LIVER CANCER

( By JASCAP )

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About liver cancer

About primary liver cancer

The liver

The liver is the largest organ in the body. It is surrounded by a fibrous capsule and is divided into two lobes left and right. It is in the upper part of the abdomen on the right-hand side of the body and is surrounded and protected from injury by the lower ribs.

The liver and surrounding organs

The liver is an extremely important organ that has many functions. These include regulating sugars and fats in the body so that they can be used for energy. It also produces proteins that circulate in the blood. Some of the proteins help the blood to clot and prevent excessive bleeding, while others are essential for maintaining the balance of fluid in the body. The liver also destroys harmful substances such as alcohol and drugs, and also gets rid of waste products. It does this by breaking down substances not used by the body so that they can be passed out in the urine or stools (bowel motions).

The liver stores glucose and vitamins so that they can be used by the body when needed. It also produces bile, which breaks down the fats in food so that they can be absorbed by the bowel (intestine).

The liver is connected to the first part of the small intestine (duodenum) by a tube called the bile duct. This duct takes the bile produced by the liver to the intestine.

The liver is very good at repairing itself. It can function normally with only a small part of it in working order.

What is cancer?

The organs and tissues of the body are made up of tiny building blocks called cells. Cancer is a disease of these cells.

Cells in different parts of the body may look and work differently but most reproduce themselves in the same way. Cells are constantly becoming old and dying, and new cells are produced to replace them. Normally, cells divide in an orderly and controlled manner. If for some reason the process gets out of control, the cells carry on dividing, developing into a lump which is called a tumour.

Tumours can be either benign or malignant. Cancer is the name given to a malignant tumour. Doctors can tell if a tumour is benign or malignant by examining a small sample of cells under a microscope. This is called a biopsy.

In a benign tumour the cells do not spread to other parts of the body and so are not cancerous. However, if they continue to grow at the original site, they may cause a problem by pressing on the surrounding organs.

A malignant tumour consists of cancer cells that have the ability to spread beyond the original area. If the tumour is left untreated, it may spread into and destroy surrounding tissue. Sometimes cells break away from the original (primary) cancer. They may spread to other organs in the body through the bloodstream or lymphatic system.

The lymphatic system is part of the immune system - the body's natural defence against infection and disease. It is a complex system made up of organs, such as bone marrow, the thymus, the spleen, and lymph nodes. The lymph nodes (or glands) throughout the body are connected by a network of tiny lymphatic ducts.

When the cancer cells reach a new area they may go on dividing and form a new tumour. This is known as a secondary cancer or metastasis.

It is important to realise that cancer is not a single disease with a single type of treatment. There are more than 200 different kinds of cancer, each with its own name and treatment.

Types of cancer

Carcinomas

The majority of cancers, about 85% (85 in a 100), are carcinomas. They start in the epithelium, which is the covering (or lining) of organs and of the body (the skin). The common forms of breast, lung, prostate and bowel cancer are all carcinomas.

Carcinomas are named after the type of epithelial cell that they started in and the part of the body that is affected. There are four different types of epithelial cells:

  • squamous cells - that line different parts of the body, such as the mouth, gullet (oesophagus), and the airways
  • adeno cells - form the lining of all the glands in the body and can be found in organs such as the stomach, ovaries, kidneys and prostate
  • transitional cells - are only found in the lining of the bladder and parts of the urinary system
  • basal cells - that are found in one of the layers of the skin.

A cancer that starts in squamous cells is called a squamous cell carcinoma. A cancer that starts in glandular cells is called an adenocarcinoma. Cancers that start in transitional cells are transitional cell carcinomas, and those that start in basal cells are basal cell carcinomas.

Leukaemias and lymphomas

These occur in the tissues where white blood cells (which fight infection in the body) are formed, i.e. the bone marrow and lymphatic system. Leukaemia and lymphoma are quite rare and make up about 6.5% (6.5 in 100) of all cancers.

