Primary liver cancer (see box, left) is a rare but serious type of cancer that mostly affects older people. The initial symptoms of liver cancer are often vague and non-specific. They include:
- unexplained weight loss
- nausea (feeling sick)
- jaundice - yellowing of the skin and the whites of the eyes
In many cases, cancer of the liver does not cause noticeable symptoms until it has reached an advanced stage. See Liver cancer - symptoms for more information about the possible warning signs of liver cancer and when to contact your GP.
The liver is one of the most complex organs in the human body and it performs more than 500 functions. Some of the liver's most important functions include:
- digesting proteins and fats
- removing toxins (poisons) from the body
- helping to control blood clotting (thickening)
- releasing bile, a liquid that breaks down fats and aids digestion
Liver cancer is a serious condition because it can disrupt these functions or cause them to fail completely, which could prove fatal.
How common is liver cancer?
Liver cancer is rare in England, but much more common in other parts of the world (see box, left).
In England, an estimated 2,750 new cases of liver cancer are diagnosed each year. Around 60% of cases affect men and 40% affect women. The number of people who are affected by liver cancer rises sharply with age: 70% of cases involve people who are 65 or older.
Risk factors for liver cancer include:
- alcohol misuse - drinking more than the recommended amount of alcohol
- hepatitis B or hepatitis C viral infections
- obesity - when a person's body mass index (BMI) is 30 or more
Non-alcoholic fatty liver disease
The reason obesity is a risk factor for liver cancer is that over time, high levels of fat in the body can damage the liver, similar to the way in which alcohol damages the liver. The medical term for this type of liver damage is non-alcoholic fatty liver disease.
People with type 2 diabetes also have a higher risk of developing non-alcoholic fatty liver disease and liver cancer.
Over the past 15 years, rates of liver cancer in England have risen by 70% as a result of the above risk factors becoming more widespread. In particular, this is due to alcohol misuse, obesity and type 2 diabetes.
As liver cancer is a relatively rare condition, there is currently no national routine NHS screening programme for it because it would not be an effective use of resources.
However, regular check-ups for liver cancer (known as 'surveillance') are recommended for people known to have a high risk of developing the condition, such as those with a confirmed hepatitis C infection or those who have had cirrhosis (scarring of the liver) as a result of alcohol misuse, diabetes or obesity.
If you are in a high-risk group for developing liver cancer, having regular check-ups will help to ensure that the condition is diagnosed early. The earlier that liver cancer is diagnosed, the more effective the treatment is likely to be.
See Liver cancer - diagnosis for more advice about when screening for liver cancer is recommended.
Generally, the outlook for people with liver cancer is poor. This is because the majority of cases are detected at quite a late stage. However, if a cancer is diagnosed at an early stage, treatment options include:
- surgical resection - surgery is used to remove a section of liver
- liver transplant - the liver is replaced with a donor liver
- radiofrequency ablation - a small electrical current is used to destroy the cancerous cells
See Liver cancer - treatment for more information about surgical resection, liver transplant and radiofrequency ablation.
However, these curative treatment options may not always be possible even if the cancer is diagnosed early. This is either because the liver is too damaged by scarring (cirrhosis) to survive ablation or resection of the tumour, or the person is not well enough to withstand the effects of a liver transplant.
Currently, only 1 in 10 people is diagnosed for liver cancer at an early stage. In most people who are diagnosed with liver cancer, the cancer has advanced too far to be cured. As a result, only 1 in 5 people live for a least a year after being diagnosed with liver cancer. Just 1 in 20 people live for at least five years.
However, it is hoped that this trend can be reversed as surveillance for liver cancer among high-risk groups becomes more widespread.
Symptoms of liver cancer
Cancer of the liver does not usually cause any noticeable symptoms until it has reached an advanced stage.
