Form of cancer that affects the liver. In Africa liver cancer is common in regions where the people eat nuts covered with certain carcinogenic fungi (aflatoxin). In Europe products that might contain this substance (peanut butter, for example) are subject to strict controls. Symptoms of the disease are pain in the area of the liver, enlargement of the liver, loss of weight and general weakness. Suspicious above all is sudden worsening of a cirrhosis of the liver that has been in existence for some time. Tests in several stages are used to diagnose the condition and to distinguish it from others such as tumours of the bile ducts or pancreas. Liver biopsy (if the tumour can be reached) can be the key; laparoscopy, examination of the abdomen with a special device, by which means a piece of liver tissue can also be removed, is another possibility. Blood tests often show increased liver enzyme production. Treatment is often difficult because of the extent of the tumour; surgery can be attempted, or drugs to destroy cells (cytostatics) may be prescribed. As well as this cancer, which originates in the liver itself, metastasis frequently occurs in the liver from malignant tumours elsewhere in the body, often the intestine (cancer of the colon, cancer of the stomach), because all the blood from the intestines flows to the liver. Cancer of the genital organs or lungs can also spread to the liver by metastasis.