What Is Liver Cancer? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Liver cancer starts in the cells of the liver — a vital internal organ that performs many important functions, including storing nutrients that the body uses for energy, removing harmful chemicals and other substances from the blood, and making bile to help the body digest fat from food.

The largest internal organ — your liver is about the size of a football — is located in the upper right area of the abdomen behind the lower ribs.

Liver cancer can affect anyone, but it’s more common in people with other conditions that damage the liver, including hepatitis B or C (inflammation of the liver commonly caused by a virus) and cirrhosis (in which scar tissue replaces healthy tissue).

While liver cancer can be serious, early diagnosis and treatment offers a favorable outlook for many patients.

“Too many people hear the word ‘cancer’ and they think it is the end,” says Theodore S. Lawrence, MD, PhD, the Isadore Lampe Professor and the chair of the department of radiation oncology at the University of Michigan in Ann Arbor. “But we cure so many people and prolong the life of those we can’t cure. Liver cancer is a tough one, no question about it, but the research we are doing is increasing the cure rate and prolonging good quality of life.”

Types of Liver Cancer

When doctors talk about liver cancer, they typically classify it as either:

  • Primary liver cancer, which starts in the liver.
  • Secondary liver cancer, which starts in another area of the body and spreads to the liver. Secondary liver cancer is also known as metastatic disease.
Secondary liver cancers are named after the organ they originated from. For instance, if the cancer started in the colon and spread to the liver, it’s known as metastatic colon cancer, not liver cancer.

Types of primary liver cancer include:

  • Hepatocellular carcinoma This is the most common type of primary liver cancer, and it starts in liver cells called hepatocytes. It’s the form doctors most often are referring to when they talk about liver cancer.

  • Intrahepatic cholangiocarcinoma (bile duct cancer) starts in cells that line the bile ducts, tubes in the liver that carry bile to the intestines. It accounts for between 10 percent and 20 percent of primary liver cancers.

  • Hepatoblastoma is a rare liver cancer that usually affects children younger than 4 years old.

  • Angiosarcoma and hemangiosarcoma are rare cancers that start in cells that line the blood vessels of the liver.

Signs and Symptoms of Liver Cancer

Learn about early and late liver cancer symptoms to increase the chance of successful treatment.
Signs and Symptoms of Liver Cancer

Signs and Symptoms of Liver Cancer

Many people with liver cancer don’t experience any symptoms.

“Patients often don’t know they have it until the tumor has become large,” explains Dr. Lawrence.

When symptoms do show up, they may include:

  • Unexplained weight loss
  • Loss of appetite
  • Yellowing of the skin or whites of the eyes (jaundice)
  • Pain in the upper abdomen
  • Swelling or bloating of the abdomen
  • Nausea or vomiting
  • Weakness
  • Fatigue
  • Chalky, white stools
  • Dark-colored urine
  • Easy bruising or bleeding

Illustrative graphic titled How Liver Cancer Affects the Body shows fatigue, abdominal pain, abdominal swelling, weight loss, yellow eyes or skin, appetite loss, and nausea. Everyday Health at bottom left
Depending on how advanced it is, liver cancer can cause these symptoms and more.Everyday Health

Causes and Risk Factors of Liver Cancer

Liver cancer is often an aftereffect of cirrhosis — scarring of the liver. Cirrhosis is often the result of other diseases of the liver, such as hepatitis, steatotic (fatty) liver disease, or chronic alcohol use. It also can be caused by other conditions, lifestyle, or medications.

“About 90 percent of hepatocellular carcinomas [primary liver cancers] arise in patients with liver disease,” says Mario Strazzabosco, MD, PhD,?the director and clinical program leader of the Smilow Liver Cancer Program at Yale School of Medicine in New Haven, Connecticut. “Most of the time the patient has advanced liver disease — cirrhosis.”

Liver cancer also affects people with healthy livers who don’t have any underlying conditions. In those cases, scientists speculate that liver cells develop defects, or mutations, in their DNA that cause them to grow out of control and form a tumor.

Risk Factors for Liver Cancer

Researchers have identified several risk factors that increase a person’s chances of developing liver cancer.

“Often, a patient presents with more than one risk factor and risk increases exponentially with the number of risk factors,” says Dr. Strazzabosco.