The symptoms of liver cancer include:
- unexplained weight loss
- loss of appetite that lasts longer than a week
- feeling very full after eating, even if the meal was small
- feeling sick
- swelling of your abdomen (tummy)
- jaundice - yellowing of your skin and the whites of your eyes
- itchy skin
- a high temperature (fever) of 38ºC (100.4ºF) or above
- feeling very tired and weak
When to seek medical advice
Visit your GP if you have any of the symptoms listed above. It is unlikely that your symptoms will be caused by liver cancer. They are more likely to be the result of a more common condition, such as an infection. However, it is important that you seek a medical diagnosis from your GP.
Also contact your GP if you have previously been diagnosed with a condition that is known to affect the liver, such as cirrhosis or a hepatitis C infection, and your health suddenly deteriorates.
- A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
- Loss of appetite
- Loss of appetite is when you do not feel hungry or want to eat.
- Nausea is when you feel like you are going to be sick.
- Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
- A rupture is a break or tear in an organ or tissue.
- Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Causes of liver cancer
How cancer begins
Cancer begins with a change to the body cells' coded information, which tells them when to grow and replicate.
The code is read from the deoxyribonucleic acid (DNA) that is found in all human cells. A change in the code is known as a mutation, which can alter the instructions that control cell growth. The mutation can cause the cells to carry on growing instead of stopping when they should. This results in the cells reproducing uncontrollably and producing a lump of tissue that is known as a tumour.
Common risk factors
In cases of liver cancer, it is uncertain why and how the DNA inside the cells of the liver is affected. However, it appears that exposure to anything that can directly damage the liver's cells and tissue will increase the risk of liver cancer developing. The most common risk factors for liver cancer are explained below.
Cirrhosis is a medical term which means that the tissue of the liver has become scarred and cannot perform many of its usual functions.
In England, the main causes of cirrhosis are:
- prolonged alcohol misuse - usually over many years
- non-fatty alcoholic liver disease
- hepatitis C
These risk factors, and how they can damage the liver, are discussed in more detail below.
The liver is a very tough and resilient organ. It can endure a high level of damage that would destroy other organs. It is also capable of regenerating itself. But despite the liver's resilience, prolonged alcohol misuse over many years can damage it.
Every time you drink alcohol, your liver filters out the poisonous alcohol from your blood. Each time your liver filters alcohol, some of the liver cells die. The liver can regenerate new cells, but if you drink heavily for many years, your liver will lose its ability to regenerate new cells. This causes serious damage, and results in cirrhosis (scarring of the liver).
It is estimated that one in three cases of liver cancer are related to alcohol misuse.
Non-alcoholic fatty liver disease
Non-alcoholic fatty liver disease occurs when small deposits of fat build up inside the tissue of the liver. The condition is common and causes no noticeable symptoms in most people. However, in some people high levels of fat can make the liver inflamed. Over time, the inflammation will scar the liver.
The exact cause of non-alcoholic fatty liver disease is unclear, but it is associated with:
- type 2 diabetes
- elevated lipids levels in the blood (lipids are a group of naturally occurring molecules, which includes fats and vitamins)
Hepatitis C is a blood-borne virus that causes inflammation and scarring of the liver. In England, most people who are infected by hepatitis C develop the infection by using contaminated needles or other drug equipment, such as mixing spoons when injecting drugs like heroin.
In the past, some people may have acquired hepatitis C after receiving a blood transfusion or blood products as part of medical treatment. However, this no longer happens. Since the 1990s, all blood products given to patients have been tested for the virus.
See the Health A-Z topic about Hepatitis C for more information.
Other risk factors
Other risk factors for liver cancer include:
- hepatitis B - a viral infection
- haemochromatosis - a genetic condition where the body absorbs too much iron from food
- autoimmune hepatitis - a rare, genetic condition where the body's immune system attacks the cells of the liver
- primary biliary cirrhosis - a rare condition where small tubes called bile ducts become damaged
These risk factors are outlined in more detail below.
