Every year, some 400 Kiwis are diagnosed with primary liver cancer, where cancer starts in the liver. Secondary liver cancer (metastatic cancer) is more common and occurs when cancer spreads to the liver from another part of the body.
In New Zealand, liver cancer numbers have been steadily increasing since the 1990s. This may be due to increased exposure to the hepatitis virus, which causes around 80% of liver cancer cases.
Incidence and mortality rates are much higher for Māori than non-Māori. Cancer in the liver is the 9th most common cancer for this group, with some 60 Māori dying each year from the disease.
Five-year survival rates for primary liver cancer are low, at just 21%.
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What does the liver do?
The liver is a major organ situated in the upper-right abdominal quadrant. There are more than 500 functions linked to the liver, and it is one of the largest organs in the human body.
Some essential functions performed by the liver include:
- Processing and controlling sugars, fats, and vitamins for energy
- Regulating protein output for blood clotting and fluid levels
- Producing bile for fat and waste metabolism
- Processing toxic substances, such as alcohol.
Liver cancer types
Primary liver cancer occurs when cells in the liver or the bile duct begin to grow abnormally.
Secondary liver cancer occurs when cancers that began in other parts of the body spread to the liver. For example, 40% of people with advanced bowel cancer will also have cancer spread (metastasise) to their liver.
There are four main types of liver cancer:
- Hepatocellular carcinoma (HCC) - is the most common. HCC usually occurs as a result of long-standing liver disease (cirrhosis) triggered by hepatitis or alcohol consumption.
- Fibrolamellar HCC - is usually found only in young women. It is not linked to an underlying liver disease.
- Bile duct cancer (cholangiocarcinoma) - occurs in the bile ducts.
- Angiosarcoma - a rare type that typically occurs in the over-70 age group.
Liver cancer symptoms
Cancer of the liver usually shows few symptoms until the disease has reached a more advanced stage.
Symptoms of liver cancer to watch out for include:
- Unexplained weight loss
- Loss of appetite
- Pain and swelling in the upper abdominal area
- Vomiting and nausea
- Weakness and fatigue
- Jaundice, or yellowing of the skin
- Stools that are chalky white
- Pain in the right shoulder.
Early diagnosis of liver cancer is vital for your survival, so see your doctor if you experience any of these symptoms. Even if you don’t have liver cancer, they could indicate an underlying liver disease that needs treatment.
What causes liver cancer?
The biggest known cause of liver cancer is a chronic hepatitis B or C infection. Hepatitis-related liver cancer accounts for around 80% of cases in New Zealand.
Alcohol consumption (another major cause), when combined with a chronic hepatitis infection, substantially increases your risk of developing liver cancer. Unfortunately, an estimated 40% of people with hepatitis are unaware that they’re infected.
Māori are three to five times more likely to develop hepatocellular-type liver cancer than European New Zealanders.
Males are three times more likely than females to develop the disease.
Other factors that increase your risk of developing cancer of the liver include:
- Obesity
- Type 2 diabetes
- Smoking
- Liver disease or damage
- Family history
- Genetic conditions, such as haemochromatosis.
As with many cancers, increasing age is also a risk factor. This is especially true if you were born in New Zealand before the introduction of the national hepatitis vaccination scheme (1988).
How is liver cancer diagnosed?
Your doctor will perform a physical examination of your abdomen to check for swelling or lumps. A series of additional tests will provide a more definitive diagnosis and might include:
- Blood tests - to pinpoint specific markers that may indicate cancer. They can also check your liver function and identify any genetic issues or the presence of hepatitis infection.
- Ultrasound scans - sound waves which produce an image of the organs inside your body.
- Biopsy - the removal of tissue for microscopic examination, often performed via fine-needle aspiration or laparoscopy.
- MRI, PET, or CT scans - to identify abnormalities, also used to help guide the needle during a biopsy.
Accessing scanning diagnostics - such as an MRI or CT - under New Zealand’s public health system can involve lengthy delays. It may also take some time for test results to become available. During this waiting period, your cancer could be growing and becoming harder to treat.
Remember: early diagnosis and treatment of liver cancer increases your likelihood of a positive health outcome.
Liver cancer stages
Using the information gathered from your tests, your doctors will assign a stage classification to your cancer. This helps your medical team plan out the best treatment options for you.
Barcelona Clinic Liver Cancer (BCLC) staging system
One system commonly used is known as the Barcelona Clinic Liver Cancer (BCLC) staging system. The BCLC system is also helpful in identifying any underlying liver damage.
The BCLC system measures:
- The dimensions and number of tumours in your liver
- How well you perform daily activities
- Liver function (based on your Child-Pugh score).
Under the BCLC system, a mix of number and letter scores gives a clear picture of your overall health, the spread of your cancer, and your ability to cope with various treatments.
