Liver cancer starts in the cells of the liver. A cancerous (malignant) tumour is a group of cancer cells that can grow into nearby tissue and destroy it. The tumour can also spread (metastasize) to other parts of the body. When cancer starts in liver cells, it is called primary liver cancer.

The liver is part of the digestive system. It is the largest solid organ in the body and it is in the upper-right part of the abdomen. The liver makes enzymes and bile to help digest food. It makes proteins to help your blood clot (stop bleeding). The liver also cleans the blood by removing harmful substances.

Cells in the liver sometimes change and no longer grow or behave normally. These changes may lead to non-cancerous (benign) tumours such as hemangiomas. But in some cases, changes to liver cells can cause liver cancer. Most often, liver cancer starts in the cells that make up the body of the liver (called hepatocytes). This type of cancer is called hepatocellular carcinoma. It is the most common type of primary liver cancer.

Liver cancer can also start in the cells that line the bile ducts in the liver. This type of cancer is called intrahepatic bile duct cancer or cholangiocarcinoma. Other types of cancer can spread to the liver, but this is not the same disease as primary liver cancer. Cancer that starts in another part of the body and spreads to the liver is called liver metastasis. It is not treated in the same way as primary liver cancer.

Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:
● Losing weight without trying
● Loss of appetite
● Upper abdominal pain
● Nausea and vomiting
● General weakness and fatigue
● Abdominal swelling
● Yellow discoloration of your skin and the whites of your eyes (jaundice)
● White, chalky stools

lnfection with hepatitis B or C virus and cirrhosis of the liver are the main risks for liver cancer. The chance of developing liver cancer increases with age. More men than women develop liver cancer. Liver cancer is more common in countries with high rates of hepatitis B and C infection. Some people with certain genetic conditions have a higher than average risk for liver cancer:
Infection with hepatitis B or C virus
Hepatitis B virus (HBV) and hepatitis C virus (HCV) can cause inflammation of the liver (called hepatitis). HBV can be spread from person to person through blood or other body fluids, such as semen or vaginal fluids. HCV is spread only through contact with infected blood. Infection with either virus increases the risk for liver cancer.
Cirrhosis of the liver
People who have cirrhosis of the liver have a higher risk for liver cancer. Cirrhosis is when scar tissue replaces healthy tissue in the liver. The scar tissue blocks blood flow through the liver so it can't work normally. Cirrhosis can be caused by:
1) infection with hepatitis B or C virus
2) drinking large amounts of alcohol over a long period of time
3) metabolic disorders that cause liver damage
4) Infection with hepatitis virus and alcohol together greatly increase your risk of cirrhosis and liver cancer.
Alcohol
Drinking alcohol increases your risk for cirrhosis, which can then increase your risk for liver cancer. The more you drink, the greater your risk.
Smoking tobacco
Smoking tobacco increases your risk for liver cancer. All forms of tobacco, including cigarettes, cigars and pipes, increase your risk. The more you smoke and the longer you smoke, the greater your risk. The risk of developing liver cancer decreases with time after you quit smoking.
Metabolic disorders
People who have certain genetic conditions that interfere with metabolism have a higher risk of developing liver cancer. These conditions may lead to liver failure or cirrhosis of the liver.
Hemochromatosis (also called iron overload) is a disorder that causes the body to store higher than normal amounts of iron. The extra iron builds up in different tissues, especially the liver. When the liver stores too much iron, and the condition is not treated, the liver may be damaged. People with untreated hemochromatosis have a higher risk of developing liver cancer.
Other metabolic disorders that may increase the risk of liver cancer include:
1) alpha-1 antitrypsin deficiency
2) porphyria cutanea tarda and acute intermittent porphyria
3) hereditary tyrosinemia
4) type I and III glycogen storage disease
Non-alcoholic steatohepatitis (NASH)
Non-alcoholic steatohepatitis (NASH) is a more advanced form of non-alcoholic fatty liver disease (NAFLD). In NAFLD, fat cells collect in the liver of people who do not drink large amounts of alcohol. The main risk factor for developing NAFLD is having obesity. In NASH, the fatty tissue in the liver becomes inflamed and causes scar tissue to form (cirrhosis). By itself, NAFLD does not cause any significant liver damage or increase the risk of liver cancer. But NASH may progress to liver damage and cirrhosis, which increases the risk of developing liver cancer.
Excess weight
Overweight and obesity can increase the risk for liver cancer. This may be because excess weight can increase the risk of NASH and cirrhosis.
Contact with aflatoxin
Aflatoxin is a type of toxin made by moulds and fungi (called a mycotoxin). It can contaminate many different foods, including corn, rice, wheat, peanuts, soybeans and sunflower seeds. It can also be found on spices, such as ginger or chilli peppers, and on nuts, including almonds, walnuts and pistachios.
Aflatoxin can be a problem in countries with hot, damp climates and poor storage facilities. People are most likely to come into contact with aflatoxin in Africa and Asia because there are high levels of contamination in food, stored grains, soil and water.
Contact with chemicals at work
Coming into contact with the chemicals at work increases the risk for liver cancer. Vinyl chloride is used in the plastics industry to make polyvinyl chloride (PVC), which is used in many products. Coming into contact with vinyl chloride increases the risk of developing both angiosarcoma (a rare type of liver cancer) and hepatocellular carcinoma. Plutonium is a radioactive substance. Workers who accidentally breathe in plutonium have a higher risk of developing angiosarcoma.
Contact with thorium dioxide
Thorium dioxide (Thorotrast) is a radioactive solution. It was used as a contrast medium to improve x-rays of the blood system, nasal passages and sinus cavities. After it is injected, thorium dioxide collects in the liver, spleen and bone marrow. People who came in to contact with thorium dioxide have a greater risk of developing angiosarcoma. The higher the dose given, the greater the risk. Cancer may develop as many as 45 years after you come into contact with it.
Type 2 diabetes
People with type 2 diabetes may have a higher risk of developing liver cancer. Studies show that people with type 2 diabetes who develop liver cancer sometimes have other risk factors, such as heavy alcohol use, hepatitis infection or both. Also, many people with type 2 diabetes tend have excess weight, which may also increase their risk for liver cancer.
Possible risks
The following have been linked with liver cancer, but there is not enough evidence to know for sure that they are risks. More research is needed:
1) birth control pills
2) infection with a liver fluke (a parasite that infects the liver)
3) contact with arsenic, trichloroethylene, polychlorinated biphenyls (PCBs) or dichlorodiphenyltrichloroethane (DDT)
4)chewing betel quid
5) eating unknown fish