Hepatitis B is a virus that can be spread via contaminated blood and other types of bodily fluids, such as saliva, semen and vaginal fluids. Hepatitis B is uncommon in England and in other western European countries. The virus is most widespread in:
- south east Asia and east Asia (particularly China)
- the Pacific islands, such as Hawaii
The outlook for people who develop a hepatitis B infection varies highly. Many people only have minor symptoms and may be unaware that they have been infected. A small number of people have severe symptoms that are similar to those of liver cancer, and they develop extensive cirrhosis (scarring) of their liver.
The risk of someone with a hepatitis B infection developing liver cancer appears to be influenced by ethnicity. People of Asian origin who are infected with hepatitis B have a higher-than-average chance of developing liver cancer, regardless of whether they have also developed cirrhosis of the liver. People of other ethnic backgrounds only seem to have an increased risk of liver cancer if they also develop cirrhosis or have another related liver condition, such as hepatitis C.
See the Health A-Z topic about Hepatitis B for more information about the condition.
Haemochromatosis is a genetic condition where the body stores an too much iron from food. The excess levels of iron have a toxic (poisonous) effect on the liver and cause cirrhosis (scarring).
It is estimated that 1 in every 250 to 300 people will develop haemochromatosis. People with haemochromatosis-related cirrhosis have a 1 in 10 chance of developing liver cancer. This risk decreases to 0.1 in 10 once treatment to remove the excess iron from the body begins.
See the Health A-Z topic about Haemochromatosis for more information about the condition.
Autoimmune hepatitis is a rare, genetic condition that is thought to affect 1 in every 7,150 people.
In autoimmune hepatitis, your immune system (the body's natural defence against infection) attacks the cells of the liver as if they are a 'foreign' infection. Exactly what triggers the attack is unknown.
If you have autoimmune hepatitis, the risk of developing liver cancer is smaller than if you have cirrhosis from one of the other common causes. This may be because most cases of autoimmune hepatitis can be treated with immunosuppressants. Immunosuppressants are medicines that help prevent your immune system from damaging your liver.
Primary biliary cirrhosis
Primary biliary cirrhosis is a rare and poorly understood liver condition. In England, an estimated 1 in 4,150 people is affected.
One of the main functions of the liver is to create a fluid called bile, which is used by the body to help break down fat. The bile is transported to the digestive system via a series of tubes called bile ducts.
For reasons that are unclear, in cases of primary biliary cirrhosis, the bile ducts are gradually damaged. This eventually leads to a build-up of bile inside the liver, which damages the liver and causes cirrhosis.
People with advanced primary biliary cirrhosis are estimated to have a 1 in 20 chance of developing liver cancer in any given year.
See the Health A-Z topic about Primary biliary cirrhosis for more information.
Diagnosing liver cancer
Surveillance for liver cancer
If you are in a high-risk group for developing liver cancer, regular testing, known as surveillance, is recommended. This is because the earlier that the cancer is diagnosed, the greater the chance of curing it.
Surveillance is usually recommended if:
- you have cirrhosis that is related to alcohol misuse but you have subsequently stopped drinking or you are willing to comply with treatment to help you stop drinking (see below for more information about this)
- you have cirrhosis that is related to either a hepatitis B or hepatitis C infection
- you are of Asian origin and you have hepatitis B
- you have cirrhosis because you have haemochromatosis (a genetic condition where the body absorbs too much iron from food)
- you have cirrhosis of any cause, even if the risk of developing cancer is a little lower - for example, if you have primary biliary cirrhosis
Surveillance will not usually be offered if you have cirrhosis and you continue to drink alcohol or inject drugs. This is because your continued drinking or drug taking is likely to make your cirrhosis worse, and the chances of effectively treating you for liver cancer, or any other liver condition, will be low.
Surveillance is usually carried out every six months and is a two-stage process. These stages are:
- blood tests - a little over half of people with primary liver cancer produce a protein in their blood called alphafetoprotein (afp). This can be detected by regular testing.
