2 main types of primary liver cancer - Hepatocellular carcinoma (80%) and cholangiocarcinoma (20%)

Secondary liver cancer - Any cancer with liver metastases has a poor prognosis (it is not uncommon to have liver mets with unknown primary)

Risk factors:

• HCC - Main risk factor is liver cirrhosis, some patients may not have had liver cirrhosis especially those with HBV
• Cholangiocarcinoma. - associated with primary sclerosing cholangitis. However, only 10% of patients with cholangiocarcinoma had primary sclerosing cholangitis.

Epidemiology:

• The mean age of diagnosis of HCC in the US is around 60 years, but the incidence rate is increasing in those between the ages of 45 and 60 years
• Cholangiocarcinoma usually presents in patients > 50 years old unless related to primary sclerosing cholangitis.

PC

*presence of risk factors

A significant number of patients may be asymptomatic and are diagnosed following screening or in late stages making the prognosis poor

There are non specific symptoms associated with liver cancer:

• Weight loss
• Abdominal pain
• Anorexia
• Nausea and vomiting
• Jaundice
• Pruritus

Cholangiocarcinoma often presents with painless jaundice in a similar way to pancreatic cancer.