Symptoms

Liver cancer may not have any symptoms, or it might be hard to spot.

The symptoms are the same if the liver cancer starts in the liver (primary liver cancer) or spreads from another part of the body (secondary liver cancer).

Symptoms of liver cancer can include:

• your skin or the whites of your eyes turn yellow (jaundice), you may also have itchy skin, darker pee and paler poo than usual
• loss of appetite or losing weight without trying to
• feeling tired or having no energy
• feeling generally unwell or having symptoms like flu
• a lump in the right side of your tummy

Other symptoms can affect your digestion, such as:

• feeling or being sick
• pain at the top right side of your tummy or in your right shoulder
• symptoms of indigestion, such as feeling full very quickly when eating
• a very swollen tummy that is not related to when you eat

Diagnosis

You will need some tests and scans to check for liver cancer if the Doctor refers you to a specialist.

These tests can include:

• blood tests
• scans, like an ultrasound scan, CT scan or MRI scan
• collecting a small sample of cells from the liver (called a biopsy), to be checked for cancer

Causes

Most people who get liver cancer get it in the setting of chronic liver disease (long-term liver damage called cirrhosis), which scars the liver and increases the risk for liver cancer. Conditions that cause cirrhosis are alcohol use/abuse, hepatitis B, and hepatitis C.

The causes of liver cancer may be linked to environmental, dietary, or lifestyle factors.

Prevention

Primary liver cancer can be prevented with vaccination against hepatitis B. Vaccination against hepatitis B is recommended by the World Health Organization for all newborns and high-risk groups. Vaccination is also recommended for young adolescents and people at higher risk of exposure to hepatitis B, such as health workers, travellers to areas where hepatitis B is common, injecting drug users, and people with multiple sex partners.

In patients with chronic hepatitis B or C, antiviral therapies are recommended, since there is very good evidence that they prevent progression to cirrhosis and possible development of liver cancer.

The main treatments used for primary liver cancer are surgery and chemotherapy. Other techniques are sometimes used. The treatment advised in each case depends on various factors such as:

• the exact site of the primary tumour in the liver.
• how large the cancer is and whether it has spread (the stage of cancer).
• your general health. In particular, the general state of your liver and liver function. Many people with primary liver cancer also have poor liver function due to scarring of the liver (cirrhosis).

Overall the outlook (prognosis) is poor. Many people who develop primary liver cancer are already in poor health with scarring of the liver (cirrhosis). The best chance of a cure is with surgery when the cancer is small, has not spread from the liver and the rest of the liver is relatively healthy. However, this situation only occurs in a small number of cases. The various other treatments described above may delay the progression of the disease but often will not cure it.