Liver Cancer Primary

Overview

Primary liver cancer is a cancer that starts inside the liver itself. The word 'primary' means the cancer began there, rather than spreading to the liver from somewhere else in the body (that is called secondary liver cancer, or liver metastases). The most common type of primary liver cancer is hepatocellular carcinoma (often shortened to HCC), which starts in hepatocytes — the main working cells of the liver. Other, rarer types include cholangiocarcinoma (cancer of the bile ducts inside the liver) and a childhood liver cancer called hepatoblastoma. The liver is a large organ in the upper right side of the abdomen. It filters blood, helps digest food, stores energy, and clears waste and toxins from the body, which is why liver problems can affect many parts of how you feel.

Primary liver cancer is one of the more common cancers worldwide and a leading cause of cancer deaths, especially in parts of East Asia and sub-Saharan Africa. Rates vary a lot between countries and have been falling in some places and rising in others. In many higher-income countries it is relatively uncommon overall, but it is seen more often in people with long-standing liver disease.

It can affect anyone, but it is much more likely in people with long-term liver problems — cirrhosis from any cause, chronic hepatitis B or hepatitis C, or a long history of heavy alcohol use. It is more common in men than in women, and most cases are diagnosed in people over the age of 60, though it can occur at younger ages. Some inherited conditions that cause liver damage, such as haemochromatosis (too much iron stored in the body), also raise the risk. In children, a rare and different type of primary liver cancer (hepatoblastoma) can occur, usually in the first few years of life.

Symptoms

Common symptoms

• No symptoms in the early stages — this is very common, especially when the cancer is small
• Feeling very tired or lacking energy that does not improve with rest
• Losing weight without trying, or losing your appetite
• Feeling full after eating only a small amount
• Feeling sick, or being sick
• Pain, aching or discomfort in the upper right side of the abdomen, sometimes spreading to the back or shoulder
• A swollen or bloated abdomen (tummy)
• Yellowing of the skin and the whites of the eyes (jaundice), often with itchy skin
• Pale, chalky stools or unusually dark urine
• A lump or feeling of fullness in the upper abdomen
• A mild fever, or generally feeling unwell in a way that does not settle
• In people who already have cirrhosis, their liver condition may suddenly get worse — for example more confusion, more swelling, or bleeding that is hard to stop

Symptoms in children

• A swelling or lump in the abdomen that keeps getting bigger
• Poor feeding, or refusing feeds
• Not gaining weight, or losing weight
• Being unusually unsettled, irritable or sleepy
• Yellowing of the skin or eyes
• Vomiting, or a swollen, firm tummy

Symptoms in older adults

• Symptoms can be vague and easy to put down to 'just getting older' — such as tiredness, poor appetite or weight loss
• New confusion, forgetfulness or drowsiness, which can be a sign the liver is struggling (ask for medical advice rather than assuming it is memory or ageing)
• Falls or general weakness linked to poor appetite and weight loss
• In older adults with known cirrhosis, a sudden change in how well they seem is worth reporting to their doctor promptly
• Several health conditions at once can make symptoms harder to spot, so regular reviews with your care team matter

Causes

Main causes

• Primary liver cancer happens when changes build up in the DNA of liver cells, causing them to grow in an uncontrolled way. In most cases these changes are linked to years of inflammation and damage to the liver.
• Long-term infection with hepatitis B or hepatitis C virus is a major cause worldwide, because ongoing infection inflames and scars the liver over time.
• Cirrhosis — heavy scarring of the liver — from any cause is the biggest single risk factor. Cirrhosis can be caused by alcohol, viruses, fatty liver disease, or inherited conditions.
• Exposure to aflatoxins, natural poisons produced by moulds that can grow on poorly stored grains and nuts, raises risk in some parts of the world.
• Liver cancer is not contagious. You cannot catch it from someone, and it is not caused by a bump, a fall or a shock to the abdomen.

Risk factors

• Long-term hepatitis B or hepatitis C infection
• Cirrhosis of the liver, whatever the cause
• Long-term heavy alcohol drinking
• Metabolic dysfunction-associated steatotic liver disease (often called fatty liver disease), especially when linked to excess weight or type 2 diabetes
• Type 2 diabetes and obesity
• Smoking
• Exposure to aflatoxins in food
• Inherited conditions that damage the liver, such as haemochromatosis (iron overload) or alpha-1 antitrypsin deficiency
• Certain long-term liver conditions such as primary biliary cholangitis
• Being male, and increasing age
• A family history of liver cancer in a close relative

When to see a doctor

See a doctor urgently if:

• You develop yellowing of the skin or eyes
• Your abdomen has become swollen or tender, especially if it happened quickly
• You have a fever with chills or feel suddenly much more unwell
• You are losing weight or have no appetite and it has lasted several weeks
• You have a liver condition and your symptoms have changed or worsened
• You notice blood in your vomit or black stools — call your local emergency number right away instead of waiting for an appointment

Book a routine appointment if:

• You have ongoing tiredness, mild upper abdominal discomfort or nausea that is not settling
• You have been told you have cirrhosis, fatty liver disease or hepatitis B or C and want to know what monitoring you need
• You want to discuss your risk factors, such as alcohol use, weight, or family history
• You are due a check-up or surveillance scan and are unsure whether you still need it
• You feel anxious about your liver health and want to talk it through — that is a good reason to book an appointment

Diagnosis

Your doctor will start by asking about your symptoms, your health history, any liver conditions you know about, your alcohol use and your family history, and will examine your abdomen. Blood tests and imaging scans of the liver usually come next. Sometimes the diagnosis can be made from scans alone, especially in someone with known cirrhosis. In other cases a small sample of tissue (a biopsy) is needed to be certain. If cancer is found, further tests work out its size, how many areas are affected, and whether it has spread — this is called staging, and it guides which treatments are suitable.

