Primary liver cancer refers to malignant tumors originating from the liver, while secondary liver cancer is caused by tumors of other organs invading into the liver through blood, lymph or directly. Primary liver cancer is one of the most common malignant tumors in China. It is one of the common malignant tumors in China. The incidence rate of liver cancer in China ranks the first in the world and the mortality rate ranks the third among malignant tumors, after stomach cancer and esophageal cancer. The disease can occur at any age, with the age of 40-49 being the most common, and the ratio of men to women is 3-5:1. Etiology and Prevention The etiology of primary liver cancer has not yet been determined. It is believed that it is related to the combination of several factors: 1. hepatitis B virus (hbv) and liver cirrhosis: more than 90% of liver cancer cases in China have been infected with hbv, and chronic hepatitis B infection in liver cancer patients is more than 10-20 times higher than that in the control group. The stronger the indicator about hbv, the higher the risk of liver cancer. Chronic hepatitis B is associated with cirrhosis, and 80% (60-90%) of liver cancers occur on the basis of cirrhosis, most of which are post-hepatitis cirrhosis. Preventive measures: Vertical transmission from mother to child and hepatitis B from 0 to 5 years of age may be the main reason for the permanent existence of hepatitis B virus carrier status. Therefore, in high-incidence areas and cities where available, newborns and susceptible people should be vaccinated against hepatitis B. The involvement of multiple hepatitis viruses and virus variants should also be taken into account and it is not appropriate to rely on one measure alone. In recent years, it has been reported that hepatitis C virus (hcv) is associated with 100% of liver cancer cases, and prevention of hepatitis C will become a real issue in the future; in addition, attention should be paid to the transmission routes of hepatitis B and C such as blood transfusion, injection, acupuncture, and face-lifting. People who receive dialysis, hemophiliacs, spouses of hbsag carriers, medical workers, especially those who come into contact with blood and blood products are also high-risk groups. 2.aflatoxin: aflatoxin b1 (afb1) is a strong chemical carcinogen in liver, may be the initiator or promoter of human liver cancer, and has synergistic carcinogenic effect with hbv. Qidong high incidence area 10% of residents eat aflatoxin (from the warm and humid zone of corn and peanuts) to 10 to 100 times higher than the residents of Beijing. Preventive measures: prevent food mold, strict health management, prevent the ingestion of afb. remove or clean moldy food, high incidence areas should reduce the intake of corn, peanuts, and promote the consumption of green tea to prevent afb induced liver cancer. 3.The relationship between drinking water pollution and liver cancer deserves attention: there are many organic carcinogenic and carcinogenic substances in lakes, ponds and ditches, and there is also a kind of blue-green algae which is easy to grow, and its toxic effect on liver is identified as another risk factor of liver cancer, and in-depth research may suggest the mystery of drinking water and liver cancer. Preventive measures: Improve water quality and pay attention to drinking water hygiene, especially in high incidence areas and areas with serious industrial pollution. It is advisable to drink live water and well water in rural areas and to use less polluted water sources as tap water in cities. In addition, the occurrence of liver cancer may also be related to parasitic infection, lack of certain trace elements, genetic factors and alcoholism. The most common symptoms and signs of hepatocellular carcinoma The majority of patients with mid- to late-stage hepatocellular carcinoma have pain in the liver area as the first symptom, with the incidence rate exceeding 50%. The pain in the liver area is usually located in the right rib area or under the raphe, and the nature of pain is intermittent or continuous hidden pain. The pain is intermittent or persistent, dull or stabbing, and the patient may feel discomfort in the right upper abdomen for a period of time before the pain. The pain may be mild and severe or may be relieved by itself for a short period of time. The pain is mainly caused by the rapid enlargement of the tumor, which compresses the peritoneum of the liver and produces pulling pain. In a few patients, the sudden onset of severe pain in the liver area spontaneously or after liver puncture is mostly due to the rupture and bleeding of cancer nodules located on the surface of the liver. If there are also signs of blood pressure drop and shock, and bloody fluid in the abdominal cavity, it means that the rupture and bleeding of cancer nodules are serious. In this case, emergency resuscitation is needed. If there is no accompanying symptom as mentioned above and the pain is more limited, it indicates that the bleeding is located in the subhepatic peritoneum. Pain may vary according to the location of tumor growth. Tumors located in the left lobe often cause pain in the middle and upper abdomen; for tumors located in the right lobe, the pain is in the right quarter rib area; when the tumor involves the transverse septum, the pain radiates to the right shoulder or right back, which is easily mistaken for shoulder arthritis; when the tumor is located in the posterior part of the right lobe, it sometimes causes lumbago; for tumors located deep in the liver parenchyma, the pain is rarely felt. Some patients may develop fever, similar to infection, due to the large tumor and necrosis in the center. Anemia and hypoproteinemia may also occur. Sometimes some systemic metabolic changes such as hypoglycemia, erythrocytosis, hypercalcemia and hyperlipidemia also occur. The symptoms of hepatocellular carcinoma are not obvious in the early stage, and even patients do not feel anything for a long time after the disease has progressed to a certain level before they gradually