Liver Cancer

Overview

What is liver cancer?

Liver cancer is a life-threatening illness and one of the fastest-growing cancer types in the United States. There are two kinds of liver cancer: primary and secondary. Primary cancer starts in your liver. Secondary cancer spreads to your liver from another part of your body. This article is an overview of primary liver cancer.

Like many kinds of cancer, healthcare providers can do more to treat liver cancer during the disease’s early stage. Unlike many kinds of cancer, healthcare providers have a good idea of what increases someone’s risk of developing liver cancer. With that in mind, healthcare providers are intent on identifying who may be at increased risk so they can catch and treat primary liver cancer as early as possible.

Is liver cancer a common disease?

No, it’s not common, but liver cancer cases are steadily increasing. Healthcare providers estimate about 1% of all men and women in the United States will be diagnosed with a form of liver cancer during their lifetime.

There are three kinds of primary liver cancer:

  • Hepatocellular carcinoma (HCC): This is the most common form of liver cancer, representing nearly all liver cancer cases.
  • Intrahepatic cancer (IHC): This is a form of cholangiocarcinoma. IHC is cancer in your liver’s bile ducts. It represents about 10% to 20% of all primary liver cancer cases.
  • Angiosarcoma: This type is very rare, representing about 1% of all primary liver cancer cases. This cancer begins in the lining of blood cells in your liver. (Angiosarcoma may also affect other organs.)

Overall, HCC and IHC represent about 2% of all new estimated cancer cases in the United States, and 5% of all new cancer deaths. Healthcare providers often diagnose and treat HCC and IHC the same way.

Who’s affected by liver cancer?

HCC and IHC affect more men than women and are most often diagnosed between the ages of 55 and 64. People whose race includes Asian/Pacific Islander, Hispanic or American Indian/Alaskan Indian are more likely to develop primary liver cancer than people who are Black or white.

How does liver cancer affect my body?

Your liver is the largest organ in your body, helping you digest your food. It’s also one of the most important organs, as no one can live without their liver. Some of the essential tasks your liver manages include:

  • Collects and filters blood flowing from your intestines.
  • Processes and stores nutrients that your intestines absorb.
  • Changes some nutrients into energy or substances that your body needs to build tissue.
  • Makes bile, a fluid that helps digest fat.
  • Digests and stores other nutrients from food like sugar, which makes energy.
  • Makes substances that help your blood to clot.

Symptoms and Causes

What is the main cause of liver cancer?

Liver cancer happens when something affects healthy liver cells’ DNA. DNA carries the genes that tell our cells how to function. We all have genes that tell cells when to grow, multiply and die. For example, oncogenes help cells grow and divide. Other genes, called tumor suppressor genes, monitor cell activity, keeping cells from multiplying uncontrollably and making sure cells die when they’re supposed to die.

When our DNA mutates or changes, our cells get new instructions. In HCC, DNA changes turn on oncogenes and/or turn off tumor suppressor genes. For example, studies show cirrhosis related to hepatitis B virus (HBV) and hepatitis C virus (HCV) account for more than half of all HCC cases. When these viruses infect liver cells, they change cell DNA, turning healthy liver cells into cancerous cells.

What causes IHC?

Healthcare providers believe long-term inflammation in your bile ducts increases the risk for developing IHC. This long-term inflammation may cause DNA changes that turn healthy cells into abnormal cells.

What are liver cancer symptoms?

When liver cancer is in its early stages, you might have no symptoms at all. Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC) have similar symptoms:

  • A lump below your rib cage or pain on the right side of your abdomen, or pain near your right shoulder.
  • Jaundice (a disease that causes skin and eyes to yellow).
  • Unexplained weight loss, nausea, or loss of appetite.
  • Fatigue.
  • Dark-colored urine.

What are early warning signs of liver cancer?

Unfortunately, you can have very early liver cancer without any symptoms. If you know you’re at risk for liver cancer, talk to your healthcare provider about tests to monitor your liver and possibly catch liver cancer in its earliest stage.

Diagnosis and Tests

How do healthcare providers diagnose liver cancer?