- ultrasound scans - high-frequency sound waves are used to create an image of your liver, which can highlight any abnormalities
There are several tests that can be used to confirm a diagnosis of liver cancer, although it would be unusual for someone to need all of the tests to confirm the diagnosis. The tests are:
- a computer tomography (CT) scan - a series of X-rays of your liver are taken, and a computer assembles them into a more detailed three-dimensional image.
- a magnetic resonance imaging (MRI) scan uses a strong magnetic field and radio waves to build up a picture of the inside of your liver.
- biopsy - a needle is used to remove a small sample of liver tissue, which is then tested in a laboratory for cancerous cells.
- laparoscopy - a test that is performed under general anaesthetic (you will be asleep during the procedure and will not feel any pain). During a laparoscopy, a small incision is made in your abdomen (tummy) and a flexible camera called an endoscope is used to examine your liver.
Staging is a term that healthcare professionals use to describe how far a particular cancer has spread. There are a number of different systems that can be used to stage liver cancer. Many liver cancer specialists use combination staging systems that include features of both the cancer and the underlying liver function to stage a person's condition.
This is because the length of time a person lives, and how well they tolerate potential treatments, will be determined not only by how advanced their cancer is, but also by their level of health and how good their underlying liver function is.
One combination system for staging liver cancer is known as the Barcelona Clinic Liver Cancer (BCLC) staging system. The BCLC staging system consists of five stages. These are:
- Stage 0 - the tumour is less than 2cm (20mm) in diameter and the person is very well and has normal liver function
- Stage A - a single tumour has grown but is less than 5cm (50mm) in diameter, or there are three or fewer smaller tumours that are less than 3cm (30mm) in diameter and the person is very well with normal liver function
- Stage B - there are multiple tumours in the liver, but the person is well and their liver function is unaffected
- Stage C - any of the above circumstances, but the person is not so well and their liver function is not so good; or where the cancer has started to spread into the main blood vessel of the liver, into nearby lymph nodes or into other parts of the body
- Stage D - where the liver has lost most of its functioning abilities and the person begins to have symptoms of end-stage liver disease, such as a build-up of fluid inside their abdomen (tummy)
Treating liver cancer
Cancer treatment team
Many hospitals use multidisciplinary teams (MDTs) to treat liver cancer. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment. See the box to the left for information about the specialists who make up MDTs.
As well as having a specialist MDT, you may also be assigned a key worker who will usually be a specialist nurse. They will be responsible for co-ordinating your care.
Deciding what treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.
Your treatment plan
Your recommended treatment plan will depend on the stage that your liver cancer is at (see Liver cancer - diagnosis for more information about staging).
If your cancer is at Stage A when it is diagnosed, a complete cure may be possible. The three main ways that this can be achieved are:
- removing the affected section of liver - this is known as a resection
- having a liver transplant - an operation to remove the liver and replace it with a healthy one
- using heat to kill cancerous cells - this is known as radiofrequency ablation (RFA)
If your cancer is at Stage B or C, a cure is not usually possible. Chemotherapy (powerful medication) can be very damaging to a cirrhotic liver. If given, it will be injected into the artery (blood vessel) that supplies the tumour to try to avoid possible side effects from organ and tissue damage not caused by the cancer. Chemotherapy can slow the progression of the cancer, relieve symptoms and prolong life for months or, in some cases, years.
There is also a medication called sorafenib, which can help to prolong life. Limited funding for this treatment is now available on the NHS.
If your cancer is at Stage D when it is diagnosed, it is usually too late to slow down the spread of the cancer. Instead, treatment focuses on relieving any symptoms of pain and discomfort that you may have.
Each treatment option is discussed in more detail below.
If the damage to your liver is minimal and the cancer is contained in a small part of your liver, it may be possible to remove the cancerous cells during surgery. This procedure is known as surgical resection.
