Liver cancers: types and prevalence

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With more than 782,000 new cases diagnosed in 2012, liver cancer is the sixth most common one. It accounts for 6% of all cancers worldwide.  Its incidence rates are highest in Eastern Asia and lowest in South Central Asia, but this partly reflects varying data quality worldwide.

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These two maps below (from World Health Organization) show the incidence of liver cancer worldwide.

Estimated  incidence worldwide among male population (2012)

Estimated incidence worldwide among female population (2012)

First, there are two types of liver cancer. Primary liver cancer starts in the liver itself. Secondary liver cancer is a separate condition, where the cells have developed in another part of the body and has spread to the liver2. The chance of developing primary liver cancer is higher for people with risk factors2. It often follows the continual damage to the liver, after fibrosis and subsequent cirrhosis have occurred.

Every single cancer is different. Some are similar, but no two types are the same and for that reason a universal cure is thought to be impossible. Cancers are named after the type of cell and part of the body they first begin to grow2. This is the primary cancer. This is important because cancers are treated according to the original cell type.

Four types of primary liver cancers (PLC) :

Hepatocellular carcinoma*, sometimes called hepatoma or HCC, is the most common type. The disease develops from the main liver cells called hepatocytes. It’s more common in people who have a damaged liver from cirrhosis3.

Fibrolamellar carcinoma*, a rare sub type of hepatocellular cancer (HCC).Fibrolamellar carcinoma tends to develop in younger people, and is not usually linked with cirrhosis or infection with hepatitis B or C3.

Cholangiocarcinoma*, sometimes known as bile duct cancer. Cholangio actually refers to the bile ducts. The liver makes bile, which helps digest fats in food, and flows through tubes called bile ducts into the gallbladder. Disease can start anywhere along the bile ducts. Cancers that start in the section of the ducts inside the liver are called intra hepatic cholangiocarcinoma. They are classed as a type of primary liver cancer.

Cancers that start in the section of ducts outside the liver are called extra hepatic cholangiocarcinoma. Both types of cholangiocarcinoma are treated as bile duct cancer3. This type  is common in Primary Sclerosing Cholangitis (PSC) and it is important that your liver is monitored closely to detect this as early as possible.

Angiosarcoma*, also called haemangiosarcoma, is a type of cancer that begins in the blood vessels of the liver, and is extremely rare. Only around 10 cases of angiosarcoma of the liver are diagnosed each year in the UK. It’s most often diagnosed in people aged in their 70s and 80s. It is a type of soft tissue sarcoma.3

Figures about liver cancers in the UK

On average, roughly 5,500 people are diagnosed with primary liver cancers in the UK each year4. These figures place it as the 17th most common cancer in the UK4, and accounts for 2% of all new cases  in the UK2.  However, cases of PLC are rising and since the early 1970s, liver cancer mortality rates have increased by almost three-fold (196%) in the UK4.

Preventing the disease

42% (49% in males and 28% in females) of liver cancers are regarded as preventable and are linked to major lifestyle and other risk factors4. These include smoking (23%), infections (16%), and alcohol (9%)4. However a person’s risk of developing cancer may depend on many other factors too, including age, genetics, and exposure to the lifestyle risk factors mentioned above4 as well as an another underlying liver condition that affects your liver health, such as Primary Biliary Cirrhosis or PSC. If a person already has liver disease where cirrhosis is present, 5–10% of cases are likely to progress to liver cancer5.

If you don’t have an existing liver condition, you can lower your risk of developing PLC by following healthy lifestyle measures, such as regular exercise, controlling your weight, and eating a healthy diet with limited amounts of alcohol. It’s also important to avoid putting yourself at risk of hepatitis B and C infection.

Diagnosis of liver cancer

You should contact your GP if you’ve previously been diagnosed with a condition known to affect the liver, such as cirrhosis or a hepatitis C infection, and your health suddenly deteriorates. Always make sure you attend your specialist appointments, and make notes beforehand to ensure you give your specialist any relevant information about changes you may have noticed in your body.

Often PLC is diagnosed fairly late, if it has not already been picked up due to the onset of cirrhosis following a known condition, such as Primary Biliary Cholangitis (PBC) or hepatitis B. The likely outcome when you have PLC depends on how advanced it is when it is diagnosed.

If you are worried about the health of your liver, it’s a good idea to visit your GP and request a liver function test. He/she is the only one able to determine whether further investigation is required.

Liver icon©EstherQueen999 

References:

  1. Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/liver-cancer/incidence#heading-Nine [accessed June 2017]
  2. NHS Choices. Liver Cancer Introduction. http://www.nhs.uk/conditions/Cancer-of-the-liver/Pages/Introduction.aspx [Accessed May 2017]
  3. Cancer Research UK. http://www.cancerresearchuk.org/about-cancer/liver-cancer/types [Accessed April 2017]
  4. Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/liver-cancer#heading-One, [Accessed April 2017].
  5. R. et al. 2014. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. The Lancet, Vol. 384, No. 9958, p1953–1997. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)61838-9.pdf [Accessed April 2017]
  6. NHS Choices. Symptoms of liver cancer. http://www.nhs.uk/conditions/cancer-of-the-liver/Pages/Introduction.aspx#symptoms [Accessed April 2017]
  7. NHS Choices. Liver Cancer Diagnosis. http://www.nhs.uk/Conditions/Cancer-of-the-liver/Pages/Diagnosis.aspx [Accessed April 2017]
  8. Cancer Research UK. TNM staging. http://www.cancerresearchuk.org/about-cancer/liver-cancer/stages/tnm-staging [Accessed June 2017]
  9. Cancer Research UK. Liver Cancer Stage 1. http://www.cancerresearchuk.org/about-cancer/liver-cancer/stages/stage-1 [Accessed June 2017]
  10. Cancer Research UK. Liver Cancer Stage 2. http://www.cancerresearchuk.org/about-cancer/liver-cancer/stages/stage-2 [Accessed June 2017]
  11. Cancer Research UK. Liver Cancer Stage 3. http://www.cancerresearchuk.org/about-cancer/liver-cancer/stages/stage-3 [Accessed June 2017]
  12. Cancer Research UK. Liver Cancer Stage 4. http://www.cancerresearchuk.org/about-cancer/liver-cancer/stages/stage-4 [Accessed June 2017]