Common risk factors include:

  • Cirrhosis of the liver, chronic hepatitis B, or hepatitis C
  • Smoking
  • Overweight or obesity
  • Certain inherited diseases, such as Wilson’s disease (a rare disorder that causes copper poisoning) or hemochromatosis (a buildup of excess iron in the liver)
  • Excessive alcohol consumption
  • Diabetes
  • Foods that contain aflatoxin (a fungus that can grow on grains and nuts that haven’t been properly stored)
  • Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (an accumulation of fat in the liver)
  • Age older than 60

“An important concept is that by addressing these risk factors, it would be possible to drastically reduce the incidence of [liver cancer],” says Strazzabosco. “There are also well-defined protocols for oncologic [cancer-preventing] surveillance in patients with identified risk factors. Unfortunately, these recommendations are not always followed.”

How Is Liver Cancer Diagnosed?

As with most cancers, the earlier liver cancer is found, the better the chance of a positive outcome. Sometimes, doctors monitor at-risk people to detect the disease earlier.

“The patients we cure were typically found first to have cirrhosis, and then were monitored on a regular basis with blood tests and ultrasounds. Small tumors can be discovered this way and cured,” says Lawrence.

Common tests and procedures used to diagnose liver cancer include:

  • Blood tests can uncover liver function irregularities or markers in the blood that suggest the development of liver cancer.
  • Imaging tests such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) are used to give doctors a more detailed look at the liver.
  • Biopsy involves removing a piece of tissue to test it in the lab for cancer.
  • Angiogram is done by injecting a dye into an artery and can reveal any tumors in the liver.

  • Laparoscopy is a type of surgery that uses smaller incisions and special instruments to look inside the liver.

Staging Liver Cancer

Once liver cancer is diagnosed doctors will next determine the stage, or extent, of the cancer. Staging helps determine a patient’s prognosis and which treatments will work best.

Liver cancer is usually staged with numbers from 1 to 4. The higher the numeral, the more advanced the cancer. For example, stage 1 cancer only affects the liver, while stage 4 cancer has spread to other places in the body.

Which Experts Diagnose and Treat Liver Cancer?

Liver cancer patients will typically be treated by a team of several different types of doctors. The team may include a:

  • Medical oncologist,?who has special training in treating cancer with chemotherapy and other medicines
  • Hepatologist, who focuses on treating diseases of the liver and related problems in the gall bladder, bile ducts, and pancreas
  • Radiation oncologist,?who uses high-energy radiation to destroy cancer cells
  • Interventional radiologist, who treats cancer with procedures like embolization (which blocks blood flow to a tumor) and ablation (which shrinks tumors)
  • Transplant surgeon, who exclusively performs organ transplants
  • General surgeon, who is skilled in many different types of operations
  • Gastroenterologist, who is an expert in diseases of the digestive system
  • Pathologist, who studies blood, body fluids, and tissue samples to help diagnose and monitor the disease
  • Palliative care specialist,?who helps with pain management and provides other types of support

“There are many different treatments, and the best way to pick the right one is to go to a center with a multidisciplinary tumor board,” advises Lawrence. “Two heads, or in this case about 10 heads, are better than one.”

Prognosis of Liver Cancer

According to the American Cancer Society, the five-year survival rate for all stages of liver cancer is 20 percent.

Each patient’s chance of recovery depends primarily on their overall health, the stage of their liver cancer, the treatments they receive, and how well they respond to those treatments.

“Liver cancer survival is tricky because patients typically have an injured liver from cirrhosis and cancer. Sometimes the extent of the cirrhosis is more important in determining how long a patient will live than the cancer,” explains Lawrence.

The Cleveland Clinic reports that about one in three people who have surgery to remove their tumors or parts of the liver will be cured. In addition, the small number of patients who are able to undergo a liver transplant are likely to be cured.

Duration of Liver Cancer

How long a person has liver cancer depends on the same factors that influence their prognosis. But many people who can’t be cured are able to live with the cancer for years, and may die of other causes.

“Some patients die with hepatocellular carcinoma, not from it,” Strazzabosco notes. “Patients with liver cancers require a really holistic approach, and they need to remain under close medical control, as in most cases the hepatocellular carcinoma recurs and needs to be treated again.”

Treatment and Medication Options for Liver Cancer

The treatments doctors recommend hinge on many factors, including how advanced the cancer is and how healthy the patient is overall.

