The liver is one of the most common sites of cancer spread in the body, and also one of the sites where surgery can make a significant and lasting difference. This guide covers the three main types of liver cancer treated by hepatobiliary surgeons.
Colorectal Liver Metastasis (CRLM)
Colorectal liver metastasis occurs when cancer from the colon or rectum spreads to the liver. This is the most common form of liver cancer encountered by HPB surgeons in the UK, and surgical resection remains the gold standard when the disease is confined and technically resectable.
Symptoms
- Often none in early stages — frequently discovered on staging scans for bowel cancer
- Abdominal pain or discomfort, fatigue, jaundice, or weight loss as disease progresses
Treatment Options
- Surgical resection: The preferred treatment when metastases are resectable. Removing the affected portion of liver with clear margins offers the best chance of long-term survival.
- Ablation: Heat or cold energy used to destroy smaller tumours not amenable to resection.
- Chemotherapy: Used before surgery to downsize disease, or after to reduce recurrence risk.
Hepatocellular Carcinoma (HCC)
HCC is the most common primary liver cancer — arising from the liver cells themselves, most frequently in the context of underlying chronic liver disease such as cirrhosis, or chronic hepatitis B or C infection.
Symptoms
- Often asymptomatic in early stages — detected through surveillance imaging in at-risk patients
- Upper right abdominal pain, jaundice, unexplained weight loss, nausea, abdominal swelling
Treatment Options
- Surgical resection: The treatment of choice for early-stage HCC in patients with adequate liver reserve.
- Liver transplantation: For selected patients with early-stage HCC and underlying cirrhosis, transplantation addresses both the tumour and the diseased liver.
- Ablation or embolisation: Local treatments for patients not suitable for surgery.
Cholangiocarcinoma (Bile Duct Cancer)
Cholangiocarcinoma is a rare cancer arising from the bile duct cells. It is often diagnosed at a late stage, making surgical resection achievable in only a proportion of cases. When it is resectable, surgery offers the only chance of cure.
Symptoms
- Jaundice — typically the presenting symptom, caused by bile duct obstruction
- Itchy skin, dark urine, pale stools
- Upper abdominal pain, unexplained weight loss
Treatment Options
- Surgical resection: Offers the best chance of long-term survival when the tumour is resectable and the patient is fit for major surgery.
- Liver transplantation: Considered in highly selected cases of early-stage perihilar cholangiocarcinoma at specialist centres.
- Chemotherapy and palliative treatment: For advanced disease, systemic chemotherapy can control disease progression and preserve quality of life.
Recovery After Liver Cancer Surgery
- Rest: Recovery after liver resection typically takes 4–8 weeks before return to full activity. Avoid heavy lifting or strenuous exercise during this period.
- Pain management: Post-operative discomfort is managed with prescribed analgesia. Light walking is encouraged from day one.
- Diet: Start with light, easily digestible food and gradually resume a normal diet. Stay well hydrated and avoid alcohol.
- Follow-up: Regular blood tests and imaging are essential to monitor liver function and watch for recurrence.
- When to call the team: Contact your surgeon promptly if you develop fever, increasing pain, jaundice, or signs of wound infection.