Understanding LIVER conditions
Dr Peter Carr-Boyd is an experienced Hepatopancreatobiliary (HPB) surgeon and a currently practising adult and paediatric liver transplant surgeon, with expertise across the full spectrum of benign and malignant liver conditions.
This advanced specialist training ensures that liver surgery is performed safely, precisely, and to the highest international standards.
How the Liver Supports Your Health
The liver is a vital organ that plays a central role in overall health and well-being. Its key functions include:
Processing nutrients from the food we eat, converting them into energy and essential building blocks such as proteins, hormones, and enzymes.
Producing bile, which is essential for fat digestion and absorption of fat-soluble vitamins (A, D, E, K). Bile is stored in the gallbladder, but production continues even after gallbladder removal.
Filtering toxins and waste from the blood, including alcohol, medications, and metabolic by-products, helping maintain a healthy bloodstream.
Regulating blood sugar levels by storing and releasing glucose as needed.
Producing essential proteins, including clotting factors, which help your blood to clot properly.
Supporting the immune system by removing bacteria and helping the body fight infections.
Storing vital nutrients, including vitamins A, D, E, K, B12, as well as iron and copper.
Regulating cholesterol and fats by producing, storing, and breaking down lipids to support heart and metabolic health.
Conditions Assessed and Treated
Non-cancer Liver Lesions
focal nodular hyperplasis
Focal nodular hyperplasia is a benign, non-cancerous liver lesion characterized by a focal growth of normal hepatocytes, often centered around a central scar. It is thought to arise as a local response to vascular abnormalities within the liver, leading to the growth. FNH has a female predominance, and is frequently discovered incidentally during imaging for unrelated reasons. Most patients with FNH are asymptomatic. When symptoms do occur, they are typically non-specific and may include mild abdominal discomfort or pain, but these symptoms are rarely attributable directly to the lesion. FNH does not cause liver dysfunction, and is not though to be associated with bleeding or transforming into a cancer. There is no evidence that oral contraceptive use or pregnancy affects lesion growth or risk. Treatment options: a conservative approach is recommended for patients with a confident diagnosis based on advanced imaging (Liver specific MRI). Occasionally the diagnosis is not clear and the lesion may represent another condition like an hepatic adenoma or a variant of hepatocellular carcinoma, fibrolamellar HCC, on imaging. Surgical resection may be considered in these undifferentiated lesions, or FNH that produce significant symptoms that are clearly attributable to FNH. There is no indication for discontinuing hormonal therapy or for special monitoring during pregnancy.
A hepatic adenoma is a benign, solid liver neoplasm composed of proliferating hepatocytes, most commonly occurring in women with a history of oral contraceptive use, but also associated with anabolic steroid use, obesity, and certain metabolic disorders. Hepatic adenomas are typically solitary but may be multifocal (adenomatosis), and are classified into molecular subtypes with distinct risks for complications, notably the β-catenin-mutated subtype, which carries a higher risk of malignant transformation. Most hepatic adenomas are asymptomatic and discovered incidentally on imaging. When symptoms occur, they are usually mild, such as vague abdominal pain or discomfort. However, the most significant clinical presentations are due to hemorrhage (up to 15% of cases), which may manifest as severe rapid-onset acute abdominal pain if the lesion ruptures. There is also a risk of malignant transformation to hepatocellular carcinoma, with higher risk in men and in β-catenin-mutated adenomas. Treatment options depend on sex, lesion size, symptoms, and molecular subtype. Women with hepatic adenomas 6.5 cm or with high-risk features.
Hepatic adenomas
hepatic cysts
There are many types of hepatic cysts. A hepatic cyst is a fluid-filled lesion within the liver, most commonly a simple hepatic cyst, which is benign, and thin-walled. Simple cysts are usually asymptomatic and incidentally found; symptoms such as abdominal pain, fullness, or early satiety may occur if the cyst is large or compresses adjacent structures. Treatment is not required for asymptomatic simple cysts. For symptomatic cysts, options include laparoscopic surgical fenestration or aspiration with sclerotherapy; surgical intervention is preferred due to lower recurrence and allows histological confirmation. Mucinous cystic neoplasm of the liver (MCN-L) is a rare, premalignant cystic tumor, typically solitary, multiloculated, and occurring in middle-aged women. Previously called cystadenomas. Symptoms may include abdominal discomfort, palpable mass, early satiety, or weight loss, especially with larger lesions. MCN-L has malignant potential (risk up to 10%). Treatment is complete surgical resection is recommended due to risk of recurrence and progression to cystadenocarcinoma. Intraductal papillary mucinous neoplasm of the bile ducts (IPNB) is a rare, preinvasive neoplasm presenting with intermittent right upper quadrant pain, recurrent cholangitis, or obstructive jaundice. A CT or MRI scan typically shows papillary growth within the bile duct and ductal dilatation. Recommended treatment is surgical resection as IPNB has high malignant potential. Hydatid cysts (echinococcal cysts) are parasitic lesions caused by Echinococcus species, often asymptomatic but may present with abdominal pain, mass effect, or complications such as rupture or infection. Imaging with a CT or MRI often characterises these cyst well. Treatment includes pre-procedural antihelminthic therapy (albendazole), followed by percutaneous aspiration or surgery for large, complicated, or refractory cysts. Asymptomatic, inactive, or calcified cysts may be observed.
