Liver cancer is cancer that occurs in the liver. The liver is your largest internal organ. It performs several critical functions to help your body eliminate waste, absorb nutrients, and heal wounds.
The liver is located in the upper right area of your abdomen, right below your ribs. It’s responsible for producing bile, which is a substance that helps you digest fats, vitamins, and other nutrients.
This vital organ also stores nutrients such as glucose so that you remain nourished at times when you’re not eating. It also breaks down medications and toxins.
When cancer develops in the liver, it destroys liver cells and interferes with the ability of the liver to function as expected.
Liver cancer is generally classified as primary or secondary. Primary liver cancer begins in the cells of the liver. Secondary liver cancer develops when cancer cells from another organ spread to the liver, or metastasize.
Unlike other cells in your body, cancer cells can break away from the primary site, or where the cancer began.
The cells can travel to other areas of your body through the bloodstream or lymphatic system. When they reach other organs or tissues, they can begin to grow there.
This article focuses on primary liver cancer, meaning that the cancer started in the cells of your liver.
There are several types of primary liver cancer. Each one corresponds to a different part of the liver or type of liver cell that is affected. Primary liver cancer can start as a single lump growing in your liver, or it can start in many places within your liver at the same time.
The main types of primary liver cancer are:
Hepatocellular carcinoma (HCC), also known as hepatoma, is the most common type of liver cancer. Around 85 to 90 percent of primary liver cancers are the HCC type. This condition develops in the hepatocytes, which are the main cells that make up your liver.
HCC is much more likely to occur in people who have long-term (chronic) hepatitis or cirrhosis. Cirrhosis is a serious form of liver damage that is usually caused by:
When the cancer begins in the section of the ducts inside your liver, it’s called intrahepatic bile duct cancer. When the cancer begins in the section of the ducts outside your liver, it’s called extrahepatic bile duct cancer.
Bile duct cancer is rare. Each year, about
Liver angiosarcoma is a very rare form of liver cancer that begins in the blood vessels of your liver. This type of cancer tends to progress very quickly, so it’s typically diagnosed at a more advanced stage.
Hepatoblastoma is an extremely rare type of liver cancer. It’s nearly always found in children, especially those
With surgery and chemotherapy, hepatoblastoma can be cured about
Many people don’t experience symptoms in the early stages of primary liver cancer. When symptoms do appear, they may include:
- abdominal discomfort, pain, and tenderness, especially in your upper abdomen
- yellowing of your skin and the whites of your eyes, which is called jaundice
- pale, chalky stools and dark urine
- loss of appetite
- feeling full unusually fast when you eat
- bruising or bleeding easily
- unexplained weight loss
Doctors aren’t sure why some people get liver cancer while others don’t. However, there are certain factors that are known to increase the risk of developing liver cancer:
- Age. Liver cancer is more common in older people.
- Race and ethnicity. In the United States, liver cancer is more common in American Indian and Alaska Native people. It’s least common in white people.
- Heavy alcohol use. Heavy drinking over many years increases your risk for liver cancer.
- Smoking. Smoking cigarettes increases your risk for liver cancer.
- Aflatoxin exposure. Aflatoxin is a toxic substance produced by a type of mold that can grow on peanuts, grains, and corn. In the United States, food-handling laws limit widespread exposure of aflatoxin. Exposure may be higher in other regions.
- Anabolic steroid use. Long-term use of anabolic steroids, which are a type of artificial testosterone, increases your risk for liver cancer.
Conditions associated with liver cancer
- Hepatitis. A long-term hepatitis B or C infection can severely damage your liver.
- Hepatitis is spread from person-to-person through direct contact with the bodily fluids of a person with the infection, such as blood or semen.
- It may also be passed from a birthing parent to their child during childbirth.
- You can lower your risk for hepatitis B and C by using condoms during sex.
- There’s also a vaccine that can protect you against hepatitis B.
- Cirrhosis. Cirrhosis is a form of liver damage in which healthy tissue is replaced by scarred tissue.
- A scarred liver can’t function properly and may ultimately lead to complications, including liver cancer.
- Long-term, heavy alcohol use and hepatitis C are the most common causes of cirrhosis in the United States.
- The majority of people with liver cancer in the U.S. have cirrhosis before they develop liver cancer.
- Type 2 diabetes. Type 2 diabetes may increase the risk of liver cancer, especially when other risk factors are present.
- Obesity-related conditions. Obesity is associated with metabolic syndrome and nonalcoholic fatty liver disease, which are risk factors for liver cancer.