Primary liver cancer is cancer that started in the liver. There are 5 main types. The type depends on the type of cell that the cancer started in:
Hepatocellular carcinoma (HCC)
Hepatocellular carcinoma is also called hepatoma or HCC. It's the most common type of primary liver cancer. Because of this, the information in this primary liver cancer section is mostly about hepatocellular carcinoma.
This type of liver cancer develops from the main liver cells called hepatocytes. It's more common in people with cirrhosis. Cirrhosis means scarring of the liver due to previous damage. For example, damage from the hepatitis B or C virus, or long term alcohol drinking. Hepatocellular carcinoma is more likely to develop in men than in women. It becomes more common as you get older.
Fibrolamellar carcinoma
Fibrolamellar carcinoma is a rare sub type of cancer. Fibrolamellar carcinoma tends to develop in people in their 20’s or 30’s. It’s not usually linked with cirrhosis or infection with hepatitis B or C. Some people with other types of liver cancer can have high levels of a chemical called alpha fetoprotein (AFP) in their blood. This is usually not the case for people with fibrolamellar carcinoma.
Bile duct cancer (cholangiocarcinoma)
Cholangio refers to the bile ducts, so cholangiocarcinoma is cancer of the bile ducts. The major bile ducts are tubes that connect the liver and gallbladder to the small bowel. The bile ducts carry bile, which is made by the liver. Bile helps to digest fats in food.
Bile duct cancer is rare. Cancer that starts in the section of ducts outside the liver is called extrahepatic cholangiocarcinoma. Cancer that starts in the section of ducts inside the liver is called intrahepatic cholangiocarcinoma. Intrahepatic cholangiocarcinoma is classed as a type of primary liver cancer
Angiosarcoma
Angiosarcoma is also known as haemangiosarcoma. It’s a type of cancer called a soft tissue sarcoma. This type of cancer begins in the blood vessels of the liver, and is extremely rare. It is most often diagnosed in older people.
Hepatoblastoma
Hepatoblastoma is a very rare type of primary liver cancer that usually affects young children. It's most often diagnosed in children under 2.
Benign liver growths (non cancerous growths)
Most growths (tumours) in the liver are benign. They aren’t cancer and won’t become cancerous (malignant) in the future. Benign tumours do not usually need treatment. This can depend on the size of the tumour and whether it's causing symptoms.The most common types of benign tumours in the liver are haemangioma, hepatic adenoma and focal nodular hyperplasia.