“The biggest challenge derives from the dual nature of hepatocellular carcinomas: a neoplastic disease [one that causes tumor growth] in a failing organ,” says Strazzabosco. “All treatments must be weighed against the ability of the patient to tolerate them.”

Surgery for Liver Cancer

Surgical options to treat liver cancer include:

  • Tumor removal A surgeon may remove the tumor and some of the healthy liver tissue that surrounds it.
  • Liver transplant?The diseased liver is removed and replaced with a healthy donor liver. This procedure is available only for a select number of patients, based on many considerations, including the stage of the disease, whether the cancer has spread beyond the liver, and whether the patient has other serious health problems.

Other Procedures

Doctors have many additional options for treating liver cancer. These include:

  • Radiofrequency ablation uses an electric current to heat up and destroy cancer cells. Similar procedures use microwaves or lasers.
  • Cryoablation involves placing liquid nitrogen directly in the liver tumor to freeze and destroy cancer cells.
  • Alcohol injection uses a needle to inject pure alcohol directly into tumors, causing cancer cells to die off.
  • Chemoembolization involves injecting chemotherapy drugs directly into the liver.
  • Radiation beads can be placed in the liver where they deliver radiation directly to the tumor.
  • Radiation therapy focuses high-energy beams on tumors to kill the cancer cells. Different types of radiation therapy include external beam radiation (beams are directed at a specific point on the liver) and stereotactic radiation (many beams are focused simultaneously at one point on the liver).

Medications for Liver Cancer

Medicines used to treat liver cancer include:

  • Targeted drugs block specific abnormalities in cancer cells. Targeted treatments for liver cancer include kinase inhibitors (which block proteins that help tumors grow) and monoclonal antibodies (which are immune system proteins created in a lab to recognize and interact with specific types of cancer cells).

  • Immunotherapy uses the body’s own immune system to attack and destroy cancer cells. Medicines that target immune checkpoints — proteins on immune cells that turn on or off to start a response — are being used for liver cancer.

  • Chemotherapy uses drugs to kill cancer cells. In liver cancer it is primarily used when other treatments have not been helpful.

Newer Treatments and Clinical Trials

Researchers are currently studying ways to improve the prognosis for people with liver cancer using newer surgical techniques, novel targeted drugs, and combination therapies.

Possible therapies include a new ablation technique (irreversible electroporation), which uses high-voltage electrical pulses to open the pores in cancer cells. Scientists are also studying whether a virus can be injected into liver tumors to kill cancer cells.

People with liver cancer also sometimes opt to join a clinical trial in the hope of receiving cutting-edge treatments that are not yet available outside the study.

“There is still a long way to go, but we are starting to see some hope also for patients with advanced disease,” Strazzabosco says. “The next few years will bring more and more advances in this field.”

Prevention of Liver Cancer

While there’s no way to completely eliminate the risk of liver cancer, certain lifestyle measures can help lower a person’s likelihood of developing the disease.

Here are some prevention strategies:

  • Don’t drink heavily. Women shouldn’t have more than one drink a day, and men should have no more than two drinks a day.

  • Get a hepatitis B vaccine. The CDC recommends the hepatitis B vaccine for all babies at birth and for adults who may be at risk of developing the infection.

  • Avoid behaviors that can lead to hepatitis C. Practice safe sex, don't share needles, and choose clean, safe shops to get tattoos and piercings to lower the risk of hepatitis C.
  • Maintain a healthy weight.?Exercise and follow a healthy diet to promote weight loss.
  • Don’t smoke.?Quit smoking, or don't start, to lower your risk of developing liver cancer.
  • Get screened.?People at risk for liver cancer, including heavy drinkers or those with liver disease, should ask their doctors about getting screened.

Complications of Liver Cancer

Complications of liver cancer can result from treatments, a diseased liver, or the cancer itself.

“The main complications of liver cancer are on the side related to the cancer itself, such as invasions of the main veins coming into the liver and metastasis to the bone, lung, or brain,” says Strazzabosco.

Patients might also experience other problems, he adds, such as:

  • Ascites (fluid buildup in the abdomen)
  • Bleeding from enlarged veins in the esophagus
  • Portosystemic encephalopathy (a neuropsychiatric syndrome that can impair brain function)
  • Liver failure

Research and Statistics: Who Has Liver Cancer?

According to the American Cancer Society, there are about 41,260 new cases of primary liver cancer and intrahepatic bile duct cancer every year in the United States. About 30,520 people die of these cancers annually.

