Improving detection and treatment of liver cancer.

Liver cancer is the sixth most common cancer worldwide. The majority (75-90%) of all primary liver tumours are hepatocellular carcinomas (HCC), arising from the liver parenchyma. Other primary liver cancers include cholangiocarcinomas (CC), which make up 10-25% of liver cancers. These tumours arise from cells lining the biliary tree. Chronic viral hepatitis, and in particular hepatitis B virus (HBV), remains the most important risk factor for the development of HCC. In the UK the incidence of CC is 1-2 cases per 100,000 population, but rates are increasing and in the mid-1990s CC overtook HCC as the most common cause of liver cancer-related death. Over the past decade survival in liver cancer has been steadily improving as a result of developments in surgery, transplantation and the introduction of a number of novel local, ablative and molecular targeted therapies. Symptoms associated with HCC include fatigue, weight loss, abdominal pain, pruritus and jaundice, which may also be caused by the underlying liver disease. However, HCCs are often relatively asymptomatic until late on, and 90% of cases are associated with one or more risk factors. Patients with risk factors should undergo surveillance by abdominal ultrasound every six months. Classical symptoms of CC include jaundice, dark urine, clay-coloured stools and pruritus and occur as a result of progressive bile duct obstruction by the tumour.