Cancer begins when the healthy body cells change and grow out of control, from a tumour. This tumour can be both benign and malignant. 80% of primary liver cancer is hepatocellular carcinoma. the other types of cancer include bile duct cancer, and angiosarcoma, defined as the cancer of the blood cells in the liver. Hepatocellular carcinoma begins in hepatocytes, the main functional cells of the liver.

A rare type of liver cancer occurring in young patients is the fibrolamellar carcinoma, grows more invasively, characterized by a prominent central scar, diagnosed by imaging techniques.

The types include:

• Tumour developing in the liver, but have originated from another organ like colon, stomach, ovary, they are called liver metastasis or secondary liver cancers
• Cancers starting in the blood cells of the liver are called angiosarcomas and hemangiosarcomas
• Cancer originating in the bile duct of the liver are called cholangiocarcinomas
• Tumours called hepatoblastomas occurs majorly in infants and children.

The median age of liver cancer in Asia and Africa is 40-50 years.

CAUSE OF LIVER CANCER

Liver cirrhosis is related as the primary reason for liver cancer, as after the liver is affected by cirrhosis, the tissue of the liver is lowly modified at the expense of normal liver cells which consists more of fibrous and scar tissue, hence increasing the probability of tumour growth.

The risk factors involved in liver cancer are :

1. Chronic infection with the hepatitis-B virus(HBV) or hepatitis-C virus (HCV): chronic infection when the virus remains in the blood for more than 6 months, causing the decline in the functioning of the liver cells. It affects 50% of the world population for cancer of the liver.

Hepatitis B infection causes liver cancer immediately without cirrhosis, increasing the risk up to 100 fold, while HCV increases the risk up to 17 fold.

2. Long-term alcohol abuse: leading cause of liver cirrhosis and liver cancer. Alcohol intake when suffering from hepatitis increases even more.
3. Inherited liver conditions: conditions like haemochromatosis which is a higher absorption of iron from food, deposits in every organ or alpha-1-antitrypsin deficiency a protein depositing in every part abnormally, increases the risk of liver cirrhosis and cancer.
4. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, affect the liver like cirrhosis
5. Medical conditions like autoimmune hepatitis, intrahepatic biliary inflammations and Wilsons disease are the serious factors affecting liver leading to cancer,
6. Gender: live cancer is 4-8 times common in men than women
7. Toxic agents exposure: anabolic steroids, increases the risk of hepatocellular adenoma. Intake of aflatoxin-contaminated food, causes DNA mutations in liver DNA cells, leading to cancer cells.

DIAGNOSIS OF LIVER CANCER

• Ultrasound tests to detect nodules, visible on imaging, determine the type of a tumour based on size.
• Blood test: for alfa-fetoprotein detection, higher levels indicate last stage liver disease.
• Biopsy: to determine the type of benign or cancerous liver cells.

SYMPTOMS OF LIVER CANCER

• Sudden weight loss
• Fatigue
• Loss of appetite after small meal
• Enlarger liver felt as a mass under the ribs on right side
• Enlarged spleen, mass felt on the left side under ribs
• Yellowing of skin and eyes-jaundice
• Swelling and fluid buildup in the abdomen
• Pain in the abdomen, near the right shoulder blade

TREATMENT OPTIONS FOR LIVER CANCER

• Resection of a tumour by surgery
• Liver transplantation
• Local ablation methods