What is Liver Cancer?
What is Liver Cancer?
The liver is a vital organ that supports digestion, metabolism, and detoxification. It produces bile to break down fats, makes proteins for blood function, and stores glucose for energy. It also regulates amino acids, stores iron and removes toxins like ammonia and drugs. The liver helps blood clot, fights infections, and clears bilirubin—a buildup of which can cause yellowing of the skin and eyes.
Liver cancer is a condition in which cells in the liver begin to grow abnormally and uncontrollably, forming a tumor that can interfere with the liver’s ability to function properly. The liver can be affected by primary liver cancer, which arises in the liver, or by cancer which forms in other parts of the body and then spreads to the liver. Most liver cancer is secondary or metastatic, meaning it started elsewhere in the body.
Types of Liver Cancer
Primary liver cancer is a malignant tumour that begins in the liver. There are different types:
- Hepatocellular carcinoma (HCC) or hepatoma, is the most common type of primary liver cancer and it starts in the main cell type in the liver, the hepatocytes
- Cholangiocarcinoma, or bile duct cancer, starts in the cells lining the bile ducts (which connect the liver to the bowel and gall bladder)
- Angiosarcoma, which starts in the blood vessels. This is a rare type of liver cancer that is more likely to occur in people over 70.
Secondary liver cancer is also known as metastatic liver cancer and means that the cancer has spread from somewhere else in the body to the liver. A secondary cancer is named after the primary site where it began, for example bowel cancer with liver secondaries. They are treated based on the site of origin or their primary site.
Bowel cancer is the most common cancer that spreads to the liver. This is because the blood supply from the bowel is connected to the liver through a major vein called the portal vein. Other cancers that can spread to the liver include breast, kidney, lung, melanoma, oesophageal, ovarian, pancreatic, prostate and stomach. Sometimes, it’s not possible to find where the cancer started; this is called cancer of unknown primary (CUP).
Cancer Council Australia - Liver Cancer InformationBenign liver tumors
Benign tumors can also grow large enough to cause problems for people. However, these tumors don't grow into the nearby tissues, nor do they spread to distant sites.
The more common benign tumors of the liver include:
- Hemangioma
- Hepatic adenoma
- Focal nodular hyperplasia
- Cysts
- Lipoma
- Fibroma
- Leiomyoma
None of these tumors are treated like liver cancer. They may need to be removed surgically if they cause pain or bleeding.
Signs and symptoms of Liver Cancer
Liver cancer symptoms are more likely to appear as the cancer grows or becomes advanced.
Symptoms may include:
Primary Symptoms:
- Weakness and unusual tiredness
- Pain or discomfort in the upper abdomen, especially on the right side
- Swelling of the abdomen due to fluid buildup (ascites)
- A hard lump on the right side just below the rib cage
- Pain near the right shoulder or shoulder blade
- Loss of appetite
Other common symptoms:
- Nausea and vomiting
- Unexplained weight loss
- Yellowing of the skin and eyes (jaundice)
- Pale bowel movements
- Easy bruising or bleeding
- Fever
Causes of Liver Cancer
The most common form of liver cancer in adults is hepatocellular carcinoma (HCC). It often develops in individuals with long-standing liver disease, particularly those affected by hepatitis B or C infections or cirrhosis. Men are more likely to develop HCC than women and having multiple risk factors can significantly increase the likelihood of developing the disease. However, liver cancer can also occur in people without any known risk factors.
Key Risk Factors for Liver Cancer
- Hepatitis B Virus (HBV): Transmitted through blood, semen, and other body fluids, HBV can lead to chronic liver inflammation and increase cancer risk. Routine infant vaccination is helping reduce HBV-related liver cancer, especially in Asia and Africa.
- Hepatitis C Virus (HCV): Spread primarily through blood exposure, HCV can cause cirrhosis and liver cancer.
- Cirrhosis: This condition replaces healthy liver tissue with scar tissue, impairing liver function. It commonly results from chronic hepatitis infections or heavy alcohol use. People with HCV-related cirrhosis face a particularly high risk.
- Heavy Alcohol Use: Excessive alcohol consumption can lead to cirrhosis and liver cancer. Even without cirrhosis, heavy drinkers are at increased risk—especially those with HBV or HCV infections.
- Aflatoxin B1 Exposure: This toxin, produced by fungi on improperly stored foods like corn and nuts, is linked to liver cancer in regions with hot, humid climates such as sub-Saharan Africa, Southeast Asia, and China.
- Nonalcoholic Steatohepatitis (NASH): The most severe form of non-alcoholic fatty liver disease, NASH can cause liver inflammation and cirrhosis. Liver cancer may develop in people with or without cirrhosis due to NASH.
