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The liver is the largest organ, present inside the body just below the right lung and the diaphragm. The liver lies close to the colon, the intestines and the right kidney. It roughly weighs about 1.5 kg and is deep red in color due to a rich blood supply. The liver performs several important functions:

It plays a major role in the metabolic process and subsequently in the absorption of nutrients.

It secretes a substance called bile, necessary for breakdown of bigger fat molecules into smaller forms. The bile reaches the small intestine through the bile duct, during the digestive process.

It also stores various nutrients such as fat, carbohydrate, proteins and vitamins (Vitamin A and Vitamin B12)

It produces substances required for clotting of blood. If not for the presence of these substances, we would bleed to death following a minor injury.

It also plays an important role in the detoxification process and clears the body of harmful substances.


Liver cancer is an abnormal growth of cells, in the liver. Liver cancer can be classified into two major categories, primary and secondary liver cancer.

Primary liver cancer originates from the cells present in the liver and is more common among middle-aged men and aged individuals (above 60 years of age). Primary liver cancer can be differentiated into two major categories, depending on the origin of the tumor.


Hepatoma or hepatocellular carcinoma originates from cells called hepatocytes that perform majority of the liver function. It accounts for 75% of all primary liver cancers. It can occur a single tumor and can spread to other parts of the liver or multiple tumors can occur in the liver at the same time.

Cholangiomas originates from the cells that line the bile ducts of the liver and accounts for 10 to 20% of all primary liver cancers. The bile duct carries the bile, produced by the liver to the gall bladder. Inflammation of the bowel and parasitic infection of the liver (liver fluke) is believed to cause this type of cancer.

Secondary liver cancer originates in some other region of the body such as the colon, stomach, lung or breast and spreads to the liver. In addition, liver cancer cells can spread to other parts of the body such as the bones or lungs. This phenomenon of spread of the tumor from one region to the other is called metastasis.


(1). AGE:

Studies conducted on numerous liver cancer patients has revealed that the incidence of liver cancer is more common among men of middle age.

(2). SEX:

Men are twice as likely to develop liver cancer, compared to women.


A person is more likely to develop liver cancer if he/she has other first-degree relatives, afflicted with the same disease. This could probably be attributed to certain genetic factors that are shared between members of the same family.


Cirrhosis is a liver disease that occurs due to long-term damage to the liver as a result of alcohol consumption, viral infection (Hepatitis B and Hepatitis C), hemochromatosis (genetic disorder characterized by defect in iron metabolism). It can also be due to prolonged use of drugs or other chemical substances. The healthy liver cells get damaged over a long time and is replaced by scar tissue. About 5% of those with cirrhosis have chances of developing liver cancer (5%).


As stated before, the liver is involved in the detoxification of substances such as alcohol from the body. Over a period of time, the liver loses its detoxifying capacity. In other words, it can no longer render the alcohol inactive and liver damage occurs. When a person who has been drinking alcohol stops drinking, the liver cells try to rectify the damage. This process of regeneration can lead to genetic change that can result in liver cancer. The risk of developing cancer may be greater when there is a concomitant liver infection.


Certain chemical agents can give rise to cancer. Such substances are called carcinogens. Aflatoxin B1, produced by a mold (Aspergillus flavus) has been known to have a strong association with respect to liver cancer. Storing of food such as peanuts, soybeans, corn, rice and wheat under hot and humid conditions can predispose to aflatoxin contamination. This type of liver cancer is most common in China and Africa. The human body has got certain genes that protect against cancer. Such genes are called tumor suppressor genes (p53 gene). Aflatoxin has been found to inactivate these genes, eventually predisposing to cancer.


