Primary Liver

Metastatic Liver

Colorectal liver

liver metastases

Primary Liver Cancer


Primary liver cancer (cancer that starts in the liver) is one of the most common malignancies in the world, with approximately 1,000,000 cases reported every year. This ranges from 15,000 cases in the United States to more than a 250,000 in China. About 80% of people with primary liver cancer are male.

Although two-thirds of people have advanced liver disease when they seek medical help, one third of the patients have cancer that has not progressed beyond the liver. The most promising treatments apply to this latter group.

Possible causes of primary liver cancer

Primary liver cancer (Hepatocellular Carcinoma, or HCC) is associated with liver cirrhosis 60-80% of the time. A strong relationship exists between HCC and chronic Hepatitis B and chronic Hepatitis C. The unfortunate worldwide epidemic of Hepatitis C is expected to result in a dramatic increase in primary liver cancer. There is also a relationship between HCC and alcoholism, although much less common.

The consumption of natural carcinogens (cancer-causing agents) also may cause HCC. Aflatoxin B is commonly found in grains, including rice, stored under hot humid conditions. This contributes to the extremely high incidence of HCC in Asian countries. Similarly, in sub-Saharan Africa the consumption of plants, fungi and bacteria that synthesize natural carcinogens relates to widespread incidence of HCC.


Abdominal pain is generally the initial and most frequent symptom. While severe in some instances, the pain is more likely to be a persistent dull ache, which intensifies in later stages. The next two most common universal symptoms are weakness and weight loss, although symptoms vary in different parts of the world. Other symptoms that result from HCC include loss of appetite (anorexia), indigestion (dyspepsia), constipation and abdominal mass.

Disease progression/prognosis

The International Union Against Cancer (UICC) System is used to distinguish the stages of liver cancer. Stage I consists of a single tumor no larger than 2 cm (about ¾ inch) in size, with no progression into the blood vessels. Patients with Stage I have the best prognosis.

Stage II is a more advanced disease with vascular (blood vessel) involvement and/or tumor(s) larger than 2 cm (3/4 inches) in diameter. Cancer in the blood vessels provides a route for malignant cells to move to other sites and has a significant negative effect on prognosis. Large tumors are also more likely to be associated with vascular involvement.

Stage III disease generally indicates disease progression in which the tumors are large and may include lymph node and vascular involvement. When patients are initially diagnosed at this stage, prognosis for survival is usually less than one year.

Stage IV disease reflects widespread, significant malignant lesions as well as vascular invasion and lymph node involvement. Prognosis for patients with this late stage disease is poor. Few patients survive more than one year after transplantation or surgery.

This Web site presents some treatment options that might prolong survival and even cure HCC if it is detected at an early stage.

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