There are two main kinds of liver cancer. Heptoma and cholangiocarcinoma. Heptoma is cancer of the hepatocytes. (The main functioning liver cell). Hepatoma is primary liver cancer. Hepatoma usually grows in the liver as a ball-like tumor, invading the normal tissue surrounding it. A history of infection with the hepatitis B virus puts individuals at risk of developing heptoma.

Cancer of the bile duct cells is called cholangiocarcinoma . Cholangiocarcinoma originates in the bile ducts and is often caused by infestation with the liver fluke Clonorchis (a parasite). The cancer grows along the bile ducts in sheets or lines,and is hard to find on X-ray studies.

Most cases of liver cancer are actually cancers that started in another organ. This is called metastases . Because of its very high blood flow and many biological functions, the liver is one of the most common places for metastases to grow. Tumors that originally arise in the colon , pancreas , stomach , lung or breast can spread to the liver.

Liver cancer is much more prevalent in many of the developing countries than in the industrialized world. Its incidence is highest in subSaharan Africa, China, southern Asia, and Japan. Japan is the exception of the industrialized countries. China accounts for about 45% of the world's cases.

Who's at Risk?

Researchers in hospitals and medical centers around the world are working to learn more about what causes liver cancer. At this time, no one knows its exact causes. However, scientists have found that people with certain risk factors are more likely than others to develop liver cancer. A risk factor is anything that increases a person's chance of developing a disease.

Chronic liver infection (hepatitis): Certain viruses can infect the liver. The infection may be chronic. (It may not go away.) The most important risk factor for liver cancer is a chronic infection with the hepatitis B virus or the hepatitis C virus. These viruses can be passed from person to person through blood (such as by sharing needles) or sexual contact. An infant may catch these viruses from an infected mother. Liver cancer can develop after many years of infection with the virus.

These infections may not cause symptoms, but blood tests can show whether either virus is present. If so, the doctor may suggest treatment. Also, the doctor may discuss ways of avoiding infecting other people.

In people who are not already infected with hepatitis B virus, hepatitis B vaccine can prevent chronic hepatitis B infection and can protect against liver cancer. Researchers are now working to develop a vaccine to prevent hepatitis C infection.

Cirrhosis: Cirrhosis is a disease that develops when liver cells are damaged and replaced with scar tissue. Cirrhosis may be caused by alcohol abuse, certain drugs and other chemicals, and certain viruses or parasites. About 5 percent of people with cirrhosis develop liver cancer.

Aflatoxin: Liver cancer can be caused by aflatoxin, a harmful substance made by certain types of mold. Aflatoxin can form on peanuts, corn, and other nuts and grains. In Asia and Africa, aflatoxin contamination is a problem. However, the U.S. Food and Drug Administration (FDA) does not allow the sale of foods that have high levels of aflatoxin.

Being male: Men are twice as likely as women to get liver cancer.

Family history: People who have family members with liver cancer may be more likely to get the disease.

Age: In the United States, liver cancer occurs more often in people over age 60 than in younger people.

The more risk factors a person has, the greater the chance that liver cancer will develop. However, many people with known risk factors for liver cancer do not develop the disease.

People who think they may be at risk for liver cancer should discuss this concern with their doctor. The doctor may plan a schedule for checkups.

Liver Cancer Symptoms

The most common symptoms of liver cancer are from a massive tumor growing in the liver, or even liver failure. A very early cancer will have no symptoms, since it is too small to cause any. As it enlarges, common symptoms include:

1. Pain in the right upper abdominal area caused by stretching of the liver's capsule, which is rich in nerves. The liver may then extend below the right costal margin ("hepatomegaly") and be painful to probe.
2. Weight Loss and loss of appetite; the liver is a digestive organ.
3. Swelling of the abdomen (called "ascites" pronounced a-site-ees) from the liver failing to produce the protein required to hold the blood's fluid in the blood vessels, so it migrates out to fill the abdomen, scrotum and limbs.
4. Cirrhosis signs like breast swelling in males (from the liver failing to break down estrogens) and little spider shaped veins (angiomata) seen on the skin. Another sign of liver failure is very red palms ("palmar erythema").
5. Blood clotting problems leading to intestinal bleeding and bruises on the skin. The liver normally uses vitamin K from the diet and intestinal bacteria sources to synthesize the clotting factor ("prothrombin") necessary for life.
6. Fatigue and eventually coma from buildup of ammonia in the body.
7. Jaundice and light stools, from blockage of the bile draining system. Also looser and smellier stools may be seen, ("steatorrhea") indicating poor breakdown of fats in the digestive tract. Jaundice normally produces itching (pruritis) when it becomes marked. The first area notable for jaundice, caused by the
liver's failure to clear bilirubin, is the whites of the eyes ("scleral icterus").
8. Paraneoplastic syndromes means unusual symptoms caused by chemical alterations in the body either from the liver failing or secretions from the tumor cells themselves. These include elevated blood calcium, low blood sugar, anemias, precocious puberty in children, intense flushing, and other metabolic
disturbances. These syndromes often will be alleviated with cancer shrinkage.
9. Signs of Distant Spread include bone pain, neurological symptoms from brain involvement, and intestinal blockage. These all indicate advanced disease.

