Liver Cancer

Liver cancer is a life-threatening malignant (cancerous) tumor in your liver. Your liver is the largest organ in your body. It’s also one of the most important organs, as no one can live without their liver.

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.

Types of liver cancer

There are three types of primary liver cancer:

• Hepatocellular carcinoma (HCC). This is the most common form of liver cancer.
• Intrahepatic cancer (IHC). This is bile duct cancer (cholangiocarcinoma) in your liver. It represents about 10% to 20% of all primary liver cancer cases.
• Hepatic angiosarcoma. This type is very rare. It represents 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.)

What are liver cancer symptoms?

The three types of liver cancer cause similar symptoms. Liver cancer symptoms may include:

• Dark-colored pee or grey or pale poop
• Unexplained bruising
• Fatigue
• Fever
• Hard bump or lump on the right side of your body just below your rib cage
• Itchy skin
• Loss of appetite or unexplained weight loss
• Nausea and vomiting
• Upper abdominal pain on the right side of your body or swollen abdomen
• Yellowing of your skin and the whites of your eyes from jaundice

What are early warning signs of liver cancer?

Unfortunately, you can have very early liver cancer without any symptoms. If you’re concerned, ask a healthcare provider to assess your risk. They may recommend you have tests that check on liver health and function.

Liver cancer causes

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. Tumor suppressor genes keep cells from multiplying uncontrollably. They also make sure cells die when they’re supposed to die.

When our DNA mutates, or changes, our cells get new instructions. Certain medical conditions and other issues can affect your liver’s DNA and increase your risk of developing liver cancer.

Risk factors

The most common risk factor for liver cancer is long-term hepatitis B (HBV) or hepatitis C (HCV) infections. These infections can cause cirrhosis. Cirrhosis can lead to liver cancer. Other activities or conditions that increase your risk of liver cancer include:

• Heavy drinking of beverages containing alcohol
• Metabolic dysfunction-associated steatotic liver disease (MASLD)
• Obesity
• Type 2 diabetes
• Tobacco use

How doctors diagnose liver cancer

Your healthcare provider will do a physical examination. They’ll ask about your symptoms and may do the following tests:

• Angiogram. This test helps healthcare providers examine your liver’s blood vessels.
• Blood tests. Healthcare providers may do blood tests for cancer. They may do liver function tests.
• CT scan. This test takes detailed images of your liver. It gives providers information about liver tumor size and location.
• ERCP test. Your provider may do this test to diagnose bile cancer in your liver.
• Liver ultrasound. This test takes pictures of the inside of your liver.
• MRI. This test uses a large magnet, radio waves and a computer. It produces very clear images of your liver’s insides.

Your provider may do a liver biopsy if blood and other tests detect cancer in your liver. Biopsies are the most reliable way to confirm a liver cancer diagnosis.

What are liver cancer stages?

Cancer staging is how healthcare providers diagnose disease and plan treatment. Providers use the Barcelona Clinic Liver Cancer system (BCLC) to stage liver cancer. This system considers factors like your symptoms, liver function and tumor size.

Your provider may use different terms for each BCLC stage. For example, they may use terms like stage I to stage V, stage O to C, or early-/advanced-stage liver cancer:

• Stage I/stage O/very early stage. You have a single tumor in your liver. The tumor measures less than 2 centimeters (cm) or about 4/5 of an inch. Blood tests show your bilirubin level is normal.
• Stage II/stage A/early stage. You have a single tumor that measures 5 cm (2 inches). Stage II liver cancer includes cases where you have several tumors that are smaller than 3 cm (1 1/4 inch). This cancer stage includes liver cancer that spreads to your blood vessels.
• Stage III/stage B/intermediate stage. You have more than one tumor and/or one that is 5 cm or larger. You may have liver cancer in your lymph nodes, large blood vessels or another organ.
• Stage IV/stage C/ advanced stage. There’s liver cancer in other places in your body, like your lungs or bones.

How do healthcare providers treat liver cancer?

Healthcare providers may treat liver cancer with medical treatments or surgery. Medical treatments may include:

• Chemotherapy
• Chemoembolization
• Immunotherapy
• Radiation therapy
• Radioembolization
• Targeted therapy

Surgical treatments may be:

• Ablation
• Hepatectomy (liver resection)
• Liver transplantation

How can I prevent liver cancer?

You may not be able to prevent liver cancer. But taking the following steps may reduce your risk:

• Get a hepatitis B shot.
• Protect yourself from hepatitis C (avoid contact with infected blood and don’t share needles or syringes).
• If you smoke, try to stop. If you need help, ask your healthcare team about smoking cessation programs.
• Cut back or stop drinking alcohol. Consuming large amounts of alcohol increases your risk of cirrhosis, which can cause liver cancer.
• Reach or maintain a weight that’s right for you.
• Ask your provider about liver cancer screening. Regular blood tests and liver ultrasounds may make sense if you have liver disease, diabetes or obesity. You may also benefit from tests if you drink large amounts of alcohol.

Is liver cancer curable?

Successful liver transplants can cure liver cancer. But not everyone who needs a liver transplant can receive one. For example, they may not be healthy enough to go through a transplant. And it can be difficult to find a donated liver that’s a match.

What is the life expectancy for someone with liver cancer?

Researchers are making progress on liver cancer treatment so people can live longer. But liver cancer remains a life-threatening disease. How long you’ll live with liver cancer depends on factors like the cancer stage, how you respond to treatment and your health.

Data show that 21% of people with HCC or ICC are alive five years after their diagnosis. A “relative survival rate” compares two sets of five-year survival rates. One rate is the percentage of people with a specific disease. The other rate is people who don’t have the disease. In this case, 21% of people with HCC or ICC were alive five years after their diagnosis. By comparison, 79% of people in the general population were alive after that same time.

Further, researchers break down survival rates by cancer stage. The five-year survival rate for early-stage (stage I or stage II) liver cancer is 37%. That survival rate drops to 13% for stage III liver cancer and 3% for stage IV liver cancer.

Remember, cancer survival rates are estimates based on other people’s experience with certain kinds of cancer. Your situation may be different. Talk to your oncologist if you have questions about what survival rate information means for you.