Liver Cancers

Overview – Liver Cancers

Liver cancers include primary hepatic tumours (most commonly Hepatocellular Carcinoma) and secondary (metastatic) liver tumours, which are far more common overall. Hepatocellular Carcinoma (HCC) typically arises in the background of chronic liver disease and cirrhosis, especially due to hepatitis B, hepatitis C, and alcohol. Conversely, metastatic deposits often originate from colorectal, breast, lung, or melanoma primaries and frequently present with systemic symptoms and hepatic dysfunction.

Hepatocellular Carcinoma (HCC) – Primary Liver Tumour

Aetiology

• Hepatitis B & C (chronic) – high risk
• Cirrhosis – regardless of cause (alcoholic, viral, haemochromatosis)

Pathogenesis

• Cirrhosis precedes HCC in nearly all cases
• Chronic inflammation → cellular dysplasia → malignant transformation

Morphology

• Single or multiple hepatic masses
• Histologically resemble hepatocytes

Clinical Features

• Symptoms:
  • Fever, night sweats
  • Anorexia, weight loss
  • RUQ pain
  • Jaundice, pruritus
• Signs:
  • Hepatic encephalopathy, asterixis
  • Cirrhotic liver – small, nodular
  • Ascites
  • Suspect HCC in deteriorating cirrhotics

Investigations

• ↑ Serum Alpha-Fetoprotein (AFP)
• LFTs – ↑ALT/AST, ↑bilirubin
• FBC – may show anaemia, ↑MCV
• Ultrasound (USS) – homogeneous mass
• CT/MRI – for staging
• +/- FNA or biopsy (if needed for diagnosis/grading)

Management

• Surgical resection – only curative option
• Chemotherapy & radiotherapy have limited benefit
• Palliative care if unresectable

Complications

• Metastasis via:
  • Portal vein or hepatic vein
  • Lymphatics
  • Common metastatic sites: lungs and bones

Prognosis

• Poor – median survival ~6 months post-diagnosis

Liver Metastases – Secondary Liver Tumours

Aetiology

• Most commonly from:
  • Colorectal cancer
  • Breast cancer
  • Lung cancer
  • Melanoma

Pathogenesis

• Haematogenous spread → liver
• Often via portal circulation or systemic blood flow

Morphology

• Multiple, well-demarcated nodules
• May be found incidentally on imaging

Clinical Features

• Symptoms:
  • RUQ pain
  • Anorexia, weight loss
  • Nausea
  • Cachexia
• Signs:
  • Jaundice, pruritus
  • Hepatic encephalopathy
  • Fevers, night sweats

Investigations

• CT scan – diagnostic and prognostic
• LFTs – typically elevated
• FNA – to confirm diagnosis if primary is unknown

Management

• Palliative chemotherapy
• Analgesia and symptom management
• Rarely resected unless isolated and chemoresponsive

Summary – Liver Cancers

Hepatocellular Carcinoma is a major complication of chronic liver disease and cirrhosis, often presenting late with systemic symptoms and liver decompensation. Liver metastases are more common overall and often signify advanced systemic cancer. Diagnosis relies on AFP, imaging, and biopsy, while curative treatment is limited to early HCC via surgical resection. All other cases require palliative care and symptom control. For further hepatology topics, see our Gastrointestinal Overview page.