Liver cancer is a life-threatening illness and one of the fastest-growing cancer types in the United States. There are two kinds of liver cancer: primary and secondary. Primary cancer starts in your liver. Secondary cancer spreads to your liver from another part of your body. This article is an overview of primary liver cancer. Like many kinds of cancer, healthcare providers can do more to treat liver cancer during the disease’s early stage. Unlike many kinds of cancer, healthcare providers have a good idea of what increases someone’s risk of developing liver cancer. With that in mind, healthcare providers are intent on identifying who may be at increased risk so they can catch and treat primary liver cancer as early as possible.

1. KUVEMPU UNIVERSITY
Department of Biotechnology
Sahyadri Science College, Shivamogga
Under the Supervision of :
Dr. Pradeepa.K.
Assistant professor,
Dept, of Biotechnology
Sahyadri Science College, Shivamogga
Submitted by:
Ms. Gayathri K L
Reg No-S1908157
Sahyadri Science College, Shivmogga
Dissertation on
“Liver cancer ”

2.  Liver cancer is cancer that occurs in the liver. The liver is your
largest internal organ. It performs several critical functions to
help your body eliminate waste, absorb nutrients, and heal
wounds.
 The liver is located in the upper right area of your abdomen,
right below your ribs. It’s responsible for producing bile, which
is a substance that helps you digest fats, vitamins, and other
nutrients.
 This vital organ also stores nutrients such as glucose so that you
remain nourished at times when you’re not eating. It also breaks
down medications and toxins.
 When cancer develops in the liver, it destroys liver cells and
interferes with the ability of the liver to function as expected.
 Liver cancer is generally classified as primary or secondary.
Primary liver cancer begins in the cells of the liver. Secondary
liver cancer develops when cancer cells from another organ
spread to the liver, or metastasize.
 Unlike other cells in your body, cancer cells can break away
from the primary site, or where the cancer began.
 The cells can travel to other areas of your body through the
bloodstream or lymphatic system. When they reach other organs
or tissues, they can begin to grow there.
Introduction:

4. Liver cancer symptoms:
Many people don’t experience symptoms in the early stages of primary liver
cancer. When symptoms do appear, they may include:
 abdominal discomfort, pain, and tenderness, especially in your upper
abdomen
 yellowing of your skin and the whites of your eyes, which is called jaundice
 pale, chalky stools and dark urine
 nausea
 vomiting
 loss of appetite
 feeling full unusually fast when you eat
 bruising or bleeding easily
 weakness
 fatigue
 fever
 unexplained weight loss

5. Types of liver cancer:
There are several types of primary liver cancer. Each one
corresponds to a different part of the liver or type of liver
cell that is affected.
Primary liver cancer can start as a single lump growing in
liver, or it can start in many places within liver at the
same time.
The main types of primary liver cancer are:
• Hepatocellular carcinoma
• Cholangiocarcinoma
• Liver angiosarcoma
• Hepatoblastoma

6. Hepatocellular carcinoma:
Hepatocellular carcinoma (HCC), also known as hepatoma, is the most common type of liver cancer. Around 85 to 90 percent of
primary liver cancers are the HCC type. This condition develops in the hepatocytes, which are the main cells that make up your
liver.
HCC is much more likely to occur in people who have long-term (chronic) hepatitis or cirrhosis. Cirrhosis is a serious form of
liver damage that is usually caused by:
•hepatitis B or C infection
•long-term, heavy alcohol use
•nonalcoholic fatty liver disease
Cholangiocarcinoma:
Cholangiocarcinoma, more commonly known as bile duct cancer, develops in the small, tube-like bile ducts in liver. These ducts
carry bile to the gallbladder to help with digestion.
When the cancer begins in the section of the ducts inside liver, it’s called intrahepatic bile duct cancer. When the cancer begins in
the section of the ducts outside liver, it’s called extrahepatic bile duct cancer.Bile duct cancer is rare.
Liver angiosarcoma:
Liver angiosarcoma is a very rare form of liver cancer that begins in the blood vessels of your liver. This type of cancer tends to
progress very quickly, so it’s typically diagnosed at a more advanced stage.
Hepatoblastoma:
Hepatoblastoma is an extremely rare type of liver cancer. It’s nearly always found in children, especially those under age 3 surgery
can be done through chemotherapy, hepatoblastoma it can be cured about 70 percent.

