Liver cancer

Liver cancer
Other names	Hepatic cancer, primary hepatic malignancy, primary liver cancer
CT scan of a liver with cholangiocarcinoma
Specialty	Gastroenterology Hepatology Oncology
Symptoms	Lump or pain in the right side below the rib cage, swelling of the abdomen, yellowish skin, easy bruising, weight loss, weakness[1]
Usual onset	55 to 65 years old[2]
Causes	hepatitis B, hepatitis C, alcoholism, aflatoxin, non-alcoholic fatty liver disease, liver flukes[3][4]
Diagnostic method	Blood tests, medical imaging, tissue biopsy[1]
Prevention	Immunization against hepatitis B, treating those infected with hepatitis B or C,[3] decreasing exposure to aflatoxin, decreasing high levels of alcohol consumption
Treatment	Surgery, targeted therapy, radiation therapy[1]
Prognosis	Five-year survival rates ~18% (US);[2] 40% (Japan)[5]
Frequency	618,700 (point in time in 2015)[6]
Deaths	782,000 (2018)[7]

Liver cancer, also known as hepatic cancer, primary hepatic cancer, or primary hepatic malignancy, is cancer that starts in the liver.^[1] Liver cancer can be primary in which the cancer starts in the liver, or it can be liver metastasis, or secondary, in which the cancer spreads from elsewhere in the body to the liver. Liver metastasis is the more common of the two liver cancers.^[3] Instances of liver cancer are increasing globally.^[8][9]

Primary liver cancer is globally the sixth-most frequent cancer and the fourth-leading cause of death from cancer.^[7][10] In 2018, it occurred in 841,000 people and resulted in 782,000 deaths globally.^[7] Higher rates of liver cancer occur where hepatitis B and C are common, including Asia and sub-Saharan Africa.^[3] Males are more often affected with hepatocellular carcinoma (HCC) than females.^[3] Diagnosis is most frequent among those 55 to 65 years old.^[2]

The leading cause of liver cancer is cirrhosis due to hepatitis B, hepatitis C, or alcohol.^[4] Other causes include aflatoxin, non-alcoholic fatty liver disease and liver flukes.^[3] The most common types are HCC, which makes up 80% of cases and intrahepatic cholangiocarcinoma.^[3] The diagnosis may be supported by blood tests and medical imaging, with confirmation by tissue biopsy.^[1]

Given that there are many different causes of liver cancer, there are many approaches to liver cancer prevention. These efforts include immunization against hepatitis B,^[3] hepatitis B treatment, hepatitis C treatment, decreasing alcohol use,^[8] decreasing exposure to aflatoxin in agriculture, and management of obesity and diabetes.^[9] Screening is recommended in those with chronic liver disease.^[3] For example, it is recommended that people with chronic liver disease who are at risk for hepatocellular carcinoma be screened every 6 months using ultrasound imaging.^[8]

Because liver cancer is an umbrella term for many types of cancer, the signs and symptoms depend on what type of cancer is present. Symptoms can be vague and broad. Cholangiocarcinoma is associated with sweating, jaundice, abdominal pain, weight loss, and liver enlargement.^[11] Hepatocellular carcinoma is associated with abdominal mass, abdominal pain, vomiting, anemia, back pain, jaundice, itching, weight loss and fever.^[12]

Treatment options may include surgery, targeted therapy and radiation therapy.^[1] In certain cases, ablation therapy, embolization therapy or liver transplantation may be used.^[1]