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:
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:
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:
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.
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:
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).
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:
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.
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.
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:
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.
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):
Numbers 0 and 1 indicate the presence of cancer in the nodes (N):
Numbers 0 and 1 tell us whether cancer has spread (metastasised M):
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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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.
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:
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.
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.
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.
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.
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:
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.
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.