Types of primary liver cancer

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Of every 100 people with primary liver cancer worldwide, 75 to 90 have HCC. HCC starts in the main liver cells called hepatocytes. It is more likely to develop in men than women and is more common in older people. HCC usually occurs in people who have a liver that is damaged from cirrhosis (scarring of the liver due to previous damage, often caused by hepatitis B and hepatitis C infections).

Other types of primary liver cancer include:

  • Cholangiocarcinoma, which starts in the cells lining the bile duct.
  • Angiosarcoma (or haemangiosarcoma), which starts in the blood vessels of the liver. It is extremely rare (1% of all primary liver cancers) and most often affects people aged over 70 years.
  • Hepatoblastoma which is very rare and usually affects young children. It affects more boys than girls.
  • Fibrolamellar HCC which is a subtype of HCC that usually affects younger women without cirrhosis.

Risks for primary liver cancer

A risk factor is anything that increases your chance of getting a disease. Risk factors for primary liver cancer (or HCC) include:

  • long-term infection with hepatitis B or C virus
  • cirrhosis (scarring of the liver due to previous damage, often a consequence of long-term infection with hepatitis B or C, or alcohol)
  • taking anabolic steroids (mainly used by body-builders as they can increase muscle bulk)
  • a family history of liver cancer.

People who are infected with hepatitis B or C also have a higher risk of primary liver cancer if they smoke.

Other possible risk factors include: arsenic, a poison which is found in the drinking water of some developing countries, having diabetes, being overweight, having lowered immunity (for example, from HIV or AIDS), and taking some types of the contraceptive pill.

In Africa and Asia, a poison called aflatoxin is a common cause of HCC. The poison is found in mouldy peanuts, wheat, soy and grain.

However, risk factors do not tell the complete story. Having one or more risk factors does not mean that you will definitely get primary liver cancer.

Symptoms of primary liver cancer

Liver tumours do not function like normal liver tissue. However, the liver function is not usually compromised by tumour tissue until most of the healthy liver has been replaced by the cancer cells. In a person with cirrhosis of the liver, this might already be the case if less than one-half of the liver has been replaced by tumour.

Liver cancer is sometimes called a silent killer because the majority of patients can seem healthy and have no any early signs or symptoms.

Small tumours in the liver are impossible to feel as the liver is shielded by the ribs. Pain is uncommon until the tumour is quite large and even some large tumours do not cause pain or other symptoms.

Later stages of liver cancer when the cancer is very large or when it impairs the functions of the liver can produce more obvious symptoms. These can include:

  • pain over the right upper abdomen
  • weight loss
  • lack of appetite
  • at a late stage, development of yellow discoloration of the eyes and skin (jaundice) and abdominal swelling (ascites)

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