The liver is located on the upper right side of the abdomen, just below the diaphragm. It is a vital organ that performs some of the most important functions inside our bodies, including; detoxification (filtering of waste products), breaking down of fat and converting glucose to glycogen for storage. This makes the liver more vulnerable to cancer cells and other infections, since all blood from the other parts of the body has to pass through the liver.
Risk Factors of Liver Cancer
- Male gender - more common in males than female.
- Unhealthy lifestyle - obese or overweight individuals are at a higher risk of acquiring liver cancer, mostly due to the fatty liver.
- Race - more common in individuals of Asian origin.
- Hereditary predisposition - family history of liver diseases or other conditions that affect metabolism.
- Steroids and use of other enhancing hormones may increase the risk of liver cancer.
- Excessive alcohol consumption and smoking.
- Wilson disease - a hereditary disease that lead to deposition of copper in the liver.
- Exposure to aflatoxins - carcinogenic substances released by fungi.
- Individuals suffering from diabetes.
Types of Liver Cancer
The two types of liver cancer is the primary liver cancer and liver mestastases. Primary liver cancer is a malignant tumor that originated in the liver. The most common type of primary liver cancer is the hepatocellular carcinoma, which account for almost 50% of cancer deaths, worldwide and 0.5% to 2% of all cancer in United states. 
Other types of primary liver cancer include; cholangiocellular carcinoma (cancer of the bile duct), a combination of both hepatocellular carcinoma and cholangiocellular carcinoma, hepatoblastoma (a liver cancer that affects infants and young children), angiosarcoma or hemangiosarcoma; liver cancer that begins on the liver blood vessels and tend to spread very fast.
Causes of Primary Liver Cancer
Primary liver cancer is common in livers that have been damaged by alcohol, individuals suffering from birth liver defects, chronic liver diseases, hepatits B, hepatitis C and cirrhosis ( accounting for the most cases of primary liver cancer). Other causes of primary liver cancer include; exposure to toxic chemicals like arsenic, cigarette smoking especially if it is combined with alcohol.
Liver Metastases
Liver metastases is a type of cancer that originates from other parts of the body and spread to the liver. Liver metastases account for 36% to 42% of patients who are diagnosed with advanced cancer. The cancer usually reaches the liver via portal system or lympatic channels or it may spread directly from an abdominal tumor.
Other liver tumors may be non cancerous or bening. Most bening tumors occur in women in their productive years and they are associated with the frequent use of oral contraceptives. Some of the bening tumor of liver include;
- Cysts
- Lipoma
- Fibroma
- Hepatic adenoma
Symptoms of Liver Cancer
In the early stages, most people do not manifest any symptoms and if they do, they appear later on as the liver cancer progress. Some of the signs and symptoms of liver cancer include;
- A persistent dull pain on the right upper side, in the middle area (epigastric region) or at the back.
- Weight loss
- Weakness and Fatigue
- Loss of strength
- Nausea and vomiting
- Anorexia
- Anemia
- Enlarged liver upon palpation
- Jaundice - yellowish discoloration of the skin and eyes.
Liver Cancer Diagnosis
Liver cancer is diagnosed using various tests. These tests may involve;
- Looking at the presenting clinical signs and symptoms.
- Patient history and physical examination - palpation to detect an enlarged liver.
- Liver function tests - ALT, AST, GGT and bilirubin test to measure the levels of bilirubin in the blood.
- X-ray studies
- Ultrasound, CT scan and magnetic resonance imaging (MRI).
- Biopsy - a tissue is removed from the affected liver and examined for cellular changes through a microscope.
- Serum test to measure alpha-fetoprotein (AFP), a liver cancer tumor marker. Increased up to 30% - 40% on patients with primary liver cancer.
- PET scan - to detect metastatic liver tumors and to determine the extent of metastases.
Liver Cancer Treatment
The kind of treatment given depends on the liver cancer stage and other underlying medical conditions, as well as the patient's preferences. The main goal of any cancer treatment is to eliminate the cancer completely and to prevent the tumor from growing and spreading to other parts of the body. However, most cancer are usually diagnosed late when the cancer is already advanced. In such cases, the goal of treatment is no longer to treat the cancer but it is shifted to making sure the individual remains comfortable and free from pain as much as possible (palliative care).
Some of the treatment of liver cancer include;
Radiation therapy - The use of external high powered beams to destroy liver cancer cells and shrink the cancer tumors. The two most effective method used in radiation therapy are; percutaneous therapy (radiation is delivered directly to the tumor cells) and intra-arterial injection (radioactive isotopes that specifically destroy tumor associated antigens).
Chemotherapy - This is the administering of anti-cancer agents directly to liver to destroy the cancer cells.
Cyrosurgery - in cyrosurgery also known as cyroablation, the tumors are destroyed by use of very cold liquid nitrogen (-196°C) under the guide of an ultrasound.
Lobectomy - This is the most common surgical procedure which is done to remove a liver tumor. However, lobectomy is most effective if the tumor is localized and it is still small in size.
Laser Hyperthermia - The heat is directed to the tumors or cancer cells, leading to necrosis or death of the tumor cells, without affecting the healthy sorrunding cells.
Percutaneous Biliary Drainage - Performed in patients who are considered at high risk for liver surgery. A tube is inserted into the abdomen wall into the duodenum, past the obstructed liver to help in draining the bile. This procedure is usually done to relieve pressure, pain from the bile buildup and to decrease jaundice.
Liver Transplant - The removal of the diseased liver and replacing it with a healthy liver from a donor. Liver transplant have be shown to be more beneficial to patients with small cancer of less than 5cm, occuring as a single lesion.
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