7. Stages:
Four stages:
Stage 1: the tumor remains in the liver and has not spread to another organ or location.
Stage 2: either there are several small tumors that all remain in the liver or one tumor that has reached a blood vessel.
Stage 3: there are various large tumors or one tumor that has reached a main, large blood vessel.
Stage 4: the cancer has metastasized, meaning it has spread to other parts of the body.

8. Risk factors for liver cancer:
•Age. Liver cancer is more common in older people.
•Race and ethnicity. In the United States, liver cancer is more common
in American Indian and Alaska Native people. It’s least common in white
people.
•Heavy alcohol use. Heavy drinking over many years increases your risk
for liver cancer.
•Smoking. Smoking cigarettes increases your risk for liver cancer.
•Aflatoxin exposure. Aflatoxin is a toxic substance produced by a type of
mold that can grow on peanuts, grains, and corn. Anabolic steroid
use. Long-term use of anabolic steroids, which are a type of
artificial testosterone, increases your risk for liver cancer.
Genetic conditions:
•alpha-1 antitrypsin deficiency
•glycogen storage diseases
•heredity hemochromatosis
•porphyria cutanea tarda
•tyrosinemia
•Wilson’s disease

9. Liver cancer diagnose
Diagnostic tests and procedures for liver cancer include:
•Liver function tests. These tests help your doctor determine the health of your liver by measuring levels of proteins, liver
enzymes, and bilirubin in your blood.
•Alpha-fetoprotein (AFP) test. The presence of AFP in your blood can be a sign of liver cancer. This protein is usually only
produced in the liver and yolk sac of a developing fetus. AFP production usually stops after birth.
•Imaging tests. Abdominal ultrasounds, CT scans, or MRI scans produce detailed images of the liver and other organs in
abdomen. They can help pinpoint where a tumor is developing, determine its size, and assess whether cancer has spread to other
organs.
Liver biopsy
Another diagnostic test available is a liver biopsy.
A liver biopsy involves removing a small piece of liver tissue. It’s often done using anesthesia to prevent you from feeling pain
during the procedure.
There are several different liver biopsy procedures.
Needle biopsy. During this procedure, insert a thin needle through abdomen and into liver to obtain a tissue sample, may use an
ultrasound or other imaging to see where to collect the sample. The sample is then examined under a microscope for signs of
cancer.
•Laparoscopic biopsy. This test is performed using a laparoscope, which is a thin, flexible tube with an attached camera. The
laparoscope is inserted through a small incision in abdomen. The camera allows to see what liver looks like and to perform a
more precise biopsy.
•Surgical biopsy. Surgery can allow a to remove a tumor sample or remove the tumor entirely, when needed. In some cases, an
abdominal surgery called laparotomy is used to examine several areas inside your abdomen.

10. Liver cancer screening:
 If you’re at an increased risk for liver cancer because of particular health conditions, your doctor may recommend regular
screening.
 Liver cancer doesn’t tend to cause noticeable symptoms in its early stages. Screening means testing for cancer before you have
symptoms. It can help to catch cancer earlier.
 People with liver cancer tend to have better outcomes when the cancer is diagnosed at an earlier stage. Treatment is generally
more straightforward when cancer is detected before it has a chance to spread.
 Experts recommend regular liver cancer screening for people with certain conditions, including:
•cirrhosis
•long-term hepatitis C infection
•nonalcoholic fatty liver disease
•ultrasound imaging
•blood tests to detect AFP

11. liver cancer treatment:
 Partial hepatectomy
A partial hepatectomy is performed to remove a portion of the liver. This surgery is typically used only for early-stage liver cancer.
 Liver transplant
A liver transplant involves replacing the entire liver with a healthy liver from a suitable donor. A transplant may be considered if the
cancer hasn’t spread to other organs. Take medications after the transplant to prevent your body from rejecting the new liver.
 Ablation
Ablation involves the use of heat, cooling, or ethanol injections to destroy the cancer cells. It’s usually performed using local
anesthesia. This numbs the area to prevent you from feeling pain. Ablation can help people who aren’t candidates for surgery or a transplant.
 Radiation therapy
Radiation therapy uses beams of high-energy radiation to kill cancer cells. It can be delivered by external beam radiation or by internal
radiation. In external beam radiation, the radiation is aimed at the parts of your body where cancer is located. Internal radiation involves the
insertion of a small amount of radioactive material directly into or near the cancer.
 Targeted therapy
Targeted therapy uses medications designed to decrease tumor growth and blood supply. Compared to chemotherapy or radiation,
these medications are fine-tuned to treat cancer cells only. However, these medications can still cause serious side effects. Targeted therapy can be
helpful for people who aren’t candidates for a hepatectomy or liver transplant. Medications of this type include tyrosine kinase inhibitors (TKIs),
such as:
•cabozantinib (Cabometyx or Cometriq)
•lenvatinib (Lenvima)
•regorafenib (Stivarga)
•sorafenib (Nexavar)