Your healthcare provider may suspect you have liver cancer if they find liver cancer signs and symptoms during your physical examination. They may order the following tests to learn more:

  • Blood tests: Healthcare providers may do blood tests for cancer, such as a liver function test, to check on liver enzymes, proteins and other substances that show whether your liver is healthy or damaged. They may test for alfa-fetoprotein (AFP). High AFP levels may indicate liver cancer.
  • Ultrasound (sonography): This test provides pictures of your soft tissue structures. Healthcare providers use ultrasound to look for liver tumors.
  • Computed tomography (CT) scan: This special type of X-ray takes detailed images of your liver, providing information about liver tumor size and location.
  • Magnetic resonance imaging (MRI): This test produces very clear images of your body using a large magnet, radio waves and a computer.
  • Angiogram: This test helps healthcare providers examine your liver’s blood vessels. During this test, your healthcare provider injects dye into an artery so they can track blood vessel activity and look for blockages.
  • Biopsy: Healthcare providers remove liver tissue to look for signs of cancer. Biopsies are the most reliable way to confirm a liver cancer diagnosis.

Your healthcare provider may do the following tests if they think you may have IHC:

  • Endoscopic retrograde cholangiopancreatography (ERCP): ERCP uses an endoscope and a catheter (thin, flexible tubes) to examine your bile ducts.
  • Percutaneous transhepatic cholangiography (PTC): A PTC creates X-rays of your bile ducts like an ERCP. Instead of an endoscope and catheter, your healthcare provider delivers contrast dye by inserting a needle directly into your bile ducts and liver. A PTC is usually only for people who can’t have an ERCP.

What are liver cancer stages?

Healthcare providers stage HCC using standards set by the Barcelona Clinic Liver Cancer system (BCLC). This system evaluates HCC liver on characteristics, including whether your liver is working well, tumor size and your symptoms. Healthcare providers may use different terms for each BCLC stage; sometimes, presented as being stages I to IV or 0-C or by terms such as early and advanced stage HCC.

Hepatocellular carcinoma stages include the following:

  • Stage I/very early stage/stage 0: You have a single tumor in your liver that measures less than 2 centimeters (cm). Blood tests show your bilirubin level is normal.
  • Stage II/early stage/stage A: You have a single tumor that measures 5 cm or less or you have more than one tumor that measures less than 3 cm. The tumor may have spread to your blood vessels.
  • Stage III/intermediate stage/stage B: In this stage, you may have more than one tumor and/or a tumor that measures more than 5 cm. The tumor may have spread to your lymph nodes, large blood vessels or another organ.
  • Stage IV/advanced stage/stage C: The cancer has spread to other places in your body, such as your lungs or bones, as well as lymph nodes.

Management and Treatment

How do healthcare providers treat liver cancer?

Healthcare providers have several common treatments for HCC and IHC, including surgery to remove part of your liver, liver transplantation and liver-directed treatments like hepatic arterial embolization and ablation. They may also use several types of chemotherapy, chemoembolization, radiation therapy, radioembolization, immunotherapy and targeted therapy.

Prevention

How can I prevent liver cancer?

While you can’t completely prevent liver cancer, you can do the following to lower your chances of getting liver cancer:

  • Avoid behaviors that lead to cirrhosis.
  • Reach or maintain a healthy weight.
  • Get a hepatitis B vaccine. This vaccine is safe for nearly everyone. Ask your doctor about the hepatitis A vaccine.
  • Avoid hepatitis C.
  • If you have any liver disease, have diabetes, obesity or are a heavy drinker, ask your healthcare provider about liver cancer screenings.

What’s involved in liver cancer screening?

You can have very early-stage liver cancer without symptoms. Liver cancer screening is how healthcare providers monitor your liver’s health for signs of liver cancer. While there aren’t any standard liver cancer screening tests, your healthcare provider may recommend you have ultrasounds and blood tests every six months.

Outlook / Prognosis

Is liver cancer curable?

Successful liver transplants can cure liver cancer, but not everyone who needs a liver transplant will be healthy enough to go through a transplant or able to find a donor. Studies show people who have surgery to remove part of their liver tend to live longer than people whose illness prevents surgery. When that happens, healthcare providers focus on treatments to help people live with quality of life for as long as possible.

