What are the primary tumours of the liver?
Liver tumours can be classified as primary (originating from the liver) or metastatic (spread from other organs to the liver).
Primary tumours are divided into benign and malignant.

What are benign tumours of the liver?
The most frequent is the angioma (hemangioma) which can be small (few mm or 1-2 cm), quite frequent, or bigger (reaching even 8-10 cm in diameter, cavernous hemangioma). This tumour, as well as other benign tumour, is generally found by chance, during an ultrasound or a CT scan of the liver executed for routine or for aspecific symptoms. In the majority of cases no therapeutic approach is required: only very large and superficial hemangiomas can be resected.
Another benign neoplastic condition is hepatocellular adenoma. It is relatively rare: however its incidence seems to have increased since the introduction of oral contraceptives.It is also associated with the use of anabolic steroid. The most common presenting symptom is right upper addominal pain or discomfort: the most feared risk is its rupture and/or bleeding within the tumour or into the peritoneum. There is the possibility (about 5% of cases) of malignant trasformation.
Surgical resection, when possible, is usually recommended because of these risks.
Focal nodular hyperplasia is a benign proliferation of hepatocytes occurring around an abnormal artery in the liver. It is generally smaller than 5 cm in diameter: in the centre of the nodule a scar that contains the abnormal artery is often detected. No treatment is required since this lesion does not give symptoms, and is not prone to rupture or malignant degeneration.

What are the malignant tumours of the liver?
The most frequent malignant primary tumour of the liver is the hepatocellular carcinoma (HCC). HCC ranks fifth in frequency among all malignancies in the world with an estimated of more than 1000000 new cases yearly. HCC is increasing in many countries, particularly where HCV is more common.
More than 80% of HCC is associated with liver cirrhosis
Cholangiocarcinoma is the next most common form of hepatic malignancy after HCC and does not occur in cirrhosis background, but rather in patients with inflammation of the biliary system (the tumour originates in the biliary cells).

How is hepatocellular carcinoma diagnosed?
Alpha-fetoprotein (AFP) is the most important tumour marker for the diagnosis of HCC. Unfortunately a considerably high number of patients with HCC have normal or slightly increased AFP, making early diagnosis difficult with this marker alone.
Imaging analysis have greatly advanced in recent years and detection of space occupying lesion is no longer a problem. Today we can count on ultrasound, color doppler ultrasound, ultrasound angiography, helical CT scan, CT angiography, nuclear magnetic resonance.
The current task for the specialist is to differentiate a benign rigenerative nodule, a dysplastic nodule and a dysplastic nodule containing an evolving early HCC. The differential diagnosis can be made comparing portal and arterial blood flow with the imaging modalities 
The final diagnosis can be confirmed by needle biopsy.
The execution of liver ultrasound and the AFP determination in the cirrhotic patients every six months is necessary every six months.

What is the therapy of HCC?
A complete cure for an early HCC is only possible with liver transplantion . This ideal treatment is rarely achieved because of the extension of the majority of HCC when diagnosed and because of the limited availability of liver donor. It is possible that this problem could be overcome in the future with living donors or the xenotransplant
Surgical resection is another therapeutic approach limited to patients with good liver function tests and small superficial tumours. These patients must be accurately studied before  surgery to exclude the presence of other nodules.
Among non surgical options local ablation therapy has been demonstrated to be useful.
Percoutaneous ethanol and more recently acetic acid, injected directly into the tumour, can be considered the treatment of choice for patients with small (3 cm) unresectable HCC.
Studies showed the achievement of complete necrosis of such small tumours, without adverse effect. Patients treated with this methodology had high long-term survival rates similar to that of patients submitted to surgical resection. Another more recent approach utilizes the heat produced by laser or radiofrequency.
Transarterial chemoembolization, which isperformed by intra arterial injection and infusion of antineoplastic agent mixed with iodized oil, lipiodol, and closing peripherally the artery with spongostan, is advised in cases of lager HCC.
Massive tumour necrosis has been demonstrated in many treated patients: however complete necrosis is rarely achieved particularly in large tumours (superior to 5-6 cm.): consequently residual tumour can be found in a certain number of the treated lesions.
The liver tumours can also be treated with a combination of therapy such as chemoebolization and alcohol injection.