Introduction: Liver cancer is the 3rd leading cause of cancer deaths in the world after lung and stomach cancer, with approximately 600,000 deaths in 2002. A deadly disease, It will kill almost all patients who have it within a year. In 1990, the World Health Organization (wHO) estimated that there were about 430,000 new cases around the world,and a similar number of persons died as a result of this disease.

About 75% of the cases occur in Southeast Asia (China, Hong Kong,Taiwan, Korea, and Japan). The occurence of liver cancer in Southeast Asia and sub-Saharan Africa is higher than 20 cases per 100,000 population. In contrast, the frequency of cases in North America and Western Europe is much less, fewer than five per 100,000 population. However, the frequency of cases among Alaskan natives is comparable to that seen in Southeast Asia.

CAUSE: The cause of liver cancer is often cirrhosis (scarring of the liver). It may be caused by viral hepatitis, primarily hepatitis B and C, alcohol abuse, hemochromatosis, various auto-immune diseases of the liver, as well as various other diseases that result in chronic inflammation of the liver.

SYMPTOMS: Many persons with liver cancer do not develop signs of it until the advanced stages of the tumor which usually makes prognosis poor. Symptoms may include a lump or pain on the right side of your abdomen and yellowing of the skin. However, you may not show any symptoms and the disease may not be found until it is advanced.

Liver cancer patients often don't experience symptoms prior to diagnosis. As the disease progresses, symptoms begin to appear causing possible discomfort. If a patient has symptoms, his or her doctor may order special x-rays, such as a computed tomographic scan or a liver scan. If you experience any symptoms of liver cancer, you should report them to your doctor.

TYPES: Because the liver is made up of several different kinds of cells, a variety of types of tumors can form in the liver. Even though there are other types of cancer of the liver, the most common form in adults is called hepatocellular carcinoma (huh-pat-uh-CELL-u-larcar-sin-o-muh). Doctors can identify several subtypes of hepatocellular cancer by examining tissue under a microscope. Most of these subtypes do not affect treatment or the patient's outlook.

RISK: Risk factors for primary liver cancer include Having hepatitis, Having cirrhosis, or scarring of the liver, Being male, Low weight at birth. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing this form of cancer.

The only hope for persons who are at risk for cancer of the liver is regular observation so that the cancers can be found early. But the most important facts about primary liver cancer is that you can greatly diminish your risk by protecting yourself from hepatitis infection and cirrhosis, the leading causes of the disease.

TREATMENT: Treatments for primary liver cancer depend on the extent (stage) of the disease as well as the persons age, overall health, feelings and personal preferences. Treatments that your doctor will consider include surgery, chemotherapy, radiation, and in a few instances liver transplantation.

Aggressive surgery or liver transplantation can be successful in treating small or slow-growing tumors if they are found early. Primary liver cancer is hardly ever discovered early and usually doesn't respond to current treatments. Thus, the prognosis is usually not very good. Even when treatments fail to produce much improvement in the cancer itself, pain and other signs and symptoms caused by the cancer can be aggressively treated to improve quality of life.

CONCLUSION: Liver cancer is the fifth most common cancer in the world. It may be difficult to diagnose early because patients often have no symptoms and the cancer usually grows quickly. It is most commonly diagnosed when tumors from other parts of the body have metastasized to the liver (metastatic liver cancer), but can also more rarely arise directly in the liver (primary liver cancer). Cancer can start within the liver (primary liver cancer or hepatocellular cancer) or spread to the liver (metastatic liver cancer) from other sites, such as the colon.

Even though many cancers are declining in the United States, new cases of primary liver cancer are increasing. Although the current techniques for surveillance are not very good at detecting early liver cancer, newer techniques are being tested and appear to be better. Because standard treatments often aren't effective against the disease, you may want to consider participating in a clinical trial, a research study that tries to improve current treatments or find new treatments. More studies are needed to understand how targeted therapies may be used to control advanced liver cancer.