Frequently asked questions about liver cancer

Hepatocellular carcinoma can develop in anyone, but in the vast majority of cases it affects people with chronic liver disease. With respect to cholangiocarcinoma, which has known risk factors (and which overlap with those for hepatocellular carcinoma), a significant number of cases emerge in previously healthy patients. 

Liver cancer is not a hereditary tumour. Some people may have a certain susceptibility to liver cancer, but only in very rare cases. However, some risk factors for developing chronic liver disease, and ultimately liver cancer, can be transmitted between generations. 
 

In most cases, this tumour does not cause any symptoms until the disease is already in an advanced stage. The most common symptoms are tiredness, increased abdominal girth, jaundice, abdominal pain, loss of appetite and weight loss. 

Above all, you should avert getting chronic liver disease. In this respect, it is a good idea to avoid drinking alcohol. Similarly, you should eat a balanced diet and exercise because obesity and metabolic syndrome represent two of the most common causes of liver disease due to fat accumulating in the liver. It is also important to follow some healthy lifestyle habits, avoid the use of potentially contaminated sharp objects, use barrier methods during sexual intercourse (especially during sex with irregular partners), and so on. Finally, an effective vaccine is available to prevent hepatitis B virus infections.  

There is no maximum age above which screening is no longer recommended. The decision to perform screening should be based on the possibility of implementing a treatment if liver cancer is diagnosed. 

If you have chronic liver disease, you will have to undergo follow-up for the rest of your life. At first, the clinical follow-up will be more frequent due to the increased risk of liver cancer emerging in the first 2 years and, in most cases, it will involve computed tomography (CT) or MRI. After this period, your doctor will return to the regular check-ups comprising ultrasound scans every 6 months. 

Over the last few years, many studies have assessed different therapeutic options in attempts to eliminate or at least delay the onset of tumour recurrence. Unfortunately, none of these treatments have proven effective. 

At the moment, the only first-line therapy approved and financially supported by the Spanish healthcare system is sorafenib. Sorafenib is an oral treatment and patients normally take two tablets every 12 hours. After starting treatment, your doctor may need to adjust the dosage if you experience side effects. 

Treatment with sorafenib stops the disease from progressing further. Therefore, while the tumour is stable and sorafenib is well tolerated, you should continue with the treatment. 

A combination of cisplatin and gemcitabine is used to treat cholangiocarcinomas. Treatment is administered once a week in cycles of two weeks of chemotherapy and one week of rest. This combination is relatively well tolerated, but not without side effects, although these are usually well tolerated and easily managed. Since cisplatin can damage the kidneys, its administration must be accompanied by an intense hydration programme which means the chemotherapy session will last up to 4–6 hours. It can produce nausea and vomiting, yet these symptoms tend to be mild and can often be prevented with other medications. Other side effects include sensory changes, reduced hearing and low defences.  

Participation in clinical trials is voluntary. All studies are designed to evaluate therapeutic strategies that improve the standard treatment.