Hepatocellular carcinoma (HCC): symptoms, risks, diagnosis and treatment

The NHS describes liver cancer as cancer found anywhere in the liver, and distinguishes primary liver cancer, which starts in the liver, from secondary liver cancer, which spreads from another part of the body. Hepatocellular carcinoma belongs to the primary group, and Cancer Research UK says it is the most common type.

Cancer Research UK says liver cancer can happen at any age but is most common in older people, with most people diagnosed being over 60 and the highest rates in the 85 to 89 age group. The NHS likewise lists being over 60 as a risk and being a man, as well as a brother, sister or parent who had primary liver cancer.

The NHS says liver cancer may not have any symptoms, or they might be hard to spot, and that they are the same whether the cancer starts in the liver or spreads there. Symptoms listed include jaundice (yellow skin or eyes, with itchy skin, darker urine and paler stools), loss of appetite or unintentional weight loss, tiredness, feeling generally unwell or flu-like, and a lump on the right side of the tummy.

Digestive symptoms are also described: feeling or being sick, pain at the top right of the tummy or in the right shoulder, feeling full very quickly when eating, and a very swollen tummy not related to meals.

The NHS advises an urgent GP appointment or NHS 111 for jaundice or for being sick for more than 2 days, and a GP visit for a lump in the tummy, major unintentional weight loss, or symptoms that get worse or do not improve after 2 weeks. It notes many of these symptoms are common and caused by other conditions.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if the skin or whites of your eyes turn yellow, or you are being sick for more than 2 days; 111 will tell you what to do and can arrange a phone call from a nurse or doctor. See a GP if you have a lump in your tummy, have lost a lot of weight without trying, or have symptoms that get worse or do not improve after 2 weeks.

The NHS stresses that many of these symptoms are very common and can be caused by other conditions, so having them does not definitely mean liver cancer, but it is important to get them checked because finding cancer early may mean it is easier to treat. A GP may feel your tummy and listen to your chest, and may arrange an urgent referral if they think the symptoms could be cancer, which does not mean you definitely have cancer.

Most HCC arises against a background of liver damage. Cancer Research UK says cirrhosis increases the risk, with the risk varying according to its cause. It lists long-term infection with hepatitis B, C or D, long-term alcohol drinking above the recommended amount, inherited diseases such as haemochromatosis and alpha 1 antitrypsin deficiency, fatty liver disease and primary biliary cirrhosis.

Lifestyle and other conditions also contribute. Cancer Research UK says smoking, overweight and obesity, and diabetes increase the risk, and drinking more than 6 units of alcohol a day is considered heavy drinking for this purpose. It gives UK figures that around 20 out of 100 liver cancers are caused by smoking, more than 20 out of 100 by overweight and obesity, and 7 out of 100 by alcohol.

The NHS adds gallstones, HIV and liver flukes to its list of conditions linked to primary liver cancer, and suggests losing weight if overweight, cutting down alcohol (avoiding more than 14 units a week), quitting smoking, and wearing protective clothes and masks if a job exposes you to harmful chemicals. It also stresses that liver cancer cannot always be prevented.

Cancer Research UK says there is no national screening programme for primary liver cancer in the UK, because it is rare, there is no suitable test for population screening, and the cost would be high. It says, however, that some groups are at higher risk of HCC and a doctor may recommend surveillance in people with liver cirrhosis or long-term hepatitis B, also considering age and how much scarring the liver has.

Surveillance means an ultrasound scan every 6 months to look for growths, possibly with a blood test for AFP, which can be raised in some people with HCC. The point is to find tumours earlier, when they are smaller and treatment such as surgery or ablation may be possible. If you have cirrhosis and are concerned that you are not being tested, Cancer Research UK suggests asking your liver specialist at your next check-up.

After a GP referral, the NHS says tests can include blood tests, scans such as ultrasound, CT or MRI, and a biopsy, which collects a small sample of liver cells to check for cancer. You may not need all of them. The NHS says results can take several weeks and a long wait does not mean anything is definitely wrong.

Further tests are used to work out the size of the cancer and how far it has spread, known as the stage, and your specialists will use the results to agree a treatment plan with you. Cancer Research UK says treatment depends on the stage of your cancer and on how well your liver is working, which in people with cirrhosis is a major factor.

The NHS describes liver cancer as often treatable but sometimes difficult to treat. Options include surgery, chemoembolisation, thermal ablation, targeted medicines and immunotherapy, and radiotherapy, with the choice depending on type, size, location, spread and general health.

Surgery is possible if the cancer is found early, is small and has not spread, and removes part or all of the liver; if all of it is removed, a liver transplant is needed. Recovery can take a long time. Where surgery is not possible, thermal ablation uses an electric current or microwaves to destroy the cancer, and chemoembolisation delivers chemotherapy into the blood vessels of the cancer. Selective internal radiation therapy (SIRT) injects radioactive beads into the liver's blood supply in suitable adults. Cancer Research UK names cabozantinib and atezolizumab among targeted and immunotherapy drugs.

If cure is not possible, the NHS says the aim is to limit the cancer and its symptoms and help you live longer, supported by a palliative care or symptom control team and a clinical nurse specialist.

On the NHS, a GP can refer you urgently for tests if symptoms could be cancer, and treatment is planned by a specialist liver team. Surveillance for people with cirrhosis or long-term hepatitis B is arranged by a liver specialist, as Cancer Research UK describes. The NHS says results can take several weeks and a long wait does not mean anything is definitely wrong.

Private liver clinics and scans are available too. In either setting, ask who coordinates your care, how scan results will be shared with your GP, and what the surveillance schedule is if you have cirrhosis. Treatment decisions depend on the stage of the cancer and how well your liver works.