Liver cancer

Blood tests

Blood tests can check how well the liver is working; and how well your blood clots; as well as checking certain chemicals known as tumour markers; whether you have hepatitis B or C; and any genetic problems.

Ultrasound

The most commonly used method to look for primary liver cancer, an ultrasound produces pictures of the organ, and can show the size and location of abnormal tissue in your liver.

CT scan

CT scans produce three-dimensional pictures of several organs at the same time, and can help doctors plan the surgery. It can also see if the cancer has spread.

MRI

An MRI scan produces detailed cross-sectional pictures of the body, and can show the extent of a tumor and whether it is affecting the main blood vessels around the liver.

PET-CT scan

More commonly used for secondary cancers in the liver, PET-CT scans produce three-dimensional colour images that show where any cancers are in the body.

Biopsy

A biopsy is when a small amount of tissue is removed for examination under a microscope.

A biopsy is done by either: fine needle aspiration, which involves a local anaesthetic, and a thin needle which removes the cells; or laparoscopy (keyhole surgery), which is done under general anaesthetic and allows the doctor to look at the liver and surrounding organs, as well as take tissue samples using a laparoscope.

Other tests

If you have secondary cancer in the liver, you may have further tests to find out where the primary cancer started, if this is not already known.

Surgery

Surgery can involve removing part of the liver, or a liver transplant, where the whole liver is replaced by a donor liver.

Surgery is suitable for a small number of people with liver cancer, and it will depend on the size, number and position of the tumours.

Surgery to remove part of the liver is called a partial hepatectomy. Following surgery, the remaining part of the liver can usually repair itself if it is not damaged, and grow back to normal size over a few months. If there are tumours in both sides of the liver, surgery may be conducted over two stages, to allow the liver to regrow following the first operation.

For some people, it is not possible to remove part of the liver, and they may be considered for a transplant. A number of factors are considered before someone is eligible for a liver transplant, including the person's overall health. In addition, a person should not smoke or take illegal drugs and should have stopped drinking alcohol for at least six months. A liver transplantation may be possible, however, waiting for a suitable donor liver may take a long time. During this time, most people have other treatment to control the cancer.

Tumour ablation

Tumour ablation is used most commonly for small primary liver cancers. It is rarely used for secondary cancer in the liver.

The most common types of tumour ablation treatments use radio waves and microwaves to heat and destroy cancer cells. This treatment is administered by either a needle inserted through the skin (percutaneous ablation) or a surgical cut (ablation with surgery).

Less common types of ablation treatment include alcohol injection, where pure alcohol is inserted into the tumour to destroy cancer cells; and cryotherapy, which is surgery that freezes and kills cancer cells.

Chemotherapy

Depending on the type of liver cancer you have, you may receive chemotherapy drugs to kill, shrink or slow the growth of the tumours.

Chemotherapy can be given systemically, via tablets or intravenously (through a drip), which means it goes throughout the whole body. This may be given following other treatment, such as surgery or cryotherapy, to get rid of any remaining cancer cells. It is not usually used to treat primary liver cancer unless the cancer has spread to other parts of the body.

Systemic chemotherapy can also be used as palliative treatment to slow down the cancer growth and reduce pain.

Chemotherapy can also be given directly into the tumour, which is called chemoembolisation (or TACE). As it is targeting the tumour directly, stronger drugs can be used. TACE is more commonly used for primary liver cancer.

Biological therapy

A range of treatments that work against the cancer cells by either stopping their growth or function, or by helping the body's immune system destroy them. Used for both primary and secondary cancers in the liver, it can be used in conjunction with, or after other treatments for cancer.

Selective internal radiation therapy (SIRT)

Also known as radioembolisation, this treatment targets liver tumours directly with high doses of internal radiation in tiny beads. It is used for both primary and secondary cancers in the liver when the tumours can't be removed with surgery. It is not available in all areas, so talk to your doctor about availability and costs involved.

Endoscopic stent placement

If the cancer in the liver has obstructed the bile duct and bile has then built up in the liver, it may be recommended that a stent (thin tube) is placed in your liver to drain the bile and ease symptoms.

Palliative care

In some cases of liver cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of liver cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiation therapy, chemotherapy or other drug therapies.