A number of rare inherited conditions increase the risk of liver cancer, including:
To diagnose liver cancer, your doctor will start by asking you about your medical history and conducting a physical exam. Make sure to tell your doctor if you have a history of long-term, heavy alcohol use or a long-term hepatitis B or C infection.
Diagnostic tests and procedures for liver cancer include:
- Liver function tests. These tests help your doctor determine the health of your liver by measuring levels of proteins, liver enzymes, and bilirubin in your blood.
- Alpha-fetoprotein (AFP) test. The presence of AFP in your blood can be a sign of liver cancer. This protein is usually only produced in the liver and yolk sac of a developing fetus. AFP production usually stops after birth.
- Imaging tests. Abdominal ultrasounds, CT scans, or MRI scans produce detailed images of the liver and other organs in your abdomen. They can help your doctor pinpoint where a tumor is developing, determine its size, and assess whether cancer has spread to other organs.
Another diagnostic test available is a liver biopsy. If your doctor has examined your other test results and the cause of your condition is still uncertain, a biopsy may be needed.
A liver biopsy involves removing a small piece of liver tissue. It’s often done using anesthesia to prevent you from feeling pain during the procedure.
There are several different liver biopsy procedures. Your doctor will select the one that’s right for you.
- Needle biopsy. During this procedure, your doctor will insert a thin needle through your abdomen and into your liver to obtain a tissue sample. Your doctor may use an ultrasound or other imaging to see where to collect the sample. The sample is then examined under a microscope for signs of cancer.
- Laparoscopic biopsy. This test is performed using a laparoscope, which is a thin, flexible tube with an attached camera. The laparoscope is inserted through a small incision in your abdomen. The camera allows your doctor to see what your liver looks like and to perform a more precise biopsy.
- Surgical biopsy. Surgery can allow a doctor to remove a tumor sample or remove the tumor entirely, when needed. In some cases, an abdominal surgery called laparotomy is used to examine several areas inside your abdomen.
If liver cancer is found, your doctor will determine the stage of the cancer. Staging describes the severity or extent of the cancer. It can help your doctor determine your treatment options and your outlook.
Stage 4 is the most advanced stage of liver cancer.
Liver cancer screening
If you’re at an increased risk for liver cancer because of particular health conditions, your doctor may recommend regular screening.
Liver cancer doesn’t tend to cause noticeable symptoms in its early stages. Screening means testing for cancer before you have symptoms. It can help to catch cancer earlier.
People with liver cancer tend to have better outcomes when the cancer is diagnosed at an earlier stage. Treatment is generally more straightforward when cancer is detected before it has a chance to spread.
Experts recommend regular liver cancer screening for people with certain conditions, including:
- long-term hepatitis C infection
- nonalcoholic fatty liver disease
For people with these conditions, experts recommend screening for liver cancer
Screening tests can include:
- ultrasound imaging
- blood tests to detect AFP
If you have a long-term condition that increases liver cancer risk, ask your doctor if you’re a candidate for regular screenings.
There are many different treatments available for liver cancer. Your doctor will consider several factors when recommending a treatment plan. These include:
- the number, size, and location of the tumors in your liver
- how well your liver is functioning
- whether cirrhosis is present
- whether the cancer has spread to other organs
Treatments for liver cancer include:
A partial hepatectomy is performed to remove a portion of the liver. This surgery is typically used only for early-stage liver cancer. Over time, the remaining healthy tissue will regrow and replace the missing part.
A liver transplant involves replacing the entire liver with a healthy liver from a suitable donor. A transplant may be considered if the cancer hasn’t spread to other organs.
You will take medications after the transplant to prevent your body from rejecting the new liver.
Ablation involves the use of heat, cooling, or ethanol injections to destroy the cancer cells. It’s usually performed using local anesthesia. This numbs the area to prevent you from feeling pain.
Ablation can help people who aren’t candidates for surgery or a transplant.
Radiation therapy uses beams of high-energy radiation to kill cancer cells. It can be delivered by external beam radiation or by internal radiation.
In external beam radiation, the radiation is aimed at the parts of your body where cancer is located. Internal radiation involves the insertion of a small amount of radioactive material directly into or near the cancer.
Targeted therapy uses medications designed to decrease tumor growth and blood supply. Compared to chemotherapy or radiation, these medications are fine-tuned to treat cancer cells only. This means that healthy cells can be spared from harm.
However, these medications can still cause serious side effects.
