The most common primary liver cancer is hepatocellular carcinoma (hepatoma, HCC). It is most commonly associated with cirrhosis - a late stage of liver damage caused by various diseases and conditions, such as fatty liver disease, alcoholic liver disease or infection with hepatitis B or C. HCC is the fifth most common cancer in the world, and the third most common cause of cancer-related death. Identifying hepatocellular carcinoma can be difficult, as they have a variety of appearances on imaging and can easily be mistaken for benign liver lesions. Subspecialist radiologist and liver surgeon review is strongly encouraged to confirm a diagnosis prior to biopsy or treatment. Fibrolamellar carcinoma is a variant of HCC that usually occurs in young people and isn’t associated with pre-existing liver disease. It is often difficult to distinguish from benign liver lesions on imaging and the serum alpha-fetoprotein (AFP) levels are usually normal. Cholangiocarcinoma is a primary liver cancer of the liver that arises within the bile ducts (biliary epithelium). It is a rare cancer, that has an increased prevalence in patients from South East Asia or those with primary sclerosing cholangitis (PSC) due to chronic inflammation within the bile ducts. Signs of bile duct cancer include jaundice, pain or itch, but these are only present in advanced disease. Diagnosis requires laboratory tests, tumour markers (CEA, CA19-9, AFP) and radiological imaging by USS, CT or MRI. Often tissue is needed to establish the diagnosis that is obtained endoscopically, percutaneously or laparoscopically. Hepatoblastoma is a rare primary liver cancer seen in children, and Angiosarcoma is a rare cancer that is associated with exposure to chemical carcinogens, such as vinyl chloride.
Metastatic liver cancer is far more common than primary liver cancer. Liver metastases are common in many types of cancer, especially those that have arisen from the gastrointestinal tract (colon, small bowel, stomach), pancreas, breast and lung. The majority are asymptomatic, and the early symptoms of metastases are non-specific (weight loss, abdominal discomfort). The majority are found on imaging by USS, CT or MRI. Liver biopsy may be required to establish the diagnosis, but careful evaluation by a liver surgeon is usually required to determine whether treatment by resection is appropriate.