Liver and biliary tract cancer

What is it?

The liver is a large organ in the upper right of the tummy. It helps digest food and filters out harmful substances. Bile ducts are tubes that carry bile, a digestive juice made by the liver, to the small intestine. Primary liver cancer starts in the liver itself; secondary liver cancer has spread there from another part of the body. Bile duct cancer (cholangiocarcinoma) is uncommon and can start in the ducts inside or outside the liver.

Anyone can get them. Liver cancer is more common after 60 and in men, and bile duct cancer after 65. Liver cancer is linked to hepatitis, cirrhosis (scarring of the liver), diabetes, heavy drinking, smoking and being overweight. Bile duct cancer is linked to ulcerative colitis, bile duct stones, liver flukes (a parasite) and cirrhosis. Having a parent, brother or sister who had primary liver cancer raises your risk.

The first signs

In the early stages there may be no signs, or signs that are hard to spot.

• yellow skin or whites of the eyes (jaundice), and you may also have itchy skin, darker pee and paler poo than usual;
• losing your appetite, or losing weight without trying;
• tiredness, or feeling generally unwell or as if you have flu;
• a high temperature, or feeling hot, cold or shivery;
• feeling or being sick, or pain in the upper right of the tummy or in the right shoulder;
• a lump or swelling in the tummy, or feeling full very quickly when you eat.

How doctors find out

Your family doctor may examine your tummy and do a blood test, then send you to a specialist. Tests can include blood tests, scans (ultrasound, CT or MRI) and a biopsy, where a small sample of cells is taken and checked for cancer. More tests, sometimes a small operation to look inside the tummy (laparoscopy), help the specialists find out the size of the cancer and how far it has spread. Results can take several weeks. A specialist nurse becomes your main contact.

Current treatment

Surgery or ablation if early; immunotherapy if advanced

Will it get worse?

It depends on where the cancer is, how big it is, whether it has spread and your general health. You may not have symptoms until the cancer is advanced, which makes it harder to treat. Advanced liver or bile duct cancer may not be curable. Treatment then aims to limit the cancer and its symptoms and help you live longer. You will be referred to a palliative care team.

Medicines: what helps, and what to watch for

Targeted medicines or immunotherapy may be used when surgery is not possible or the cancer has spread to another part of the body. Immunotherapy helps your immune system attack the cancer, and targeted medicines kill cancer cells or slow their growth. In bile duct cancer, you may have chemotherapy after surgery to help stop the cancer coming back, or to make it smaller and ease symptoms if you cannot have surgery. It can be given with radiotherapy, targeted medicines or immunotherapy. In liver cancer, chemotherapy is usually given into the blood vessels of the cancer (chemoembolisation).

Good to know:

• Your team explains the benefits and side effects of each treatment and helps you manage them, including changes to your diet to help digestion;
• You have regular check-ups during and after treatment, and you may also have tests and scans;
• Tiredness is common during treatment and for some months after. Rest, together with gentle activity, can help.

Surgery, for some people

If the cancer is found early, is small and has not spread, surgery may remove it. For liver cancer this means removing part of the liver, or the whole liver followed by a transplant with a donated liver. For bile duct cancer, all or part of the bile duct is removed, often with parts of nearby organs. Recovery can take a long time. If liver cancer cannot be removed by surgery, it may be treated with heat (thermal ablation) or radiotherapy. In bile duct cancer, surgery can unblock or bypass a blockage in the bile duct or small intestine to help with jaundice and feeling or being sick.

Is there a cure?

Sometimes. In early liver cancer, a liver transplant, surgery or ablation can offer a chance of cure. When liver cancer is found early, surgery, a liver transplant or ablation can offer a chance of cure. If the cancer cannot be cured, treatment aims to limit the cancer and its symptoms and help you live longer.

See the 1,509 trials you can join

Median survival

About 16 months with modern first treatment, for advanced liver cancer

Measured in: Advanced hepatocellular carcinoma (the main liver cancer; not bile duct cancer), first treatment: the HIMALAYA trial (1,171 patients)

Sources

Written in plain words by Frontlight from these pages:

1. MedlinePlus: Bile Duct Cancer
2. NHS: Liver cancer – Symptoms
3. NHS: Liver cancer – Treatment
4. NHS: Liver cancer – Causes
5. NHS: Liver cancer – What is liver cancer?
6. NHS: Bile duct cancer – Causes
7. NHS: Bile duct cancer – Symptoms
8. NHS: Liver cancer – Tests and next steps
9. MedlinePlus: Liver Cancer
10. NHS: Bile duct cancer – Treatment
11. Cancer Research UK (charity): Coping and support when you have liver cancer
12. NCI PDQ: Hepatocellular Carcinoma Treatment (PDQ®) – Health Professional Version