Liver Cancer Diagnosis

Physical exam: The doctor feels the abdomen to check the liver, spleen, and nearby organs for any lumps or changes in their shape or size. The doctor also checks for ascites, an abnormal buildup of fluid in the abdomen. The doctor may examine the skin and eyes for signs of jaundice.

Blood tests: Many blood tests may be used to check for liver problems. One blood test detects alpha-fetoprotein (AFP). High AFP levels could be a sign of liver cancer. Other blood tests can show how well the liver is working.

CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the liver and other organs and blood vessels in the abdomen. The patient may receive an injection of a special dye so the liver shows up clearly in the pictures. From the CT scan, the doctor may see tumors in the liver or elsewhere in the abdomen.

Ultrasound test: The ultrasound device uses sound waves that cannot be heard by humans. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture (sonogram) of the liver and other organs in the abdomen. Tumors may produce echoes that are different from the echoes made by healthy tissues.

MRI: A powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.

Angiogram: For an angiogram, the patient may be in the hospital and may have anesthesia. The doctor injects dye into an artery so that the blood vessels in the liver show up on an x-ray. The angiogram can reveal a tumor in the liver.

Biopsy: In some cases, the doctor may remove a sample of tissue. A pathologist uses a microscope to look for cancer cells in the tissue. The doctor may obtain tissue in several ways. One way is by inserting a thin needle into the liver to remove a small amount of tissue. This is called fine-needle aspiration. The doctor may use CT or ultrasound to guide the needle. Sometimes the doctor obtains a sample of tissue with a thick needle (core biopsy) or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another way is to remove tissue during an operation.

How is liver cancer treated?

Primary liver cancer is difficult to treat. Surgical removal is the best option but these tumours are often too large and too extensive for surgery. Chemotherapy is occasionally used for inoperable tumours but any benefit is usually short lived. Unfortunately, survival rates for primary liver cancer are low.

The treatment of secondary (metastatic) liver cancer is determined by the site of origin of the original (primary) tumour. It is important to realise that the tumour, even though it has spread to the liver, will still behave according to its origin. A leopard does not change its spots: breast cancer involving the liver behaves like breast cancer, not like primary liver cancer. Consequently the outlook can be rather better for patients with secondary, as opposed to primary, liver cancer.

Surgery is increasingly being used for patients with secondary liver cancer. This can sometimes involve removing a segment of liver. Alternatively, keyhole techniques can be used to apply extreme cold or heat to localised areas of the liver.

The presence of secondary cancer within the liver implies that the primary tumour has spread via the bloodstream and as a result other organs may be at risk.

It is sensible, therefore, to consider using a treatment such as chemotherapy, which acts all over the body. The type of chemotherapy used will depend on the type of primary cancer.

Hormone treatment is an additional option for patients with cancers of the breast or prostate that have spread to the liver.

Conventional radiotherapy has little role to play in the management of liver cancer, whether primary or secondary.

Specialised techniques, involving the temporary placement of radioactive wires, can be used to treat certain primary cancers of the ducts within, or immediately adjacent to, the liver.

Liver transplantation is not usually a viable option for patients with cancer involving the liver - the cancer has often spread beyond the liver itself and the medicines used to suppress the immune system after the transplant can stimulate the growth of any remaining cancer cells.

Side Effects Of Liver Cancer Treatment

Can I prevent liver cancer?

You can follow a few simple guidelines, to reduce the risk of liver cancer:

• Avoid excessive alcohol consumption.
• Ensure that you work in a safe environment, compliant with safety regulations.
• If you work in a high risk area, immunise against hepatitis B.