Sarcomas

Sarcomas are very rare. They are a group of cancers that form in the connective or supportive tissues of the body such as muscle, bone and fatty tissue. They account for less than 1% (1 in 100) of cancers.

Sarcomas are split into two main types:

  • bone sarcomas - that are found in the bones
  • soft tissue sarcomas - that develop in the other supportive tissues of the body.

Others forms of cancer

Brain tumours and other very rare forms of cancer make up the remainder of cancers.

Causes of primary liver cancer

The exact cause of primary liver cancer isn't known. Like other cancers, it isn't infectious and can't be passed on to other people.

Some factors may slightly increase a person's risk of developing primary liver cancer and these are described here.

Cirrhosis

This is scarring throughout the liver which can be due to a variety of causes. These include infection, heavy alcohol drinking over a long period of time, and a few rare conditions, such as haemochromatosis and primary biliary cirrhosis. Cirrhosis of the liver increases the risk of developing hepatocellular carcinoma (HCC), and the risk varies depending on the cause of the cirrhosis. However, only a small number of people with cirrhosis of the liver develop primary liver cancer.

Infection

Infection with either the hepatitis B or hepatitis C virus can lead to liver cancer and can also cause cirrhosis, which increases the risk of HCC. People with hepatitis B or C should avoid excessive amounts of alcohol, as this can further increase their risk of primary liver cancer.

Inherited medical conditions

Primary liver cancer is not caused by an inherited faulty gene, and so members of your family are highly unlikely to be at an increased risk of developing it because you have it.

However, people who have an inherited condition, such as haemochromatosis (which causes excess deposits of iron in the body), or tyrosinaemia, (where people have too much of an amino acid called tyrosine in their blood), have a higher chance of developing cirrhosis and HCC.

Aflatoxin

In Africa and Asia a poison called aflatoxin is a major cause of HCC. The poison is found in mouldy peanuts, wheat, soya and grain.

Other risk factors

People who take anabolic steroids over a long period of time have a slightly increased risk of developing primary liver cancer. Anabolic steroids are mainly used by body-builders as they can increase muscle bulk.

Types of primary liver cancer

Primary liver cancer is quite rare in the UK and the rest of the Western world, but the number of people developing it is increasing. Around 2,800 people in the UK are diagnosed with this type of cancer each year. In other parts of the world, such as some parts of Africa and Asia, it's one of the most common cancers. It is twice as common in men as in women.

There are different types of primary liver cancer. They are usually named after the types of cells from which it is thought the cancer has developed. Knowing the exact type of cancer helps the doctors to decide on the most appropriate treatment.

Hepatocellular carcinoma (HCC)

Hepatocellular carcinoma (HCC) is the main type of primary liver cancer and approximately

85 out of every 100 (85%) primary liver cancers are this type. It's sometimes known as hepatoma and arises in the main cells of the liver called hepatocytes. HCC is usually confined to the liver, although occasionally it spreads to other organs. It's more common in men and occurs mostly in people with a type of liver disease called cirrhosis.

There is a rarer sub-type of HCC called fibrolamellar HCC , which usually occurs in younger women and isn't related to previous liver disease.

Cholangiocarcinoma

This type of cancer starts in the cells that line the bile duct and is sometimes called bile duct cancer . Cholangiocarcinoma is more common in women.

Rarer types of liver cancer

There are two rare types of primary liver cancer:

  • Angiosarcomas are very rare. They develop in the blood vessels of the liver and are sometimes known as haemangiosarcomas . They tend to occur in people over 70.
  • Hepatoblastomas are very rare and usually affect young children under three.

The information here is about hepatocellular carcinoma. You may find our section on bile duct cancer (cholangiocarcinoma) useful. We also have information available about the rarer types of primary liver cancer.

Benign liver tumours

Some primary tumours in the liver are non-cancerous (benign) and don't spread to other parts of the body. They are usually small and may cause no symptoms. They are often discovered by chance during operations or investigations for other conditions. Unless they are causing symptoms they don't usually need to be removed. Benign liver tumours do not turn into cancer.

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