12.  Embolization, chemoembolization, and radioembolization:
Embolization procedures are used to reduce blood supply to liver tumors,insert small particles to create a partial blockage
in the hepatic artery. This reduces the amount of blood flowing to the tumor. Another blood vessel known as the portal vein
continues to nourish the healthy liver tissue.
In chemoembolization, injects chemotherapy drugs into the hepatic artery before injecting the blocking particles. This
sends the chemotherapy drugs directly into the tumor. The blockage reduces blood flow to the tumor.
Radioembolization is a combination of radiation therapy and embolization. It involves injecting tiny radioactive beads into
the hepatic artery. This decreases blood flow to the tumor and provides radiation therapy to the direct area of the tumor.
 Chemotherapy:
Chemotherapy is a powerful form of drug therapy that destroys cancer cells. The medications are typically injected
intravenously, or through a vein. In most cases, you can receive chemotherapy as an outpatient treatment.
Chemotherapy may be used for liver cancer when other therapies aren’t appropriate or aren’t working well. Because
chemotherapy affects healthy cells in your body, not just the cancer cells, side effects are common.
 Immunotherapy:
Immunotherapy treats cancer using your body’s own immune system. Treatment with immunotherapy drugs can help your
body recognize and destroy cancer cells. Like other cancer therapies, serious side effects are possible.
Continue..,

13. Prevention of the liver cancer:
 The following steps are prevent liver cancer:
 Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For women, this means no
more than one drink a day. For men, this means no more than two drinks a day.
 Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising
most days of the week. If you need to lose weight, reduce the number of calories you eat each day and increase the amount of
exercise you do. Aim to lose weight slowly — 1 or 2 pounds (0.5 to 1 kilogram) each week.
 Get vaccinated against hepatitis B: You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine. The
vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems. No
vaccine for hepatitis C exists.
 Seek treatment for hepatitis B or C infection: Simple treatments are available for hepatitis B and hepatitis C infections.
Research shows that treatment can reduce the risk of liver cancer.
 Know the health status of any sexual partner. Don't engage in unprotected sex unless you're certain your partner isn't
infected with HBV, HCV or any other sexually transmitted infection. If you don't know the health status of your partner, use a
condom every time you have sexual intercourse.
 Don't use intravenous (IV) drugs, but if you do, use a clean needle. Reduce your risk of HCV by not injecting illegal
drugs. Make sure any needle you use is sterile, and don't share it. Contaminated drug paraphernalia is a common cause of
hepatitis C infection.
 Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the
hepatitis C virus. Before getting a piercing or tattoo, check out the shop and ask staff members about their safety practices.

14. Conclusion:
 Liver functions include detoxification, digestion, and regulation of the body’s metabolic rate. Fatty liver, hepatitis virus
infections, and alcohol all contribute to liver disease. It’s possible to die from liver failure if you have cirrhosis (liver scarring).
As a result, it is imperative that the cause affecting it be identified and counteracted.
 In some countries, there has been an improvement in the survival rates for patients with liver cancer. Improvements in HCC
patient outcomes are attributed to clinical trials optimizing individual treatment strategies and to the development of more
complex therapeutic modalities. Constant development of new techniques and new drugs is providing hope of further advances.
Given the various treatment options now available, including natural compounds, chemotherapeutics, immunotherapies, and
new methods for delivery of drugs, there are now unprecedented opportunities to treat liver cancers, including use of
combination therapy that can improve the effects of current agents.
 This report provides an overview of the rationales behind some current clinical trial interventions. Although new drugs could be
useful, finding the ideal combinations will challenge scientists and physicians. Since the adjusted incidence rates and death
rates have continued to increase, researchers must continue to work to reduce these rates and to remove liver cancer from the
list of the most commonly diagnosed and fatal cancers.

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