- Cigarette Smoking: Smoking increases liver cancer risk, with higher risk associated with greater tobacco use over time.
- Inherited and Rare Conditions: Certain genetic and metabolic disorders can raise liver cancer risk, including:
- Hereditary hemochromatosis
- Alpha-1 antitrypsin deficiency
- Glycogen storage disease
- Porphyria cutanea tarda
- Wilson disease
Stages of Liver Cancer
After diagnosis of liver cancer, one of the most important procedures done is staging. Staging refers to the extent of the cancer and how far it has spread. The liver cancer staging is done based on the TNM system of staging.
- Stage IA (T1aN0M0A): A single tumor 2 cm (4/5 inch) or smaller (T1a). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
- Stage IB (T1bN0M0): A single tumor larger than 2cm (4/5 inch) that hasn't grown into blood vessels (T1b). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
- Stage II (T2N0M0): Either a single tumor larger than 2 cm (4/5 inch) that has grown into blood vessels, OR more than one tumor but none larger than 5 cm (about 2 inches) across (T2).The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
- Stage IIIA (T3N0M0): More than one tumor, with at least one tumor larger than 5 cm across (T3). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
- Stage IIIB (T4N0M0): At least one tumor (any size) that has grown into a major branch of a large vein of the liver (the portal or hepatic vein), or that has grown directly into a nearby organ (other than the gallbladder) (T4).The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
- Stage IVA (Any TN1M0): A single tumor or multiple tumors of any size (Any T). The cancer has spread to nearby lymph nodes (N1) but not to distant parts of the body (M0).
- Stage IVB (Any NM1): A single tumor or multiple tumors of any size (any T). The cancer might or might not have spread to nearby lymph nodes (any N). The cancer has spread to distant organs such as the bones or lungs (M1).
The Barcelona Clinic Liver Cancer (BCLC) staging system
While the TNM system is widely used for liver cancer staging, it does not consider the effects of declining liver function. The BCLC staging system factors in key aspects of liver health and classifies the cancer into five main stages:
- Stage 0 (very early stage) - The tumor is smaller than 2 centimeters in diameter, the tumor is not pressuring the portal vein and bilirubin levels are normal.
- Stage A (early stage) - The tumor is smaller than 5 centimeters in diameter, the tumor is pressuring the portal vein and bilirubin levels are normal or elevated.
- Stage B (intermediate stage) - There is a single large tumor or multiple tumors, but the liver is functioning well overall.
- Stage C (advanced stage) - The cancer has spread to blood vessels, lymph nodes or other organs, but the liver is functioning relatively well.
- Stage D - The liver is severely damaged and noticeable symptoms have developed.
Screening & Diagnosis
Liver cancer screening is recommended only for adults at increased risk. You’re at increased risk if you have chronic hepatitis B infection or cirrhosis of the liver. Adults at increased risk (Age 21 to 75) should get Liver ultrasound every six months and Alpha-fetoprotein (AFP) blood test every six months as screening for Liver cancer.
MD Anderson Cancer Center - Liver Cancer ScreeningMedical History & Physical Exam
Your doctor will ask about your symptoms, medical history, and risk factors. A physical exam focuses on your abdomen, skin, and eyes to check for signs such as jaundice (yellowing). If liver cancer is suspected, more tests will follow.
Imaging Tests
Imaging helps detect, confirm, and monitor liver cancer.
- Ultrasound: Often the first test used to spot liver tumors. A special type, contrast-enhanced ultrasound (CEUS), can sometimes diagnose cancer without a biopsy.
- CT scan: Uses x-rays to show detailed images of the liver, tumors, and blood vessels. It can also guide a biopsy needle.
- MRI: Produces detailed images using magnets and radio waves. It can show how far cancer has spread and help assess blood flow in and around the liver.
- Bone Scan: Used only if symptoms suggest cancer has spread to the bones or if transplant eligibility needs to be evaluated.
Biopsy
A biopsy involves removing a small tissue sample to confirm cancer. Types include:
- Needle biopsy: Guided by ultrasound or CT.
- Laparoscopic biopsy: Taken during a minimally invasive surgery.
- Surgical biopsy: Part or all of the tumor is removed during surgery.
Sometimes, imaging results are enough to diagnose liver cancer without a biopsy.
Blood Tests
Blood tests help assess liver function, overall health, and response to treatment.
- Alpha-fetoprotein (AFP): High AFP levels can indicate liver cancer and help monitor treatment response.
- Liver function tests (LFTs): Show how well the liver is working.
- Viral hepatitis tests: Check for hepatitis B or C.
