Primary liver cancer is a malignant (cancerous) tumour that starts in the liver.
Learn more about:
- What is liver cancer?
- The liver
- Who gets liver cancer?
- What are the risk factors for liver cancer?
- The link between hepatitis and liver cancer
- Watch videos on liver cancer
What is liver cancer?
Cancers in the liver can be either a primary or secondary cancer. The two types of cancer are different. Primary liver cancer is cancer that starts in the liver. The most common type of primary liver cancer in adults is hepatocellular carcinoma (HCC). HCC starts in the hepatocytes, the main type of liver cell. This section is only about HCC.
Less common types of primary liver cancer include:
- cholangiocarcinoma or bile duct cancer – starts in the bile ducts
- angiosarcoma – a rare type of liver cancer that starts in the blood vessels
- hepatoblastoma and hemangiosarcoma– rare types of liver cancer that affects only young children.
Secondary liver cancer is cancer that started in another part of the body and has spread to the liver. It is more common than primary liver cancer in Australia. If you are unsure if you have primary or secondary liver cancer, check with your doctor.
The liver
The largest organ inside the body, the liver is about the size of a football. It is part of the digestive system, working with the gall bladder and pancreas to help break down food and turn it into energy.
The liver has many important jobs, including:
- storing sugars and fats, so they can be used for energy
- producing bile to help dissolve fat so it can be easily digested
- making proteins to help blood clot and to balance fluid in the body
- breaking down harmful substances, such as drugs and alcohol.
The liver is found on the right side of the abdomen (belly), sitting just above the stomach and under the rib cage (see diagram below). It is divided into two main sections – the right and left lobes.
The digestive system
How the liver works
Blood flows into the liver from the hepatic artery and the portal vein. The hepatic artery carries blood from the heart. The portal vein carries blood from the digestive organs to the liver.
Bile is carried between the liver, the gall bladder and the first part of the small bowel (the duodenum) by a series of tubes called bile ducts. The common bile duct carries bile from the liver and the gall bladder to the bowel, where the bile helps to break down and absorb fats and other nutrients from food.
The liver can continue to work when only a small part is healthy. A healthy liver may be able to repair itself if it is injured or part of it is surgically removed during cancer treatment.
Bile duct cancer (cholangiocarcinoma)
This uncommon form of primary liver cancer accounts for about 10–15% of all liver cancers worldwide. Bile duct cancer (cholangiocarcinoma) starts in the cells lining the ducts that carry bile between the liver, gall bladder and bowel. Most risk factors are similar to those of HCC, but exposure to certain chemicals in the print industry may also increase the risk of developing bile duct cancer.
For more on this, see Bile duct cancer (cholangiocarcinoma).
Who gets liver cancer?
In Australia, more than 3000 people are diagnosed with primary liver cancer each year, with about three times more men than women affected. The rate of primary liver cancer has almost doubled since 2002, which is possibly due to increasing rates of obesity, type 2 diabetes, hepatitis B and C infections, drinking too much alcohol, and an ageing population. More than 80% of cases occur in people aged 60 and over.
What are the risk factors for liver cancer?
Primary liver cancer most often develops in people with underlying liver disease, usually cirrhosis. In cirrhosis, healthy liver cells are replaced by scar tissue, and benign nodules (non-cancerous lumps) form throughout the liver. As this gets worse (advanced cirrhosis), the liver stops working properly.
Cirrhosis may be caused by:
- long-term (chronic) infection with hepatitis B or C virus
- drinking too much alcohol
- metabolic-associated fatty liver disease (MAFLD) as a result of obesity and/or type 2 diabetes
- having too much iron in the bloodstream (haemochromatosis)
- certain autoimmune conditions (e.g. primary biliary cholangitis).
A small but increasing number of people are developing liver cancer without cirrhosis. This may occur in people with long-term hepatitis B infection, or with liver disease related to obesity or type 2 diabetes.
Other risk factors for liver cancer are smoking tobacco or having a family history of HCC. Aboriginal and Torres Strait Islander peoples and migrants from countries with higher rates of hepatitis B infection (e.g. countries in the Asia–Pacific region and Sub-Saharan Africa) are also at greater risk of developing primary liver cancer.
The more risk factors a person has, the greater the chance of developing liver cancer.
For an overview of what to expect during all stages of your cancer care, visit Liver Cancer – Your guide to best cancer care. This is a short guide to what is recommended, from diagnosis to treatment and beyond.
The link between hepatitis and liver cancer
Worldwide, up to 8 in 10 cases of liver cancer (HCC) can be linked to infection with the hepatitis B or C virus (viral hepatitis). This is changing as vaccinations and effective treatments for viral hepatitis are helping to reduce the rates of hepatitis-related liver cancer.
How hepatitis spreads
Hepatitis B and C spread through contact with infected blood, semen or other body fluids.
The most common way hepatitis B spreads is from an infected mother to a baby during birth. Hepatitis B can also be transmitted during unprotected sex with an infected partner, or by sharing personal items, such as razors or needles, with an infected person.
Hepatitis C is usually transmitted through the sharing of needles during illicit drug use, tattooing, sharing personal items, or contaminated medical equipment.
Viral hepatitis infects the liver cells (hepatocytes). When the body’s immune system attacks the virus, the liver becomes inflamed. Infection that lasts for more than six months may lead to liver damage (cirrhosis), which increases the risk of primary liver cancer. Importantly, people with cirrhosis should have long-term monitoring for liver cancer.
Preventing hepatitis
All babies in Australia are offered the hepatitis B vaccine at birth. To further prevent the spread of hepatitis B, at-risk people should also be vaccinated.
This includes:
- Aboriginal and Torres Strait Islander peoples
- people from countries with higher rates of hepatitis B
- people living with someone with hepatitis
- people who are immunocompromised
- health care workers.
If you already have hepatitis B, vaccination won’t be helpful, but you will usually have regular tests to ensure you don’t develop cancer or other liver problems. If you also have signs of liver damage, you may be offered antiviral medicines to help prevent further damage.
There is no vaccine for hepatitis C infection, but effective medicines are available and the virus can often be cured. While this treatment can lower the risk of primary liver cancer, it does not eliminate it.
→ READ MORE: Liver cancer symptoms
Watch videos on liver cancer
What is liver cancer?
Liver Specialist Dr Jacob George explains what the function of a liver is, and how liver cancer can start and spread.
What is the difference between primary and secondary liver cancer?
Dr Jacob George explains the difference between primary and secondary liver cancer.
A/Prof Simone Strasser, Hepatologist, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital and The University of Sydney, NSW (clinical update); A/Prof Siddhartha Baxi, Radiation Oncologist and Medical Director, GenesisCare, Gold Coast, QLD (clinical update); Prof Katherine Clark, Clinical Director of Palliative Care, NSLHD Supportive and Palliative Care Network, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Anne Dowling, Hepatoma Clinical Nurse Consultant and Liver Transplant Coordinator, Austin Health, VIC; A/Prof Koroush Haghighi, Liver, Pancreas and Upper Gastrointestinal Surgeon, Prince of Wales and St Vincent’s Hospitals, NSW; Karen Hall, 131120 Consultant, Cancer Council SA; Dr Brett Knowles, Hepato-Pancreato-Biliary and General Surgeon, Royal Melbourne Hospital, Peter MacCallum Cancer Centre and St Vincent’s Hospital, VIC; Lina Sharma, Consumer; David Thomas, Consumer; Clinical A/Prof Michael Wallace, Department of Hepatology and Western Australian Liver Transplant Service, Sir Charles Gairdner Hospital Medical School, The University of Western Australia, WA; Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT.
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