There are two ways in which cancer can involve the liver. The cancer can arise from the liver itself (primary liver cancer) or it can spread to the liver from a primary tumour at another site (secondary, or metastatic, cancer).

Primary liver cancer can arise from the liver cells themselves (hepatocellular carcinoma) or from the system of tubes that drains the bile from the liver (cholangiocarcinoma, gall bladder cancer). Most patients with primary liver cancer have suffered previously from liver disease such as chronic hepatitis, cirrhosis or, in the less developed world, been exposed to poisons from plants (aflatoxins). Immunisation against hepatitis B might, particularly in the developing world, prevent many cases of primary liver cancer.

Secondary (metastatic) cancer reaches the liver by spreading through the blood system from a primary tumour at a separate site. In about 50 per cent of patients with metastatic liver cancer, the primary tumour is in the bowel (colon, rectum) or stomach. The other common primary sites are the breasts and lungs.

The symptoms of cancer involving the liver can include:

• tiredness.
• loss of appetite.
• nausea.
• a dragging sensation or heaviness felt up under the lower ribs on the right hand side of the body.
• pain in the upper part of the belly.

In the later stages, the skin can develop a yellowish tinge (jaundice) together with fevers and drenching sweats, particularly at night.