What is the life expectancy of liver cancer?

Healthcare providers are making progress on liver cancer treatment so people can live longer. But liver cancer remains a life-threatening disease.

Data show that 35% of people treated for early-stage hepatocellular carcinoma (HCC) liver are alive five years after diagnosis. About 12% of people treated for HCC that has spread to nearby tissues organs or lymph nodes are alive five years after diagnosis. About 3% of people treated for HCC that has spread further are alive five years after diagnosis.

The five-year survival rates for intrahepatic bile (IHC) duct cancer are 24% for bile duct that hasn’t spread outside of your liver, 9% for cancer that’s spread to nearby lymph nodes and 2% for cancer that’s spread further.

Living With

I have liver cancer. How do I take care of myself?

Liver cancer and liver cancer treatments take a toll on your body. Some people have liver transplants or surgery to remove part of their liver. Other people may need treatment for as long as they live. Either way, you should plan on regular appointments with your healthcare provider so they can monitor your progress and watch for signs of recurring liver cancer (cancer that comes back). For example, people who don’t have signs of liver cancer after treatment should plan on follow-up imaging and blood tests every three to six months for the first two years after treatment.

If you’ve been treated for liver cancer, here are some steps you can take that may reduce your risk for recurrent liver cancer:

  • Protect yourself from hepatitis B and hepatitis C viruses.
  • If you smoke, try to stop. If you need help, ask your healthcare provider about smoking cessation programs.
  • If you drink alcohol, either cut back or try to stop. Again, if you need help, your healthcare provider can recommend programs and services.
  • Eat a healthy diet. Liver cancer and liver cancer treatment may affect your appetite just when your body needs nutrition to heal and stay strong. If you’re having trouble eating, talk to a nutritionist. They’ll suggest ways you can get the nutrition you need.
  • Get some exercise. Ask your healthcare provider what exercise makes sense given your situation. Cancer is stressful. Exercise can relieve some of that stress.
  • Get enough rest. Fatigue is a common side effect of liver cancer and treatment.
  • Living with liver cancer can be lonely. You may not feel comfortable talking about your illness with others. If that happens, ask your healthcare provider to recommend support groups where you’ll find people who know what you’re going through. Their support and understanding can make a difference.

A note from Cleveland Clinic

Primary liver cancer is a life-threatening illness. Often, people don’t know they have liver cancer until the cancer is in an advanced stage, which limits treatment options. When that happens, healthcare providers focus on treatments to relieve symptoms and slow cancer growth while helping you maintain a quality of life. If you have an advanced form of liver cancer, talk to your healthcare provider about your treatment options, including benefits and side effects so you can feel confident about your choices going forward.

Last reviewed by a Cleveland Clinic medical professional on 05/09/2022.

References

  • American Society of Clinical Oncology. Liver Cancer: Introduction. (https://www.cancer.net/cancer-types/liver-cancer/introduction) Accessed 5/9/2022.
  • Baj J, Bryliński Ł, Woliński F, et al. Biomarkers and Genetic Markers of Hepatocellular Carcinoma and Cholangiocarcinoma-What Do We Already Know. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946081/) Cancers (Basel). 2022;14(6):1493. Accessed 5/9/2022.
  • Kulik L, El-Serag HB. Epidemiology and Management of Hepatocellular Carcinoma. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340716/) Gastroenterology. 2019;156(2):477-491.e1. Accessed 5/9/2022.
  • National Institutes of Health, National Cancer Institute. Advances in Liver Cancer Research. (https://www.cancer.gov/types/liver/research) Accessed 5/9/2022.
  • National Institutes of Health, National Cancer Institute. Liver (Hepatocellular) Cancer Prevention (PDQ®)–Patient Version. (https://www.cancer.gov/types/liver/patient/liver-prevention-pdq) Accessed 5/9/2022.
  • National Institutes of Health; National Cancer Institute; Surveillance, Epidemiology and End Results Program. Cancer Stat Facts: Liver and Intrahepatic Bile Duct Cancer. (https://seer.cancer.gov/statfacts/html/livibd.html) Accessed 5/9/2022.

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