develop some symptoms such as pain in the liver area, loss of appetite, fatigue and weakness, and gradually losing weight. Since liver cancer mostly occurs on the basis of chronic hepatitis and cirrhosis, these symptoms are often mistaken by patients and even some medical personnel as manifestations of hepatitis and cirrhosis and delay further examination, thus delaying the time of treatment. There are few cases that liver cancer is not discovered until advanced patients develop jaundice, ascites, vomiting blood, coma and so on. Therefore, those who have previous history of chronic hepatitis B and cirrhosis and have recent symptoms of right upper abdominal discomfort, loss of appetite, wasting and weakness should be highly alert to the possibility of hepatocellular carcinoma and be examined as early as possible to avoid delaying treatment. Progressive hepatomegaly is the most common sign of hepatocellular carcinoma, and many patients visit the doctor before they feel the lump in the upper abdomen. Some patients with diffuse hepatocellular carcinoma may not have hepatomegaly. If the cancer is located in the right lobe of the liver near the septum, the septal muscle can be elevated, and the movement can be restricted, and the upper border of the liver can be moved upward, but the mass is not easily palpable. On palpation, the liver has a hard texture, the surface is not smooth, with or without nodularity, and the liver margin is relatively sharp. In a few larger masses with liquefaction necrosis, the mass becomes softer. However, the findings of physical examination are often non-specific, and it is difficult to differentiate them from the enlarged liver in cirrhosis. Serum fetoprotein is the most specific index for the diagnosis of liver cancer other than pathological examination. The presence of alpha-fetoprotein in adult serum indicates incomplete differentiation of hepatocytes and therefore most often occurs in hepatocellular carcinoma. A value of >400 μg/L is typical for hepatocellular carcinoma, but in other cases, except for a rare tumor, testicular teratoma, alpha-fetoprotein rarely exceeds 400 μg/L. Lower values of alpha-fetoprotein are less specific and may also occur during hepatocellular regeneration (e.g., hepatitis). In areas with a high prevalence of HBV, most hepatocellular carcinomas eventually show significantly elevated fetoprotein levels, although they are often normal in the early stages; high levels of fetoprotein are less common in low prevalence areas. In recent years, it has been found that hepatocellular carcinoma also contains an acidic isoferrin, called carcinoembryonic isoferrin, which may help in early diagnosis. Therefore, serum ferritin measurement can be used as one of the means to monitor the efficacy of treatment, especially for patients with negative AFP. In addition, elevated levels of carcinoembryonic antigen (CEA), glycoprotein 19-9 (CA19-9), and serum des-gamma-carboxy prothrombin (a prothrombin precursor) may also be used as biochemical markers of hepatocellular carcinoma, but more information is needed to confirm their clinical value. Ultrasound, CT and MRI are important diagnostic methods and can sometimes diagnose liver cancer in patients with no clinical symptoms, while B-mode ultrasound can detect liver cancer over 1 cm and is valuable for early localization. It has become one of the main tools for screening and early diagnosis. Ultrasound screening of chronic hepatitis B virus carriers is performed in HBV endemic areas to monitor the occurrence of liver cancer. In cases of pre-existing cirrhosis, scans are of little value because the results are difficult to interpret. Hepatic angiography is often indicative of tumor characteristics and may be considered if liver cancer is highly suspected. Hepatic angiography can also clarify the anatomy of the liver vessels when preparing for surgical treatment. Liver biopsy can confirm the diagnosis and has a high positive rate, especially when performed under ultrasound guidance. The risk of liver biopsy is generally low, but increases if the tumor is largely vascular or necrotic in nature. Treatment Surgery is currently the most effective treatment for liver cancer. The survival rate of early hepatocellular carcinoma is over 80% in one year and over 50% in five years after surgical resection. If post-operative treatment is supplemented with comprehensive treatment, better results can be achieved. Arterial embolization chemotherapy is to interrupt the blood flow through the tumor by injecting embolic substances and anti-cancer drugs into the tumor nutrient vessels through a catheter. It is currently the preferred non-surgical treatment option. Radiotherapy can shrink the cancer mass, relieve the symptoms and prolong the life of primary liver cancer, and it is mainly applied to cases with normal general condition, normal liver function and limited mass that cannot be removed. Chemotherapy and combination chemotherapy. At present, because liver cancer is not sensitive to chemotherapy, systemic chemotherapy is not the main means of liver cancer treatment, and finding more effective and reasonable combination chemotherapy methods is one of the research topics for liver cancer treatment in the future. Hepatic artery cannulation chemotherapy: Since 90% of the blood supply of hepatocellular carcinoma comes from hepatic artery, intrahepatic artery infusion of chemotherapeutic drugs makes the local drug concentration of tumor higher, thus greatly improving the effect of drugs in killing cancer cells, while the systemic side effects are small. In recent years, local treatments such as radiofrequency ablation, microwave curing, ultrasound focused knife and tumor anhydrous ethanol injection have been applied more and more widely. Local treatment is safe and has little impact on patients, and is even as effective as surgical resection for small hepatocellular carcinoma less than 5 cm. In addition, biological therapy, cryotherapy, microwave therapy, laser therapy and liver transplantation are also available for the treatment of liver cancer.