Hepatitis is the medical term used to represent infection of the liver. Amongst the various agents that can give rise to infection, hepatitis C virus and Hepatitis B virus deserve special mention. The viruses can be passed on from one individual to another through sexual contact or blood and other body fluids. In addition, it may be passed on from an infected mother to her offspring. It is hypothesized that the ability of the Hepatitis B virus to induce a genetic change in the normal liver cells could be responsible for causing liver cancer. For liver cancer to occur, a prolonged period of infection with the virus is necessary. Hepatitis B infection can be prevented by active immunization through administration of the Hepatitis B vaccine. The exact mechanism of how Hepatitis C causes liver cancer is not known. It could be due to the result of cirrhosis, which is one of the sequelae of the infection. A vaccine for Hepatitis C under the experimental phase and would be developed soon.


Symptoms are very rarely seen during the initial stages of liver cancer development. As the tumor progresses, it can lead to certain symptoms that can be experienced by the patient.

->Loss of weight

->Loss of appetite

->Generalized fatigue (Common to all types of cancer)

-> A vague pain, slight discomfort or a sensation of fullness may be felt in the upper abdominal area. The pain can also radiate to the right shoulder or to the back (enlargement of the liver affects the nerves that supply the area)

-> Ascites (Swelling/Bloating of the abdomen due to fluid collection)

-> Jaundice
(Yellowish discoloration of the eyes and skin): If there is a block in the bile duct, the bile produced by the liver cannot reach the intestines or the gall bladder. It will then flow back into the blood, leading to the development of a yellow color in the skin and eyes. A pateint with jaundice would also pass dark-colored urine and pale stools.


-> Clinical examinaton .

-> Blood test.
( A specialized test is the screening for alpha-fetoprotein)

-> Ascitic fluid analysis.

-> Ultrasound.

-> Computed tomography.

-> Magnetic resonance imaging:

-> Angiography.

-> Liver biopsy.


Early detection and diagnosis of liver cancer is the key to successful treatment. The treatment outcome is much better if it is diagnosed before it has spread to other parts of the body. Surgery is one of the options available for treatment. The patient’s health status should be good enough to enable surgery and post-operative recovery. At present, liver cancer is very difficult to cure using the currently available techniques. Therefore most of the treatment is directed towards extending the lifespan and improving the quality of life of a liver cancer patient. A team of medical professionals (general surgeons, transplant surgeons, oncologists, radiotherapists, gastroenterologists) may participate in the treatment process.


-> Number of tumors (Single/ Multiple)

-> Size of the tumor (Small/ big)

-> Extend of liver damage as a result of liver cancer

-> Age and general health condition of the patient

-> Severity of the disease (Spread to other parts of the body)

-> Concerns regarding side effects of treatment


At this moment, liver cancer can be effectively treated only if diagnosed at an early stage. Surgery remains the viable treatment option if the tumor is small enough to be treated and is located in such a place that it can be removed easliy. Liver cancer cannot be removed if it has spread to other places such as the lungs or bones or the liver is extensively damaged as in cirrhosis. A specific part of the liver that is affected by the tumor is removed by a process called liver resection. In some cases, removal of an entire lobe of the liver may be necessary. The liver has an excellent regenerative capacity and the removed segement would be substituted by a new tissue within few weeks or months.


Liver transplantation (removal of the diseased liver and replacement with a liver segment from a donor) is yet another option. Howver, it can be done only when the tumor is sufficiently small.


In this technique, anti-cancer agents are directly delivered to the liver cancer cells, with the help of X-ray. This procedure does not provide a cure for liver cancer but can provide symptomatic relief. Most patients who receive this treatment live longer. The treatment may be offered alone or in combination with other therapies.

A small incision is made in the skin and a thin tube (catheter) is introduced into the body and directed to the exact site of the liver cancer. Once the position of the tube is confirmed through X-rays, small anti-tumor agents along with particles about the size of grains of sand are delivered directly to the blood vessel that supplies tumor. After successful delivery, the tube is removed and a bandage is applied over the skin surface to arrest the bleeding. This procedure requires hospital admission. The main advantage of the procedure is that it can be repeated number of times.

The ...

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