I. What is liver cancer? Liver cancer refers to malignant tumors occurring in the liver, including primary liver cancer and metastatic liver cancer, and people mostly refer to primary liver cancer when they talk about liver cancer in daily life. Primary liver cancer is one of the most common malignant tumors in clinical practice. According to the latest statistics, the global incidence rate has exceeded 626,000/year, ranking 5th among malignant tumors: death is close to 600,000/year, ranking 3rd among tumor-related deaths. Primary liver cancer is highly prevalent in China, and the number of incidence in China now accounts for about 55% of the global incidence; it ranks second after lung cancer in tumor-related deaths. Liver cancer is a serious threat to people’s health and life in China. Who are prone to get liver cancer? (1) Patients with chronic hepatitis: epidemiological statistics show that areas where hepatitis B is prevalent are also areas with high incidence of liver cancer, and people who have suffered from hepatitis B have more chances to develop liver cancer than those who have not, and this risk is as much as 10.7 times. Hepatitis virus (including hepatitis B and C) is the main initiating factor among many factors in the development of human liver cancer. (2) Unclean diet: Long-term consumption of moldy food, food containing nitrite and lack of trace elements of selenium in food are also important factors in the development of liver cancer. Aflatoxin in moldy corn, peanuts, etc. is the main factor that induces cancer, and is the only substance that has a clear carcinogenic effect so far, and is one of the auxiliary causes of liver cancer. Nitrite exists in many foods in nature, and nitrite in daily meals will not cause harm to human body, but if a large amount of nitrite is not discharged in time, it can be transformed into nitrosamines in the body, which has a clear carcinogenic effect. (3) Alcoholics: Those who have alcoholic habits have a high incidence of cirrhosis, especially if they drink a lot of alcohol on top of hepatitis, it will accelerate the formation and development of cirrhosis and promote the occurrence of liver cancer. Strictly speaking, alcohol consumption is not the direct cause of liver cancer, but it is a catalyst that can promote the carcinogenic effect of carcinogens. 3.What are the manifestations of liver cancer? The clinical manifestations of primary liver cancer are extremely atypical, and its symptoms are usually not obvious, especially in the early stage of the disease process. Usually, about 70% of small liver cancers under 5cm are asymptomatic, and about 70% of asymptomatic subclinical liver cancers are also small liver cancers. Once symptoms appear, it means that the tumor is already large, and the progression of the disease is usually very rapid, usually presenting malignant quality within a few weeks and often failing and dying within a few months to a year. Clinical symptoms are mainly in two aspects: (1) manifestations of cirrhosis, such as ascites, development of collateral circulation, vomiting of blood and edema of limbs; (2) symptoms of the tumor itself, such as weight loss, generalized weakness, pain in the liver area and enlargement of the liver. After the development of hepatocellular carcinoma reaches a certain stage, some clinical symptoms that are easily confused with hepatitis, cirrhosis, gastrointestinal, pancreatic and biliary system diseases may appear. The onset of hepatocellular carcinoma is often insidious, and it is mostly discovered by chance during the follow-up of liver disease or physical examination and screening with AFP and B-type ultrasound, when the patient has no symptoms and physical examination lacks signs of tumor itself. Once symptoms appear and patients come to the clinic, most of them have already entered the middle and late stages of the disease. How to detect liver cancer in early stage? According to the “Expert Consensus on Standardized Diagnosis and Treatment of Primary Liver Cancer”, for those who are at high risk of liver cancer, i.e. men aged ≥35 years old, those with hepatitis B and/or C virus infection, and alcoholics, screening is generally performed every 6 months, mainly including serum fetoprotein (AFP) and liver ultrasonography. For AFP > 400 μg/L without liver occupancy on ultrasonography, care should be taken to exclude pregnancy, active liver disease, and germinal gland embryonic-derived tumors; if this can be ruled out, liver CT and/or MRI should be performed. If AFP is elevated but not at the diagnostic level, in addition to the above-mentioned conditions that may cause AFP increase, the dynamic changes of AFP should be closely tracked, the interval of ultrasound examination should be shortened to 1 to 2 months, and CT and/or MRI examination should be performed when needed. V. What should I do if I have liver cancer? Liver cancer is not terrible because there are many treatment methods for liver cancer, which involve many disciplines. At present, the general principle of liver cancer treatment is early detection and early diagnosis, and the implementation of standardized and comprehensive treatment is emphasized. The common treatment methods for liver cancer can be divided into surgical and non-surgical treatments. Surgical treatment, including liver transplantation and hepatectomy, is the preferred treatment method for liver cancer, which can completely remove tumor tissues and achieve the purpose of radical treatment. At present, about 4,000 liver transplants are performed in China every year, and the technology has become very mature, among which the proportion of liver transplant patients with liver cancer accounts for 40%. The long-term survival rate and tumor-free survival rate of liver transplant patients with liver cancer are significantly better than those who receive liver resection treatment. Non-surgical treatment for liver cancer includes arterial chemoembolization, local ablation therapy (radiofrequency ablation, microwave ablation, alcohol injection, high-intensity focused ultrasound), radiotherapy and molecular targeted therapy, which are mainly used for patients who cannot receive surgical treatment due to various reasons or as adjuvant treatment before and after surgery. Arterial chemoembolization, which is often called interventional therapy, is the first choice of non-surgical treatment and is often used for patients with mid- to late-stage liver cancer that cannot be surgically resected. For early stage liver cancer patients with single tumor ≤5cm in diameter or multiple nodules (within 3) with maximum diameter ≤3cm, no vascular-biliary invasion and good liver function, radiofrequency or microwave ablation is the best alternative to surgical operation. For patients with advanced hepatocellular carcinoma, sorafenib, a new molecularly targeted drug introduced in the past two years, can delay tumor progression and significantly prolong survival, bringing hope for improved prognosis for hepatocellular carcinoma patients.