Cancer starting in a different area including the breast, lung, or colon before spreading to the liver is classified as metastatic cancer as opposed to liver cancer. This kind of cancer is named according to the organ in which it started. This means if cancer originates in the colon then spreads to the liver it is called metastatic colon cancer.

Liver cancer is one of the most diagnosed types of cancer throughout the world. This type of cancer is more common for men with approximately three men diagnosed for every woman. The rate of liver cancer is increasing quickly. From 1990 until 2015, there was a 75 percent increase in liver cancer diagnosis across the globe. Since 1980, the number of liver cancer diagnoses in the United States has more than tripled. According to the American Cancer Society, more than 42,800 new diagnoses are predicted in the United States by the end of 2020.

Types of Liver Cancer

There are several different types of liver cancer including:

• HCC or hepatocellular carcinoma
• Angiosarcoma or hemangiocarcinoma
• Bile duct cancer or Cholangiocarcinoma
• Fibrolamellar HCC
• Secondary liver cancer or liver cancer metastasis

The most common type of tumor located in the liver is hepatocellular carcinoma. This type of cancer accounts for approximately 75 percent of all diagnoses.

Symptoms of Liver Cancer

If you have one or more of the symptoms listed below it does not mean the cause is liver cancer. A lot of these symptoms are frequently caused due to another condition. If you do have some of these symptoms, you should have them checked by your physician to find and treat the cause. In many cases, the symptoms and signs of liver cancer do not become apparent until the disease has reached the later stages.

There are some symptoms that can appear earlier. Making an appointment with your physician when the symptoms first appear can result in an earlier diagnosis of liver cancer. Treatment is generally more helpful in the earlier stages of the disease.

The most common symptoms include:

• Unintentional weight loss
• Vomiting or nausea
• Fluid-buildup or swelling in the abdomen
• A feeling of fullness after consuming a small meal
• Jaundice or yellowing of the eyes and skin
• An enlarged spleen determined by fullness on the left side below the ribs
• Loss of appetite
• Pain close to the right shoulder blade or in the abdomen
• Itching
• An enlarged liver determined by fullness on the right side below the ribs

You may also experience other symptoms including abnormal bleeding or bruising or enlarged veins on the abdomen you can see through your skin. If you have cirrhosis or chronic hepatitis, you might not feel as well as usual or see changes in your lab test results. Common tests include checking your APF or alpha-fetoprotein levels and liver function testing.

Specific types of liver tumors can cause your hormones to act on other organs in addition to your liver. These hormones can cause:

• High cholesterol levels
• Hypoglycemia or low levels of blood sugar causing fainting or fatigue
• High counts of erythrocytosis or levels of blood calcium resulting in a flushed and red appearance
• Gynecomastia or male breast enlargement or the shrinkage of male testicles
• Hypercalcemia or high blood calcium levels resulting in confusion, weakness, nausea, constipation, or muscle issues.

Diagnosing Liver Cancer

There are several different procedures and tests used to diagnose liver cancer. Blood tests can reveal abnormalities in your liver function. Your physician might also recommend imaging tests including MRI, CT, and ultrasound. In some instances, a liver tissue sample is removed for testing. Lab testing may be required on a liver tissue sample for a positive diagnosis of liver cancer.

When a liver biopsy is performed, a thin needle is inserted by the physician through the skin. To obtain a tissue sample, the liver is penetrated. Physicians in a laboratory use a microscope to examine the tissue and look for cancer cells. There is a risk of infection, bruising, and bleeding with a liver biopsy.

Determining the Stage of the Cancer

Once a diagnosis of liver cancer is received, the stage or extent of the cancer must be determined by a physician. The location and size of the cancer and if it has spread can be determined through staging tests. Liver cancer is staged with imaging tests including bone scans, MRIs and CTs. Liver cancer is staged using different methods. Some methods use the letters A through D while others use Roman numerals. The treatment options are determined by the stage of the cancer and prognosis.

Causes of Liver Cancer

When the DNA of liver cells mutates or changes, the result can be liver cancer. Your DNA provides every chemical process throughout your body with instructions. These instructions change when DNA mutations are present. The growth of your cells can become out of control, eventually resulting in the formation of a cancerous mass of cells or a tumor.

The cause of liver cancer is not always known including chronic hepatitis infections. Liver cancer can occur even if no underlying diseases are present with no known cause.

Risk Factors

The risk factors for primary liver cancer include:

• Cirrhosis is an irreversible and progressive condition resulting in the formation of scar tissue on the liver. The risk of developing liver cancer increases.
• Chronic infections due to either the (HCV) hepatitis C virus or the (HBV) hepatitis B virus increase the risk of developing liver cancer.
• Nonalcoholic fatty liver disease can result when an increase of fat in the liver accumulates. This risk of developing liver cancer then increases.
• Some liver diseases can be inherited and increase the risk of developing cancer. This includes Wilson's disease and hemochromatosis.
• Individuals with diabetes have a greater risk of developing liver cancer than those without a blood sugar disorder.
• Consuming an excessive amount of alcohol on a daily basis over a period of numerous years can result in irreversible liver damage while increasing the risk of developing liver cancer.
• The risk of liver cancer increases with exposure to aflatoxins. These are poisons molds that can be produced when crops are stored poorly. Aflatoxins can contaminate crops including nuts and grains. The foods manufactured using these products can then be contaminated.

Decreasing the Risk of Cirrhosis

Scarring of the liver is called cirrhosis. The risk can be decreased by eliminating alcohol or drinking in moderation. The recommendation for men is limiting drinks to two per day and one per day for women. Maintaining a healthy weight by exercising regularly and consuming a healthy diet is recommended.

If you need to lose a few pounds, you should decrease the number of calories you consume every day. Increasing the amount of exercise you receive is also recommended. Your goal should be to lose weight gradually with a loss of one to two pounds per week.

Liver Cancer Screenings

You can speak with your physician about liver cancer screenings. For the average person, liver cancer screenings have not been proven effective and do not decrease the risk. If you have a specific condition known to increase your risk of developing liver cancer, screenings are generally recommended. This includes:

• Hepatitis C infection
• Hepatitis B infection
• Liver cirrhosis

Your best option is to talk to your physician about the pros and cons of having a liver cancer screening. You can both contribute to the decision as to whether your risk mandates a screening. Screenings usually involve having an abdominal ultrasound and blood test once every six months.

Treating Liver Cancer

There are numerous treatment options available for liver cancer including immunotherapy, radiation therapy and surgery. The most appropriate treatment is dependent on numerous factors including the amount of liver damage due to cancer, if the cancer has spread somewhere else in the body and any other conditions present. There are teams of cancer experts available to answer questions and recommend the best option for treatment based on individual needs and diagnosis. This includes:

• Chemotherapy can be recommended to target cancer cells or shrink tumors after of before surgery. Chemotherapy is also used for metastatic disease as a systematic treatment.
• The procedures for interventional radiology are created to provide direct treatment to the tumor. These technologies are minimally invasive to help avoid damage to healthy surrounding tissue.
• Drugs for targeted therapy search for specific proteins unique for cancerous cells.
• Different radiation procedures can be an option for delivering radiation directly to the cancerous cells.
• Immunotherapy drugs block receptor proteins enabling cancerous cells to hide from the body's immune system.
• In some instances, a gastroenterologist is necessary to help with side effects or for the treatment of liver cancer.

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