As the liver can regenerate itself, it may be possible to remove a large section of it without it seriously affecting your health. However, the majority of people with liver cancer do not have a 'normal liver', which means that their liver's regenerative ability may be significantly impaired and resection may be unsafe.
Whether or not a resection can be performed is often determined by estimating the severity of the cirrhosis. One way of doing this is by measuring the degree of scarring and nodular regeneration in the liver, which is reflected by the degree of 'portal hypertension'. The 'portal pressure' is a measure of the blood going in and out of the liver. In a normal liver, the measure is low, but it can be much higher if cirrhosis is severe because the diseased tissue obstructs the flow of blood.
If a liver resection is recommended, it will be carried out under a general anaesthetic, which means that you will be asleep during the procedure and will not feel any pain.
Most people are well enough to leave hospital six to 12 days after surgery. However, depending on how much of your liver was removed, it may take up to three or four months for you to fully recover from the surgery.
Liver resection is a complicated form of surgery and can have a considerable impact on your body. Therefore, the risk of complications after surgery is relatively high, estimated at around one in four.
Possible complications of liver resection include:
- infection at the site of the surgery - injections of antibiotics may be required to treat the infection
- bleeding after the surgery - a blood transfusion may be required to replace the lost blood
- blood clots that develop in your legs - the medical term for this is deep vein thrombosis
- bile leaking from the liver - further surgery may be required to stop the leak
- jaundice - yellowing of your skin and the whites of your eyes that is caused by excessive levels of bile inside the liver; jaundice is usually temporary and should improve after your liver has recovered from the surgery
- liver failure - if the remaining liver is insufficient and does not regenerate adequately
Liver resection can sometimes cause fatal complications, such as a heart attack. It is estimated that 1 in every 30 people who have liver resection surgery will die during or shortly after the operation.
If you only have a single tumour that is less than 5cm (50mm) in diameter, you may be suitable for a liver transplant. However, if you have multiple tumours, or a tumour that is larger than 5cm, the risk of the cancer returning is usually so high that a liver transplant will be of no benefit.
Some people who have three or fewer small tumours, each less than 3cm (30mm) in diameter may be offered a transplant. Occasionally, if a person has a tumour that responds exceptionally well to treatment, with no evidence of tumour growth for a six-month period, they may also be offered a transplant.
The donated liver usually comes from a donor who has recently died. Therefore, everyone who is accepted for liver a transplant will be placed on a waiting list until a suitable liver becomes available.
Sometimes, a person's cancer will progress before a liver becomes available for them, and they will have to be removed from the waiting list. In some cases, a small part of the liver of a living relative can be used. This is known as a living donor liver transplant.
The advantage of using a living donor liver transplant is that the person receiving the transplant can plan the procedure with their medical team and relative, and they will not usually have to wait very long.
However, there are also disadvantages associated with this type of transplant, such as higher complication rates. Research has also found that the results of live donor liver transplants tend not to be as good as transplants using a liver from someone who has died.
After the transplant, you will be given a type of medicine known as an immunosuppressant. Immunosuppressants decrease the risk that your immune system will treat the new liver as a foreign object and attack it. If this happens, the body is said to 'reject' the liver.
One of the side effects of taking immunosuppressants is that they increase your risk of infection.
See the Health A-Z topic about Liver transplant for more information.
Radiofrequency ablation may be recommended as an alternative to surgery to treat liver cancer at an early stage where the tumour or tumours are smaller than 2cm (20mm) in diameter.
Radiofrequency ablation involves passing small needles that contain electrodes through your skin and into your liver. Your skin will be numbed with a local anaesthetic so you will not feel any pain when the needles are inserted.
After the needles have been inserted into your liver, an electrical current will be passed through them. The current generates heat, which is used to kill the cancerous cells.
Radiofrequency ablation takes around 10 to 30 minutes to complete. You may need to have several sessions, depending on how much of your liver has been affected by cancer.