Targeted therapy can be helpful for people who aren’t candidates for a hepatectomy or liver transplant. Medications of this type include tyrosine kinase inhibitors (TKIs), such as:
- cabozantinib (Cabometyx or Cometriq)
- lenvatinib (Lenvima)
- regorafenib (Stivarga)
- sorafenib (Nexavar)
Embolization, chemoembolization, and radioembolization
Embolization procedures are used to reduce blood supply to liver tumors. Your doctor will insert small particles to create a partial blockage in the hepatic artery. This reduces the amount of blood flowing to the tumor. Another blood vessel known as the portal vein continues to nourish the healthy liver tissue.
In chemoembolization, your doctor injects chemotherapy drugs into the hepatic artery before injecting the blocking particles. This sends the chemotherapy drugs directly into the tumor. The blockage reduces blood flow to the tumor.
Radioembolization is a combination of radiation therapy and embolization. It involves injecting tiny radioactive beads into the hepatic artery. This decreases blood flow to the tumor and provides radiation therapy to the direct area of the tumor.
Chemotherapy is a powerful form of drug therapy that destroys cancer cells. The medications are typically injected intravenously, or through a vein. In most cases, you can receive chemotherapy as an outpatient treatment.
Chemotherapy may be used for liver cancer when other therapies aren’t appropriate or aren’t working well. Because chemotherapy affects healthy cells in your body, not just the cancer cells, side effects are common.
Immunotherapy treats cancer using your body’s own immune system. Treatment with immunotherapy drugs can help your body recognize and destroy cancer cells. Like other cancer therapies, serious side effects are possible.
You can’t always prevent liver cancer. However, you can reduce your risk for liver cancer by taking steps to protect the health of your liver.
Get the hepatitis B vaccine
There’s a vaccine for hepatitis B that is recommended for all eligible children. Adults who are at high risk for infection should also be vaccinated.
This includes people who use illegal drugs like heroin, crack cocaine, and crystal methamphetamine.
The vaccination is usually given in a series of three injections over a period of 6 months.
Take measures to prevent hepatitis C
There’s no vaccine for hepatitis C, but there are several ways to reduce the risk of getting the infection:
- Use condoms. You can reduce your risk of getting hepatitis by using a condom every time you have sex. If you and your partner are thinking about stopping condom use, it’s important to talk with them first about getting tested for hepatitis and other sexually transmitted infections (STIs).
- Be aware of hepatitis risk associated with illegal drug use. There’s a high risk of hepatitis C infection among people who inject illegal drugs. To reduce hepatitis risk, those who use these drugs should use new, sterile equipment (like needles) every time. It’s important not to share needles or other equipment with others. The best way to prevent hepatitis infection is to stop injecting.
- Be cautious about tattoos and piercings. Go to a trustworthy shop for a piercing or tattoo. Regulations on tattoo and piercing safety vary state-by-state, so check out the relevant laws and licensing in your area. Sterile and safe practices are very important, so it’s best to make sure you’re going to a shop that takes infection control seriously.
All types of hepatitis can be treated, and hepatitis C can sometimes be cured. If you test positive for hepatitis, it’s important to talk with a doctor about treatment options.
Reduce your risk of cirrhosis
Changes you can make to lower your risk of cirrhosis include the following:
If you drink alcohol, drink in moderation
Limiting the amount of alcohol you drink can help prevent liver damage. Because of the differences in how alcohol is processed in your body, moderate drinking guidelines differ by sex:
- Female: up to one alcoholic drink per day
- Male: up to two alcoholic drinks per day
Take steps to treat obesity
Having obesity increases your risk of liver cancer. Obesity is associated with a higher risk of nonalcoholic fatty liver disease, which can lead to cirrhosis.
Talking with a doctor is a good way to determine lifestyle changes or other treatments for obesity.
Live a healthy lifestyle
Higher levels of physical activity may reduce your risk of liver cancer. Exercising regularly can improve your general health. It’s also an important part of maintaining your weight within a healthier range.
Eating a balanced diet is important for cancer prevention. Make sure you incorporate lean protein, whole grains, and vegetables into your meals.
If being overweight or having obesity is a concern for you, talk with a doctor or dietician about creating a meal plan for healthy weight loss.
If you already have one of these conditions and you’re concerned about your risk for liver cancer, talk with your doctor about a liver cancer screening.
A liver cancer diagnosis can be overwhelming. It’s important to connect with people in your life who can help you deal with stress, anxiety, or other feelings. This might include family members and friends.
You may want to speak with a counselor who can help you work through your emotions or consider joining a cancer support group. Sharing your experiences with others who can relate to what you’re going through can help you feel more connected.
Liver cancer is often treatable. Be sure to speak with your doctor about new or concerning symptoms, as well as treatment side effects that may be affecting you. Your doctor may be able to adjust your treatments and help you feel more comfortable.