Introduction

Primary liver cancer is one of the commonest cancers worldwide, and it predominantly affects people in developing countries. It is often associated with chronic liver infections and it is more common in males. Patients usually present with advanced disease, and treatment options are influenced, and often limited, by comorbidities, especially poor function of the rest of the liver.

Tumours of the gallbladder and biliary tract are relatively rare. Patients often present late with symptoms of biliary obstruction, which, together with cholangitis, is a common cause of morbidity and death and the main target for palliative therapies. Gallbladder and biliary tract tumours are moderately chemosensitive. Cytological or histological confirmation of disease is often difficult, and specialist multidisciplinary teams with expert radiologists and pathologists should be involved in the diagnosis and staging. Radical surgery should be carried out only by tertiary surgical teams, and patients should be managed, whenever possible, within clinical trials.

Tumours of the liver

Types of tumour affecting the liver are shown in Table 14.1.

Anatomy of the liver

The liver is divided into right and left lobes by the falciform ligament, but more importantly, in terms of surgical resection, a segmental division can be made and seen with imaging, which is based upon the relationship to the hepatic and portal veins. There are four segments in both the left and the right liver. The left liver consists of the caudate lobe (segment I), the lateral segments II and III (superior and inferior lateral, respectively, seen extending to the left surface on CT) and the medial segment IV. The division between the lateral and medial segments is the gall bladder and IVC and not the falciform ligament. The right part of the liver is made up anteriorly of segments V and VIII (inferior and superior, respectively) and posteriorly of segments VI and VII (inferior and superiorly, respectively). The latter is the right lateral surface as seen on CT scan. Contrast in the portal, hepatic and inferior caval veins on CT allows distinct segmental definition.

Hepatocellular carcinoma

Incidence and epidemiology

Primary hepatocellular carcinoma (HCC) is the sixth most common solid tumour worldwide. Although the incidence is low in the UK and other developed countries, it is rising because of the increase in viral hepatitis.