The most common complication of radiofrequency ablation is flu-like symptoms, such as chills and muscle pains, which occur in about one in four cases. These symptoms usually begin three to five days after the procedure, and last for around five days.
Less common complications of radiofrequency ablation include:
- organ and tissue damage near the liver that may require surgery to correct; this occurs in about 1 in 20 cases
- a pus-filled swelling (abscess), which develops inside the liver and may need to be drained; this occurs in around 1 in 100 cases
Chemotherapy involves using a combination of powerful cancer-killing medications to slow the spread of liver cancer.
A type of chemotherapy called transcatheter arterial chemoembolisation (TACE) is usually recommended to treat cases of stage B and C liver cancer. This is a palliative treatment that can prolong your life but is not curative. TACE is not recommended for Stage D liver cancer because it can make the symptoms of liver disease worse.
TACE may also be used to help prevent cancer spreading out of the liver in people who are waiting to receive a liver transplant.
TACE uses a combination of two techniques:
- chemotherapy medications are injected directly into your liver
- gel or small plastic beads are injected into the blood vessels that are supplying the tumours with blood; this should help to slow down the speed at which the tumours are growing
TACE usually takes one to two hours to complete. After the procedure, you will stay in hospital overnight before returning home. Your response to the treatment will be assessed a month or so after the procedure, usually by having a CT scan. If you remain well, further TACE treatment may be requested for you. People who have TACE often receive three to four sessions, with a period of about one month in between each session.
Injecting chemotherapy medications directly into the liver, rather than into the blood, has the advantage of avoiding the wide range of side effects that are associated with 'traditional chemotherapy', such as hair loss and fatigue.
However, the procedure is not free of side effects and complications. The most common side effect of TACE is known as post-chemoembolisation syndrome, which occurs in around one in three cases.
Post-chemoembolisation syndrome can cause the following symptoms:
- abdominal (tummy) pain
- high temperature (fever) of 38ºC (100.4ºF) or above
- nausea (feeling sick)
- loss of appetite
These symptoms may last for one to two weeks after having a session of TACE.
Less common complications of TACE include:
- worsening of liver function, which is usually temporary
- swelling of the abdomen due to a build-up of fluid - this occurs in around 1 in 20 cases
- liver abscess
- damage to the biliary tract or gall bladder
A new £200 million cancer drug fund (CDF) has recently been set up and is set to start in April 2011. The fund covers the use of medication that is currently unavailable on the NHS. Some regional committees have included a medication called sorafenib for the treatment of advanced liver cancer.
An interim cancer drug fund (ICDF) has also been set up, with funds available immediately for approved medications. Whether or not you are eligible for sorafenib will be decided by your medical team and will depend on whether it is likely to do you more good than harm. If you are unwell and your liver function is not very good, sorafenib will not help you and may make you worse, so it will not be recommended.
Sorafenib is available in tablet form. Common side effects of the medication include:
- nausea (feeling sick)
- hair loss
- itchy skin
- pain, such as headaches, abdominal (tummy) pain or bone pain
Advanced liver cancer
Treatment for advance liver cancer focuses on relieving the symptoms of pain and discomfort, rather than attempting to slow down the progression of the cancer.
Some people with advanced liver cancer require strong painkillers, such as codeine or possibly morphine. These will be given to you if they are needed. Nausea and constipation are common side effects of these types of painkillers, so you may also be given an anti-sickness tablet and a laxative.
See the Live Well section of the website about end of life care for more information about pain relief for people with terminal conditions.
- Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
- Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.
- Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
- Radiation therapy
- Radiation therapy uses x-rays to treat disease, especially cancer.
Coping with liver cancer
Being diagnosed with cancer, particularly if it is incurable, can be very distressing. For many, the news is difficult to take in and comprehend. Many people who are diagnosed with cancer experience the classic stages of the grieving process. These are outlined below.