Other liver lesions
If imaging identifies a liver lesion that is unclear or “indeterminate,” careful assessment by a specialist liver surgeon like Dr Peter Carr-Boyd is essential. Appropriate work-up ensures that investigations, treatment, and ongoing surveillance are tailored to your individual risk. Most small, incidentally detected liver lesions in patients without risk factors for liver cancer or chronic liver disease are benign, such as simple cysts or haemangiomas, and may not require further intervention. However, for patients with a history of cancer, chronic liver disease, or concerning symptoms—including unexplained weight loss, fever, or abdominal discomfort—every lesion warrants a thorough evaluation. This includes laboratory testing (liver function tests, AFP tumour markers, viral hepatitis screening) and a detailed medical history to identify risk factors. When CT or MRI scans are inconclusive, contrast-enhanced ultrasound (CEUS) is a useful, minimally invasive tool that can help differentiate benign from malignant lesions in real time. If uncertainty persists, short-interval follow-up imaging is recommended, typically every 3–6 months, especially for small lesions under 2 cm. Biopsy is reserved for cases where imaging and clinical assessment cannot provide a definitive diagnosis or when tissue confirmation will change management, such as in atypical or unresectable lesions. Decisions about biopsy and surgery are best made in a specialist multidisciplinary team (MDT), ensuring all factors—including surgical risks, tumour type, and potential benefits—are carefully considered. With a specialist liver surgeon like Dr Carr-Boyd, you can be confident that your liver lesion will be thoroughly evaluated, appropriately treated, and closely monitored, whether it is benign, potentially malignant, or requires surgical removal. This patient-centred, evidence-based approach maximises safety, preserves healthy liver tissue, and optimises outcomes.
Liver Cancer
Hepatocellular carcinoma (HCC)
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. In most people, it develops on a background of severe liver scarring, namely "cirrhosis". Because of this, regular monitoring of liver health is important for those at higher risk. It can also arise in livers that don't have cirrhosis, such as those with metabolic associated liver disease which unfortunately is becoming more common. What Increases the Risk of Liver Cancer? You may be at higher risk of developing HCC if you have: - Chronic hepatitis B or hepatitis C - Long-term alcohol-related liver disease - Fatty liver disease - Metabolic conditions such as diabetes, obesity, or metabolic syndrome - Hereditary conditions like hemochromatosis (iron overload) - Other liver disease such as primary sclerosing cholangits, autoimmune hepatitis, primary biliary cholangitis. The strongest risk factor is cirrhosis, regardless of the underlying cause. Around 8 in 10 people with HCC have cirrhosis. How Is HCC Diagnosed and Assessed? HCC is often picked up on surveullance imaging in those with cirrhosis, however, it may also present with and abdominal lump or pain. Once HCC is suspected, the stage of the tumour and overall liver health are assessed to help determine the safest and most effective treatment options. Treatment Options Treatment depends on the size and number of tumours, liver function, and your overall health. Options may include: 1. Curative Treatments (for very early or early-stage cancer) These aim to completely remove or destroy the cancer: Surgical removal (resection) – removing the tumour if the rest of the liver is healthy enough Liver transplantation – replacing the entire liver if cirrhosis is advanced Local tumour ablation, such as (microwave ablation), to destroy cancer cells 2. Treatments for Intermediate-Stage Cancer These focus on controlling the cancer within the liver: Transarterial therapies (TACE) – delivering treatment directly to the tumour through its blood supply 3. Treatments for Advanced Disease When the cancer has spread or cannot be treated locally, systemic therapies (whole-body treatments) may be used: Targeted medications (such as sorafenib, lenvatinib, regorafenib, cabozantinib) Immunotherapy – helping the immune system recognise and attack cancer (e.g., atezolizumab with bevacizumab, nivolumab, pembrolizumab, durvalumab, ipilimumab) For patients whose liver function is very poor or whose overall health is fragile, the focus may shift toward supportive care to maintain comfort and quality of life.
Colorectal liver metastases (CRLM) occur when colorectal cancer spreads to the liver, which is the most common site of metastasis. Not all liver lesions in patients with colorectal cancer are resectable, but surgical removal of liver metastases can significantly improve survival and, in some cases, offer the potential for cure. Evaluation typically includes high-resolution liver imaging (CT or MRI), tumor markers (CEA), and sometimes PET scans to assess disease spread. Surgery is planned by a specialist liver surgeon like Dr Peter Carr-Boyd, often in consultation with a multidisciplinary team (MDT) including oncologists, hepatologists, and radiologists. Minimally invasive liver resection is possible in select patients, though open surgery may be required for larger or centrally located lesions.
Colorectal Liver metastases
cholangiocarcinoma
Cholangiocarcinoma is a rare but aggressive cancer arising from the bile ducts within or near the liver. Symptoms may include jaundice, abdominal discomfort, dark urine, and itching. Early detection and specialist evaluation are critical, as complete surgical removal (often with part of the liver and surrounding bile ducts) offers the best chance for long-term survival. Assessment involves liver imaging (CT, MRI, MRCP), blood tests including liver function tests and CA 19-9, and sometimes endoscopic or percutaneous biopsy. Surgery is complex and requires specialist expertise in hepatopancreatobiliary (HPB) surgery, particularly when combined with liver resection. Multidisciplinary planning ensures the safest approach, optimal timing, and integration with chemotherapy or other treatments as indicated.