Liver cancer (HCC)
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Bile duct cancer (cholangiocarcinoma)
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Fibrolamellar cancer
FIND OUT MOREWhat is liver cancer?
Liver cancer is a disease of the cells that make up your liver. Each cell is controlled by its deoxyribonucleic acid (DNA), which is like an instruction manual telling it what to do.
If its DNA instructions get very damaged, the cell can go out of control and make too many new copies of itself. These copies don’t work like healthy liver cells. They go on to make even more new, damaged copies. The copies form a clump called a tumour.
As the tumour gets bigger, your liver will eventually struggle to work properly.
Over time, the cancer can spread and form secondary cancers (metastases) in other parts of the body. For example if the cancer grows through the wall of a blood vessel, cells can travel around the body in the bloodstream and start new cancer sites. It is harder to treat cancer once it has started to spread.
Cancer staging
When all the tests have been completed, your consultant will review your results with a team (MDT or multidisciplinary team) that includes specialists in surgery, liver disease (hepatologist), digestive diseases (gastroenterologist) and cancer (oncologist), as well as other professionals who may be involved in your care. That team may be at another hospital in the region.
As well as confirming a cancer diagnosis, the tests will provide information on how advanced the cancer is (how big it is, where it is and the number of tumours present). This is referred to as ‘staging’ the cancer and is often measured using the Barcelona Clinic Liver Cancer (BCLC) staging system. The BCLC takes into account the size and number of tumours in your liver, whether the cancer has spread, how well your liver is working, and how well you are generally (performance status).
Another type of staging is the TNM classification which considers the size of the primary tumour and whether and how far it has spread.
The health of your liver will also be classified, most commonly using a scoring system called Child-Pugh (class A, B or C). This takes into consideration blood test results, the presence of fluid in the abdomen (ascites) and brain function (encephalopathy). A Child-Pugh class A indicates the liver is working well, whereas class C indicates more severe liver damage.
No two patients are the same and this information will help your medical team to decide on the most appropriate treatment options to discuss with you.
Looking after yourself
Diet supplements
If you are finding it difficult to eat, there are plenty of dietary supplements available on prescription. Some are powders you sprinkle on your food and some are drinks that are complete meals in themselves. Ask your doctor or dietician for help, and see our information on Diet and liver disease.
Alcohol and smoking
Alcohol is processed by your liver and as a result, it can be dangerous for anyone with liver problems. Check with your doctor whether it is safe for you to drink any alcohol and if so, how much.
Smoking is dangerous to everyone’s health. People with liver disease are more vulnerable to infection and to poor health overall, so smoking or exposure to passive smoking is not advised.
Palliative care
Your team may suggest that you are referred to your local community palliative care team. They are experts in pain relief and can be very helpful in supporting you and your family while you are having treatment or when treatment is no longer possible. They can advise and help you with symptom control and also provide emotional support to you and your family. For more on planning your future or palliative care, download our Thinking Ahead publication here.