- Denial - you may initially disbelieve the diagnosis and think that there is nothing wrong with you.
- Anger - you may lash out at friends, family or medical staff.
- Bargaining - sometimes, people with terminal conditions will try to 'bargain' with their doctors, asking for any sort of treatment that can prolong their life.
- Depression - you may lose all interest in life and feel that your situation is hopeless.
- Acceptance - in time, most people will eventually accept the diagnosis.
If you have been diagnosed with cancer, talking to a counsellor or psychiatrist may help you combat feelings of depression and anxiety. Antidepressants, or medicines that help reduce feelings of anxiety, may also help you through the grieving process.
The useful links section contains links to cancer support organisations that can provide you with advice and support if you or a family member have been affected by cancer.
Preventing liver cancer
The three most effective ways of preventing liver cancer are:
- drinking alcohol in moderation
- eating healthily and exercise regularly to avoid obesity-related illnesses, such as cardiovascular disease (disease of the heart or blood vessels)
- avoiding exposing yourself to risk factors such as hepatitis C and hepatitis B
Giving up drinking alcohol altogether is the most effective way of reducing your risk of developing liver cancer, particularly if you have been drinking for many years.
As a minimum preventative measure, stick to the recommended daily amounts for alcohol consumption. The recommended daily amounts are:
- 3-4 units a day for men
- 2-3 units a day for women
A unit of alcohol is approximately half a pint of normal-strength lager, a small glass of wine or a single measure (25ml) of spirits.
Visit your GP if you are finding it difficult to moderate your alcohol consumption. Counselling services and medication are available to help you reduce your alcohol intake.
If you regularly inject drugs, such as heroin, the best way of avoiding a hepatitis C infection is to not share any of your drug-injecting equipment with other people. This does not just apply to needles but to anything that could come into contact with other's people blood, such as:
- mixing spoons
- water used to dissolve drugs
- tourniquets - the belt that drug users sometimes tie around their arm to make their veins easier to inject
Hepatitis C does not cause noticeable symptoms for several years, so many people may be unaware that they are infected. It is therefore safer to assume that anyone may have the infection.
Even if you are not a drug user, it is important to take some common-sense precautions to minimise your exposure to other people's blood, such as avoiding sharing any object that could be contaminated with blood, such as razors or toothbrushes.
There is less risk of getting hepatitis C by having sex with someone who is infected. However, as a precaution, it is recommended that you use a barrier method of contraception during sex, such as a condom.
It may also be possible to get hepatitis C by sharing banknotes or 'snorting tubes' with an infected person to snort drugs, such as cocaine or amphetamine. These types of drugs can irritate the lining of your nose and small particles of contaminated blood could be passed on to the note or tube which you could then inhale.
See the NHS Choices Hepatitis C, get tested, get treated page for more information and advice about hepatitis C.
There is a vaccine that protects against hepatitis B. However, because hepatitis B is a relatively rare condition in England, the vaccination does not form part of the routine childhood vaccination schedule.
Vaccination is usually only recommended for people in high-risk groups, such as:
- injecting drug users (including their partners and children and other people living with them)
- people who change sexual partners frequently (including men who have sex with men, and male and female sex workers)
- close family contacts of someone with a chronic hepatitis B infection
- people who receive regular blood products and their carers
- people who have chronic kidney failure
- people who have chronic liver disease
- prisoners and some prison service staff
- people who live in residential accommodation for those with learning difficulties
- families that foster or adopt children who may have been at increased risk of developing a hepatitis B infection
- people travelling to, or going to live in, areas where there is a high or moderate incidence of hepatitis B, such as China
People who have an occupation that increases their exposure to hepatitis B should also be vaccinated. These occupations include:
- healthcare workers
- laboratory staff
- staff who work in residential care homes for people with learning difficulties
- morticians and embalmers
- some emergency services personnel
Contact your GP for advice if you are uncertain about whether you should be vaccinated against hepatitis B.
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