Liver cancer or hepatic cancer is cancer that originates in the liver. Liver tumors are discovered on medical imaging equipment (often by accident) or it presents themselves symptomatically as an abdominal mass, abdominal pain, yellow skin, nausea or liver dysfunction.

The leading cause of liver cancer is viral infection with the hepatitis B virus or hepatitis C virus.

Cancer usually forms secondary to cirrhosis caused by these viruses. For this reason, the highest rates of liver cancer occur where these viruses are endemic.

Liver cancers should not be confused with liver metastases, also known as secondary liver cancer, which are cancers that originate from organs elsewhere in the body and migrate to the liver.

They are formed from either the liver itself or from structures within the liver, including blood vessels or the bile duct.

Primary liver cancer is the sixth most frequent cancer globally and the second leading cause of cancer death.

The most frequent liver cancer is hepatocellular carcinoma (HCC).

HCC is cancer formed by liver cells, known as hepatocytes, that become malignant.

Another type of cancer formed by liver cells is hepatoblastoma, which is specifically formed by immature liver cells.

Liver cancer can also form from other structures within the liver such as the bile duct, blood vessels, and immune cells.

Cancer of the bile duct (cholangiocarcinoma and cholangiocellular cystadenocarcinoma) accounts for approximately 6% of primary liver cancers.

Cancers produced from muscle in the liver are leiomyosarcoma and rhabdomyosarcoma. Other less common liver cancers include carcinosarcomas, teratomas, yolk sac tumors, carcinoid tumors, and lymphomas.

Lymphomas usually have diffuse infiltration to liver, but It may also form a liver mass on rare occasions.

Many cancers found within the liver are not true liver cancers, but are cancers from other sites in the body that have spread to the liver (known as metastases).

Cholangiocarcinoma is associated with sweating, jaundice, abdominal pain, weight loss, and hepatomegaly.

Hepatocellular carcinoma is associated with an abdominal mass, abdominal pain, emesis, anemia, back pain, jaundice, itching, weight loss, and fever.

Many imaging modalities are used to aid in the diagnosis of primary liver cancer. For HCC these include sonography (ultrasound), computed tomography (CT) and magnetic resonance imaging (MRI).

Prevention of cancers can be separated into primary, secondary and tertiary prevention.

Primary prevention preemptively reduces exposure to a risk factor for liver cancer. One of the most successful primary liver cancer preventions is a vaccination against hepatitis B. Vaccination for hepatitis C virus is currently unavailable.

Other forms of primary prevention are aimed at limiting the transmission of these viruses by the promotion of safe injection practice, screening of blood donation products and screening of high-risk asymptomatic individuals.

Reducing alcohol abuse, obesity, and diabetes would also reduce rates of liver cancer.

Diet control in hemochromatosis could decrease the risk of iron overload, decreasing the risk of cancer.

Secondary prevention includes both the cure of the agent involved in the formation of cancer (carcinogenesis) and the prevention of carcinogenesis if this is not possible.

Cure of virus-infected individuals is not possible, but treatment with antiviral drugs such as interferon can decrease the risk of liver cancer. Chlorophyllin may have the potential in reducing the effects of aflatoxin.

Tertiary prevention includes treatments to prevent the recurrence of liver cancer. These include the use of chemotherapy drugs and antiviral drugs.

Surgical resection is often the treatment of choice for non-cirrhotic livers. Increased risk of complications such as liver failure can occur with resection of cirrhotic livers.

Liver transplantation can also be used in cases of HCC where this form of treatment can be tolerated and the tumor fits specific criteria.

Less than 30-40% of individuals with HCC are eligible for surgery and transplant because the cancer is often detected late stage. Also, HCC can progress during the waiting time for liver transplants, which can prevent transplant due to the strict criteria.

Percutaneous ablation is the only non-surgical treatment that can offer a cure.

There are many forms of percutaneous ablation, which consist of either injecting chemicals into the liver (ethanol or acetic acid) or producing extremes of temperature using radiofrequency ablation, microwaves, lasers or cryotherapy.

Of these, radiofrequency ablation has one of the best reputations in HCC, but the limitations include the inability to treat tumors close to other organs and blood vessels due to heat generation and the heat sync effect, respectively.

Systemic chemotherapeutics are not routinely used in HCC, although local chemotherapy may be used in a procedure known as transarterial chemoembolization.

Radiotherapy is not often used in HCC because the liver is not tolerant to radiation. Although with modern technology it is possible to provide well-targeted radiation to the tumor, minimizing the dose to the rest of the tumor.

Dual treatments of radiotherapy plus chemoembolization, local chemotherapy, systemic chemotherapy or targeted therapy drugs may show benefit over radiotherapy alone.

Resection is an option in cholangiocarcinoma, but less than 30% of cases of cholangiocarcinoma are resectable at diagnosis. After surgery, recurrence rates are up to 60%.

A liver transplant may be used where partial resection is not an option, and adjuvant chemoradiation may benefit some cases.

Photodynamic therapy is a novel treatment that utility light-activated molecules to treat the tumor. The compounds are activated in the tumor region by laser light, which causes the release of toxic reactive oxygen species, killing tumor cells.

Radiofrequency ablation, transarterial chemoembolization and internal radiotherapy (brachytherapy) all show promise in the treatment of cholangiocarcinoma.

Removing the tumor by either surgical resection or a liver transplant can be used in the treatment of hepatoblastoma. In some cases, surgery can offer a cure. Chemotherapy may be used before and after surgery and transplant.

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