TNM staging system
The TNM system is often used in other cancers but may also be used for liver cancer.
Under the TNM system:
T = the size of the Tumour.
N = the presence of cancer cells in the lymph Nodes.
M = whether tumours have spread to other parts of the body (Metastasised).
Numbers 1 to 4 represent the size of the tumour (T):
- T1 - indicates a single tumour that may be larger than two centimetres but has not spread into blood vessels.
- T2 - tumours are between two and five centimetres across and may have reached the blood vessels.
- T3 - indicates several tumours. At least one of the tumours is bigger than five centimetres.
- T4 - cancer cells have spread into blood vessels and nearby organs.
Numbers 0 and 1 indicate the presence of cancer in the nodes (N):
- N0 = no cancer cells in the lymph nodes.
- N1 = there are cancer cells in the neighbouring lymph nodes.
Numbers 0 and 1 tell us whether cancer has spread (metastasised M):
- M0 = cancer has not spread beyond the liver.
- M1 = cancer cells are found in other organs or parts of the body such as the bones.
Number staging system
Uses numbers one to four to describe the size and position of tumours, as well as letters to provide further detail. The system looks very similar to TNM staging. Four is the most advanced stage.
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Treatment for liver cancer
Surgery
Surgery is relatively straightforward for removing tumours if your liver function is still reasonably healthy, the cancer is not too large, and has not spread very far. The potentially positive outcome of surgery is one reason why an early diagnosis of liver cancer is critical.
Hepatectomy: The surgeon may remove sections of your liver if the cancer is restricted to just that part. When done in the early stages of cancer, it may allow the liver to grow back to its original size and to function as usual.
Liver transplant: If cancer has spread or there are too many tumours, the surgeon may consider a liver transplant. There are strict requirements to be considered for a transplant, and liver donors are rare. The lengthy wait for a liver donor can mean your cancer spreads so much that you’re no longer fit for a transplant.
Ablation
This is an effective way of killing the tumour without having to remove it. It is usually only effective for smaller tumours. Ablation can be performed using:
- Heat via microwaves or radio waves.
- Cryoablation (nitrogen freezing).
- Pure alcohol, which is injected into the tumour.
Radiation therapy
Intense x-rays are used to kill cancer cells. One type of radiation therapy is selective internal radiation therapy (SIRT). By feeding glass bubbles containing radiation through a catheter, radiation specifically targets cancer cells. The highly focused nature of SIRT means doctors can apply more intense radiation for longer without damaging healthy tissue.
Stereotactic body radiation therapy (SBRT) uses an external machine to deliver the radiation. Both SIRT and SBRT are used when surgery is not possible or to shrink tumours before surgery.
Unfortunately, SIRT is not funded and is only available privately.
Trans-arterial chemoembolization (TACE)
TACE is a form of chemotherapy where a catheter is used to deliver drugs directly to the tumour. Traditional forms of chemotherapy are not usually used with liver cancer, but TACE is useful for patients who cannot have surgery or who are waiting for a liver transplant.
Targeted therapy
These drugs halt specific cancer behaviours, such as cell growth or the formation of new blood vessels within cancer cells. These drugs can help slow things down and are helpful in advanced-stage cancers where other options might not be available. Targeted therapy is not publicly funded so you’ll need to source private treatment.
Other options
There are other options - such as immune therapy and clinical trials - that may also offer some hope. Under the New Zealand public health system, your treatment plans will be limited to what is available in your local hospital. Advanced treatment options, like SIRT and targeted drug therapy, are only available privately. This means you’ll either fund the treatments yourself or, if you have health insurance, your insurer will pay.
Can liver cancer be prevented?
Two of the biggest risk factors for liver cancer are chronic hepatitis B or C infections and liver damage (cirrhosis). The best things you can do to reduce your risk of developing liver cancer include:
- Vaccinate against hepatitis B.
- Take antiviral medication if you have chronic hepatitis B or C.
- Have regular liver check-ups if you have chronic hepatitis.
- Stop smoking and drinking.
- Eat a healthy diet and exercise regularly.
Early diagnosis and treatment are essential for a successful liver cancer outcome. Private medical insurance gives you fast access to diagnostic tools and treatment that can save your life.
Are you prepared for life’s uncertainties?
You may not have liver cancer but that’s no guarantee it won’t happen to you or someone you love. Think about how health insurance can prepare you for the possibility.
And not all health insurance plans are the same. Some plans only pay for a tiny fraction of your treatment expenses.
Don’t let this happen to you. When buying health insurance, talk to a Policywise adviser about maximum benefit amounts for cancer treatments, non-Pharmac cover, inclusions, and any exclusions.
We provide clear, easy-to-understand plan comparisons from different insurers so you can choose the policy with the best cover. Our service is free - and it might just change your life for the better.