blood vessels. They are usually diagnosed at an advanced stage.
A very rare type of liver cancer predominantly found in children. Early detection yields a survival rate of over 90%.
Important Note: Some liver tumours are benign (non-cancerous). These may require surgery if they are difficult to diagnose or grow large enough to cause problems.
Metastatic liver tumours are those that begin in another part of the body and subsequently spread to the liver. The liver is a common site for cancer to spread due to its large size and high blood flow, which makes it a target for tumour cells moving through the bloodstream. While any cancer can spread to the liver, it is most common with colorectal, breast, and lung cancers.
A risk factor is anything that increases the chance of developing liver cancer. Risk factors for primary liver cancers are detailed below:
Scarring or damage to the liver (cirrhosis) is the primary cause of HCC. Conditions or activities that lead to cirrhosis are also risks for liver cancer, including:
Most individuals diagnosed with liver cancer are over 55, although rare types such as fibrolamellar HCC and hepatoblastomas are almost exclusively found in younger patients.
Primary liver cancers are more common in men than women.
Several other conditions may increase your risk, including:
Exposure to certain substances may increase risk, especially when other risk factors are present. These include:
Using tobacco products can increase the risk of liver cancer.
The use of anabolic steroids has been associated with benign liver tumours called adenomas, some of which may progress to HCC.
In rare instances, liver cancer may be passed down through generations. Genetic counselling may be appropriate in these cases.
In its early stages, primary liver cancer often does not produce noticeable symptoms. When symptoms do occur, they can vary from person to person as the tumour grows. These may include:
Certain types of liver cancer can produce hormones that may lead to other effects, such as:
While these symptoms do not always indicate liver cancer, it is vital to discuss any new or concerning symptoms with your doctor as they may signal other health issues.
Due to the lack of early symptoms and the small size of early-stage tumours, liver cancer can be challenging to detect. SSCHRC's highly skilled specialists employ advanced techniques to find and diagnose even the smallest lesions.
If liver cancer is suspected, the initial step is a physical examination, where the doctor will:
If cancer is suspected, one or more of the following tests may be performed to diagnose the disease and determine if it has spread:
A common blood test checks for alpha-fetoprotein (AFP), which can be a marker for liver cancer. Other blood tests are also conducted to assess how well the liver is functioning.
These help doctors visualise the liver and surrounding structures:
A tissue sample from the tumour is removed and examined under a microscope. Healthy tissue may also be tested to check liver function. Biopsy techniques include:
This testing is used to identify specific biomarkers, which help in selecting the most effective liver cancer treatments and clinical trials.
If a diagnosis is confirmed, your doctor will determine the stage of the disease, classifying the amount of cancer in the body and its spread. This staging helps the care team decide on the most appropriate treatment plan.
SSCHRC offers innovative treatments provided by leading liver cancer experts. Your personalised treatment plan is based on several factors, including:
Treatments aiming for a cure are typically reserved for early-stage cancers. For tumours found at a later stage, non-surgical treatment options may be used. Your care team will determine the most suitable therapy.
One or more of the following therapies may be used to treat liver cancer or help alleviate symptoms:
Surgery offers the best chance for successful treatment in patients with early-stage disease, particularly if the entire cancer can be removed. However, complete removal is sometimes not possible if the cancer is large, has spread to other parts of the liver or body, or if the liver is damaged by other conditions. Surgeons strive to remove as much of the tumour as possible while ensuring enough healthy liver remains to function.
The main types of surgery for liver cancer are:
The portion of the liver containing the tumour is removed. A partial hepatectomy removes only the tumour and a rim of surrounding tissue, while a major hepatectomy removes a larger section.
The diseased liver is removed and replaced with a healthy donor liver. This is an option for patients with advanced cirrhosis or when a tumour cannot be surgically removed. Liver transplants carry a risk of serious infection and other health issues.
SSCHRC has pioneered several liver cancer surgery techniques, including two-stage operations for liver disease and minimally invasive procedures, leading to reduced blood transfusions, fewer complications, shorter hospital stays, quicker recovery, and less pain post-surgery.
Life after liver cancer surgery: Possible post-operative symptoms may include fatigue (as the liver regenerates) and an accumulation of fluid in the abdomen (ascites). These symptoms often subside over time. Your physician will carefully monitor you for any signs of cancer recurrence.
These are minimally invasive, image-guided procedures typically performed on an outpatient basis, resulting in much shorter hospital stays than major surgery. An interventional radiologist targets tumours via small injections or needle placements.
Uses heat (radiofrequency or microwave ablation) or extreme cold (cryosurgery) to freeze or burn the liver cancer away. This is used when surgical removal of a tumour is not an option.
Material is injected into the artery supplying blood to the tumour. This can deliver chemotherapy or radiation directly to the tumour, or in some cases, block the blood flow to the tumour, causing the cancer cells to die from a lack of blood. Embolization treatments include:
SSCHRC's Interventional Oncology Clinic performs these treatments for liver cancer and liver metastases.
New techniques allow SSCHRC doctors to target liver tumours more precisely, delivering the maximum radiation dose with minimal damage to healthy cells. Options include:
Chemotherapy drugs are used to kill cancer cells, control their growth, or relieve disease-related symptoms. The treatment may involve a single drug or a combination, depending on the type and growth rate of the cancer. SSCHRC experts are researching new methods to deliver chemotherapy drugs directly to the liver.
This therapy works by engaging the patient's own immune system to fight the cancer. It can be used alone or in combination with other treatments.
Unlike treatments that kill cancer cells directly, targeted therapies work on a cellular level to stop or slow the growth and spread of cancer. They are designed to interfere with specific molecules (often proteins) or the cancer-causing genes that these cells need to survive and multiply.
This advanced technique uses a robotic machine to target cancerous tumours with precise sound waves, breaking them apart without the need for surgery, needles, or radiation. Patients undergo the procedure under general anaesthesia to ensure minimal movement. At SSCHRC, histotripsy is currently used in cases where more established treatments are not viable options.
SSCHRC offers clinical trials for new treatments across every type and stage of liver cancer, providing patients with access to the latest therapeutic advancements.
While it may be tempting to explore unproven remedies, such as those popularised on social media, SSCHRC experts emphasise that products like castor oil are not a validated cancer treatment or liver detox strategy. If you are considering using any unconventional therapy while undergoing cancer treatment, it is best to discuss it with your care team so they can assess safety, potential drug interactions, and toxicity. Focus on a healthy lifestyle, including proper diet, regular exercise, and adequate sleep, to support your body's natural mechanisms for healing and recovery.