- Clotting, kidney, and blood count tests: Evaluate how well organs are working and whether it’s safe to proceed with certain treatments.
Treatment
Treatment for liver cancer depends on the tumor’s size, location, stage, and overall liver function. Your care team will create a personalized treatment plan that may include one or more of the following options.
Surveillance (Active Monitoring)
For very small liver lesions (less than 1 cm), treatment may not be needed right away. Instead, doctors closely monitor the condition with imaging and blood tests every few months. Treatment begins only if there are signs of cancer growth or change.
Surgery
Partial hepatectomy is a procedure to remove the part of the liver where the cancer is located. The remaining liver tissue can regrow and continue functioning normally. Surgery offers the best chance for cure when the cancer is confined to the liver and the remaining liver is healthy.
Liver Transplant
A liver transplant involves replacing the diseased liver with a healthy donor liver. It is an option for patients whose cancer is limited to the liver and who meet specific medical criteria. While waiting for a donor liver, other treatments may be used to control the disease.
Ablation Therapy
Ablation therapies destroy cancer cells without removing the tumor surgically. These treatments are often used for small tumors or for patients who cannot have surgery. Common types include:
- Radiofrequency or Microwave Ablation: Uses heat to destroy cancer cells.
- Ethanol Injection: Injects pure alcohol directly into the tumor to kill cancer cells.
- Cryoablation: Freezes the tumor using extreme cold.
- Electroporation Therapy: Uses electrical pulses to destroy cancer cells (under study in clinical trials).
Embolization Therapy
Used when surgery or ablation is not possible and the cancer has not spread outside the liver. This treatment blocks the tumor’s blood supply, causing it to shrink or stop growing. Two main types are:
- Transarterial Embolization (TAE): Blocks the hepatic artery to cut off blood flow to the tumor.
- Transarterial Chemoembolization (TACE): Delivers chemotherapy directly to the tumor while blocking its blood supply, minimizing side effects to the rest of the body.
Targeted Therapy
Targeted therapies attack specific molecules involved in cancer growth. These drugs are often used for advanced liver cancer. Common targeted therapy drugs include: Bevacizumab, Cabozantinib, Lenvatinib, Ramucirumab, Regorafenib, and Sorafenib.
Immunotherapy
Immunotherapy boosts the body’s natural defenses to fight cancer. Immune checkpoint inhibitors are commonly used for liver cancer, including: Atezolizumab (with Bevacizumab or Cabozantinib), Durvalumab (with Tremelimumab), Nivolumab (with Ipilimumab), and Pembrolizumab.
Radiation Therapy
External radiation uses high-energy beams to destroy cancer cells while sparing healthy tissue. Types include:
- Conformal Radiation Therapy (3D-CRT): Shapes radiation to match the tumor.
- Stereotactic Body Radiation Therapy (SBRT): Delivers precise, high-dose radiation over a few sessions.
- Proton Beam Therapy: Uses protons to target the tumor while reducing radiation exposure to nearby tissues.
Treatment of localized liver cancer
Treatment of localized liver cancer may include:
- Surveillance for lesions smaller than 1 centimeter
- Partial hepatectomy (surgery to remove the part of the liver where cancer is found)
- Liver transplant
- Ablation of the tumor using:
- Radiofrequency ablation
- Microwave therapy
- Percutaneous ethanol injection
- Cryoablation
- Radiation therapy
Treatment of locally advanced or metastatic liver cancer
Treatment of locally advanced or metastatic liver cancer may include:
- Transarterial embolization (TAE) or transarterial chemoembolization (TACE) in people with locally advanced liver cancer
- Bevacizumab, cabozantinib, lenvatinib, ramucirumab, regorafenib, or sorafenib
- Atezolizumab with bevacizumab or cabozantinib, durvalumab with tremelimumab, nivolumab with ipilimumab, or pembrolizumab
- Radiation therapy
Treatment of recurrent liver cancer
Treatment options for recurrent primary liver cancer may include:
- Total hepatectomy (surgery to remove all of the liver) and liver transplant
- Partial hepatectomy (surgery to remove the part of the liver where cancer is found)
- Ablation therapy
- Radiation therapy
- Transarterial chemoembolization (TACE) and sorafenib as palliative therapy to relieve symptoms and improve quality of life.
Survival Rate
In general, survival rates are higher for people who can have surgery to remove their cancer, regardless of the stage. The 5-year survival rate for liver cancer in 2025 is an estimate, but for the overall disease, including all stages, it is around 22% in the U.S. according to the American Cancer Society. Survival rates are much higher for early-stage cancer (37% for localized) but decrease significantly for regional (13%) and distant (3%) disease. Early detection, thus, is very important as survival rates may increase to 70% at 5 years.