According to the Centers for Disease Control and Prevention (CDC), liver cancer is more common in other parts of the world, such as sub-Saharan Africa and Southeast Asia, than in the United States.

The American Cancer Society says liver cancer is a leading cause of cancer death worldwide.

More men than women develop the disease.

?About 28,600 men in the United States are diagnosed with liver cancer each year, compared with 12,660 women.

Black Americans and Liver Cancer

Black men are more than 60 percent more likely to have liver cancer and die of the disease than non-Hispanic white men, according to the U.S. Department of Health and Human Services Office of Minority Health. Black women are about 30 percent more likely to die of liver cancer than non-Hispanic white women.

In a February 2021 study published in the journal Cancer, researchers found that liver cancer tumors appeared to be larger in Black patients and that liver cancer often developed in Black adults before the onset of cirrhosis. The study authors said current screening guidelines should be modified for Black patients.

Related Conditions and Causes of Liver Cancer

Resources for Liver Cancer

Dealing with liver cancer can be overwhelming for patients and their loved ones. Arming yourself with education and support can help you in your journey. Here are a few of Everyday Health’s top resources for people with liver cancer:

  • American Cancer Society
  • National Cancer Institute
  • American Liver Foundation
  • Cancer.net
  • Centers for Disease Control and Prevention (CDC)
  • Mayo Clinic
  • CancerCare
  • DailyStrength.org
  • VA Healthcare: Liver Cancer Patient Guide
Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Liver Cancer. CDC.
  2. Liver Cancer. Mayo Clinic.
  3. Liver Cancer. Cleveland Clinic.
  4. Liver Cancer Survival Rates. Moffitt Cancer Center.
  5. What Is Liver Cancer? American Cancer Society.
  6. Cirrhosis. Mayo Clinic.
  7. Liver Cancer: Risk Factors and Prevention. Cancer.net.
  8. Who Treats Liver Cancer? American Cancer Society.
  9. Liver Cancer Survival Rates. American Cancer Society.
  10. Liver Transplant. Johns Hopkins Medicine.
  11. Radiation Therapy for Liver Cancer. American Cancer Society.
  12. Targeted Drug Therapy for Liver Cancer. American Cancer Society.
  13. Immunotherapy for Liver Cancer. American Cancer Society.
  14. Chemotherapy for Liver Cancer. American Cancer Society.
  15. What’s New in Liver Cancer Research? American Cancer Society.
  16. Key Statistics About Liver Cancer. American Cancer Society.
  17. Chronic Liver Disease and African Americans. U.S. Department of Health and Human Services Office of Minority Health.
  18. Hepatitis C-Positive Black Patients Develop Hepatocellular Carcinoma at Earlier Stages of Liver Disease and Present With a More Aggressive Phenotype. Cancer.

Resources

  • Liver Cancer. Centers for Disease Control and Prevention (CDC). January 19, 2021.
  • Liver Cancer: Symptoms and Causes. Mayo Clinic. May 18, 2021.
  • Liver Cancer. Cleveland Clinic. May 9, 2022.
  • Liver Cancer Survival Rates. Moffitt Cancer Center.
  • What Is Liver Cancer? American Cancer Society. April 1, 2019.
  • Cirrhosis. Mayo Clinic. February 6, 2021.
  • Liver Cancer: Risk Factors and Prevention. Cancer.net. January 2021.
  • Who Treats Liver Cancer? American Cancer Society.
  • Liver Transplant. Johns Hopkins Medicine.
  • Radiation Therapy for Liver Cancer.?American Cancer Society. April 1, 2019.
  • Targeted Drug Therapy for Liver Cancer. American Cancer Society. June 10, 2020.
  • Immunotherapy for Liver Cancer. American Cancer Society. July 27, 2021.
  • Chemotherapy for Liver Cancer. American Cancer Society. April 1, 2019.
  • What's New in Liver Cancer Research? American Cancer Society. April 1, 2019.
  • Key Statistics About Liver Cancer. American Cancer Society. January 12, 2022.
  • Chronic Liver Disease and African Americans. U.S. Department of Health and Human Services Office of Minority Health. August 11, 2021.
  • Shaltiel T et al. Hepatitis C-Positive Black Patients Develop Hepatocellular Carcinoma at Earlier Stages of Liver Disease and Present With a More Aggressive Phenotype. Cancer. February 25, 2021.
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