Tests and procedures used to diagnose liver cancer include:
Blood tests
Blood tests may reveal liver function abnormalities.
Imaging tests
Your doctor may recommend imaging tests, such as an ultrasound, CT and MRI.
Removing a sample of liver tissue for testing
Sometimes it's necessary to remove a piece of liver tissue for laboratory testing in order to make a definitive diagnosis of liver cancer. During a liver biopsy, your doctor inserts a thin needle through your skin and into your liver to obtain a tissue sample. In the lab, doctors examine the tissue under a microscope to look for cancer cells. Liver biopsy carries a risk of bleeding, bruising and infection

Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health and personal preferences.
Surgery
Operations used to treat liver cancer include:
1) Surgery to remove the tumor
In certain situations, your doctor may recommend an operation to remove the liver cancer and a small portion of healthy liver tissue that surrounds it if your tumor is small and your liver function is good. Whether this is an option for you also depends on the location of your cancer within the liver, how well your liver functions and your overall health.
2) Liver transplant surgery
During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery is only an option for a small percentage of people with early-stage liver cancer.
Localized treatments
Localized treatments for liver cancer are those that are administered directly to the cancer cells or the area surrounding the cancer cells. Localized treatment options for liver cancer include:
Heating cancer cells
Radiofrequency ablation uses electric current to heat and destroy cancer cells. Using an imaging test as a guide, such as ultrasound, the doctor inserts one or more thin needles into small incisions in your abdomen. When the needles reach the tumor, they're heated with an electric current, destroying the cancer cells. Other procedures to heat the cancer cells might use microwaves or lasers.
Freezing cancer cells
Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells.
Injecting alcohol into the tumor
During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol causes the tumor cells to die.
Chemoembolization injecting chemotherapy drugs into the liver
Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. A procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor. Sometimes, the anticancer drugs are attached to small beads that are injected into an artery that feeds the tumor. The beads block blood flow to the tumor as they release the drug. This allows a higher amount of drug to reach the tumor for a longer period of time, which may kill more cancer cells. It also causes fewer side effects because very little of the drug reaches other parts of the body. Chemoembolization is used to treat liver cancer. Also called TACE and transarterial chemoembolization.
Placing beads filled with radiation in the liver
Tiny spheres that contain radiation may be placed directly in the liver where they can deliver radiation directly to the tumor.
Radiation therapy
This treatment uses high-powered energy from sources such as X-rays and protons to destroy cancer cells and shrink tumors. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue. Radiation therapy might be an option if other treatments aren't possible or if they haven't helped. For advanced liver cancer, radiation therapy might help control symptoms.
Targeted drug therapy/
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Many targeted drugs are available for treating advanced liver cancer. Some targeted therapies only work in people whose cancer cells have certain genetic mutations.
Immunotherapy
Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process. Immunotherapy treatments are generally reserved for people with advanced liver cancer.
Chemotherapy
Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both. Chemotherapy is sometimes used to treat advanced liver cancer.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

The five-year survival rate for patients with localized liver cancer is 33%. This survival rate is reduced if the cancer has spread to the lymph nodes or nearby structures (11%) and even further reduced if the cancer has spread to distant structures, such as the lungs or the bones (2%).

Cancer is a life threatening disease that can affect anyone regardless of race, age, and gender. Traditional cancer treatments like radiotherapy and chemotherapy often result in undesirable and uncomfortable side effects such as vomiting, numbness, nausea, and diarrhea to name a few. Herbal medicine is a complementary therapy that some people with cancer use to ease cancer symptoms. Herbal remedies for cancer such as those commonly found in traditional medicine contains antimutagenic, anti-inflammatory, and apoptosis inducing compounds that help in slowing the development of cancer and relieve treatment side effects for patients.

Herbal medicine has a wide variety of applications but all of them rely on the sustainable use of various plant parts such as flowers, leaves, bark, and roots. Each part of a plant features different medicinal properties and uses. Although herbal medicine has countless use cases, cancer care is one of the most practical applications because of how harsh traditional oncology treatments can be on patients.

Herbal remedies are a part of a growing field of medicine called integrative oncology. Research conducted on the use of herbal medicine for cancer complementary therapy has proven herbs can:
• Slows the spread of cancer
• Reduces the side effects of cancer treatment
• Boosts immune system strength and functionality
• Minimizes the symptoms of cancer
• Attacks cancer cells

Several herbs may help control the side effects of conventional cancer treatment. However, doctors do not recommend that cancer patients take herbal medicine while undergoing normal traditional cancer treatment. Herbal medicines may be likely less to cause side effects than traditional drugs. But patients may can still experience complications. Some herbs may can cause negative interactions with chemotherapy drugs. Closely monitor how you feel before and after taking herbal remedies. Patients should always consult with their doctor before trying herbs as a complementary therapy or the supplements to avoid complications.