Cases of primary liver cancer have increased two to three fold in the past decade in parts of the UK. Here consultant hepatologist Dr Helen Reeves says some cases could be prevented by a healthier lifestyle.
Primary vs. secondary
According to the British Liver Trust your liver is the largest organ in your body; it acts as a factory in charge of 500 different processes.
“Secondary liver cancer which begins in another part of the body and spreads to the liver is much commoner than primary liver cancer where cancer cells begin in the liver,” explains Dr Reeves.
“But having said that, there are still 4,000 cases of primary liver cancer diagnosed in the UK every year and that number has increased dramatically in most areas, fuelled by a rise in obesity, type 2 diabetes and alcohol consumption.
“It mainly affects older people and the average age of diagnosis is 68.”
Types of primary liver cancer
According to the National Cancer Intelligence Network, 85 per cent of primary liver cancer cases are hepatocellular carcinomas, which are more common in people with liver disease and scarring of the liver (cirrhosis).
The second most common type of liver cancer is cholangiocarcinoma – cancer of the bile ducts.
One of the main causes of liver cancer is chronic liver disease which leads to scarring or cirrhosis of the liver.
“This happens when the liver is under constant pressure to regenerate – this leads to mistakes in the regulatory pathways governing cell growth and cancer cells can then develop,” explains Dr Reeves.
“Contrary to popular belief the main cause of liver cancer isn’t always due to excessive alcohol consumption leading to cirrhosis,” says Dr Reeves.
“The commonest causes in some areas of the UK at the moment are obesity and diabetes.
“Obesity can lead to a build up of fat in the liver. Sometimes this also involves inflammation, especially if affected people also have type 2 diabetes. Inflammation and repair of damaged liver cells heals with scarring, which causes cirrhosis.”
Other causes of damage include the Hepatitis B and C viruses (the most common causes in some areas of the world) and a hereditary condition called haemochromatosis, where the body makes too much iron and it’s dumped in the liver.
Primary liver cancer doesn’t cause symptoms in most cases until the cancer is quite advanced – only 10 per cent of cases are diagnosed at an early stage, says Cancer Research UK. This partly explains the poor outlook, with only 20 per cent surviving one year and 5 per cent surviving five years after diagnosis.
Cancer Research UK describes some of the symptoms as:
- Nausea and loss of appetite
- Enlarged liver causing a lump in the upper abdomen or under the left rib
- Accumulation of fluid e.g. swollen ankles, due to poor liver function
- Unexplained weight loss
“Your treatment will depend on the size and number of tumours, but also your underlying liver function,” says Dr Reeves. Options include:
- Liver resection: If your tumour is small and you have good liver function you may be able to have a curative treatment called a liver resection where the diseased section of the liver is removed. Five year survival rate after this is 75 per cent.
- Liver transplant: Patients who are fit, with good liver function and a small tumour may be able to have a curative treatment such as a liver transplant.
- Radio frequency ablation: If your tumour is quite small but you are not fit for a surgical treatment, this treatment uses a needle placed in the tumour to generate heat to burn the tumour.
- Chemo-embolisation: Those with good liver function who have larger or multiple tumours may be able to have chemo-embolisation, where the blood supply to the tumours is blocked off and chemotherapy drugs delivered. This is palliative rather than curative.
- Medical treatments: Chemotherapy drugs such as Sorafenib can be given to prolong life in patients with advanced or metastatic disease, for months or in some cases years.
You can reduce your chances of developing liver cancer by:
- Losing weight: “Being obese increases your risk of dying from cancer. In men, for all cancers this risk is increased 1.2 fold. For primary liver cancer in particular, this risk is increased 4.5 fold,” says Dr Reeves.
- Exercising more: “Even if you’re overweight, exercising two to three times per week for 20 to 30 minutes may be enough to protect your liver.”
- Drinking alcohol within safe limits: “But if you’re overweight and also have type 2 diabetes be aware that drinking even a small amount of alcohol can increase your risk of liver cancer further,” she adds.
'I’m still here five years after my diagnosis'
Norman Morrell, age 80, from Gosforth near Newcastle was diagnosed with hepatocellular liver cancer in 2008. Here he tells the story of his diagnosis and treatment.
“In 2005 I was diagnosed with hemochromatosis. Unfortunately it led to me developing liver cancer nodules in 2008, which were picked up on a scan. I don’t drink alcohol at all.
“The nodules were very small though, so radiologists were able to treat them using chemo-embolisation and ablation techniques. I’ve had the same procedure performed successfully three times over the past five years.
“I’ve actually felt very well throughout my treatment and have had a very good quality of life for the past five years – I don’t get pain from my liver at all and actually have more trouble from the osteoporosis I have in my knees.
“A scan has picked up another nodule on my liver close to my gall bladder and the surgeons are now discussing whether to use an ablation technique. There are lots of treatment options if your cancer is diagnosed early; I’ve done very well and it seems there is always hope.”