Tests that may be done

• Blood tests, including liver function tests and a full blood count
• Blood tests for hepatitis B and hepatitis C
• A tumour marker blood test, which can be raised in liver cancer but is not a diagnosis on its own
• Ultrasound scan of the abdomen — often the first imaging test
• CT scan or MRI scan to get a detailed picture of the liver and check for spread
• A biopsy, where a small sample of liver tissue is taken with a thin needle, if scans are not conclusive
• A chest X-ray or other imaging if your doctor needs to check the lungs
• Assessment of how well your liver is working, which is an important part of planning treatment

What to expect at your appointment

Being tested can feel unsettling and the waiting is often the hardest part. Tests usually happen over a few appointments rather than all at once. Some, like blood tests and ultrasound, are quick and painless; a CT or MRI scan is painless but you may need to lie still for a while in a machine that can feel noisy or enclosed. A biopsy is done with local anaesthetic and you may be asked to rest for a few hours afterwards. Ask questions at any point — it is completely reasonable to bring someone with you, write down what you want to ask, and ask for the results to be explained in plain words. Your healthcare team should tell you when and how you will hear back.

Treatment

Treatment for primary liver cancer is planned around you — the type and stage of the cancer, how well your liver is working, your general health, and what matters most to you. Some treatments aim to remove or destroy the cancer completely. Others aim to control it, slow it down and relieve symptoms, sometimes for many months or years. You may be seen by a team of specialists including liver doctors, cancer doctors, surgeons, radiologists and specialist nurses, and they will usually agree a plan together. It is always your choice, and you can ask for a second opinion or more time to decide.

Self-care at home

• Tell your care team about every medicine, supplement, herbal remedy or vitamin you take before starting anything new — some can be harmful to a damaged liver, and your pharmacist can advise
• Avoid alcohol completely, as it puts extra strain on the liver
• Ask your doctor before using any over-the-counter pain relief, because not all common painkillers suit a liver condition
• Eat small, frequent meals if your appetite is poor, and ask about a dietitian for practical, personalised advice
• Keep a simple note of your symptoms, weight and how you feel, so you can share patterns at appointments
• Rest when you need to, and gently build activity back up rather than pushing through exhaustion
• Make sure you have had the vaccinations your care team recommends, since some infections are more serious when your liver is unwell
• Ask for help with practical things — finances, travel to appointments, childcare — your hospital social worker or support team can often assist

Medical treatments

The main approaches fall into a few groups. Surgery aims to remove the part of the liver containing the cancer, and is only possible when the remaining liver will still work well enough. A liver transplant may be an option for a small number of people with early cancer and particular liver conditions. Treatments that destroy the cancer without cutting it out include heating or freezing it with a thin probe guided by scans, or injecting it with a substance that kills the cancer cells. Another approach blocks the blood supply to the tumour and delivers cancer treatment straight into the liver; sometimes tiny radioactive beads are used. External radiotherapy, using focused X-rays, is used in certain situations. If the cancer cannot be removed, systemic treatments — medicines that travel through the whole body, such as targeted therapies or immunotherapy, and in some cases chemotherapy — can help control it. Where cure is not possible, palliative and supportive care can do a great deal to ease pain and other symptoms and protect quality of life. Your specialist team will explain which options fit your situation, what benefits and side effects to expect, and how each one might affect your day-to-day life.

When is surgery considered?

Surgery is generally considered when the cancer is found in one part of the liver, has not spread outside it, and the rest of the liver is healthy enough to keep doing its job afterwards. It is not suitable for everyone, particularly if the liver is very scarred or the cancer is in several places. Your surgical team will assess this carefully with scans and liver function tests, and will talk you through the risks, recovery time and alternatives so you can weigh up what is right for you.

Living with this condition

Life after a liver cancer diagnosis often settles into a new rhythm of appointments, scans and treatment, mixed in with ordinary life. Many people find it helps to keep a diary or calendar of appointments, test results and side effects, and to bring one person with them to key conversations to help remember what was said. Fatigue is common, so plan demanding tasks for when your energy is best and allow for rest afterwards. Tell your team early about symptoms such as pain, sickness, itching or poor sleep — there is usually something that can be done, and you do not need to simply put up with them. Ask for clear written information and a single point of contact if you can.

Lifestyle tips

• Stop drinking alcohol, and ask for support if that feels hard — it is a common challenge and help is available
• If you smoke, ask about stop-smoking support; it is never too late to benefit
• Keep to any monitoring or surveillance scans your team recommends, even when you feel well
• Get plenty of rest but stay gently active, building up gradually on good days
• Ask your team before travelling or taking on big commitments, so plans fit around treatment
• Keep up routine dental and general health checks, and tell any other clinician about your liver condition
• Ask your pharmacist to check any new medicine, including cold remedies and painkillers

Diet and exercise

Eating well can genuinely help you feel stronger and cope better with treatment, but it is not always easy when your appetite is low or you feel sick. Try small, frequent meals and snacks rather than three large ones, keep simple foods to hand, and sip drinks steadily through the day. Ask your doctor to refer you to a dietitian for advice tailored to your liver — general 'healthy eating' advice does not always fit liver disease, and some people are advised on salt, protein or sugar intake. Gentle activity such as short walks, light housework or chair-based exercises helps maintain strength, mood and appetite; start where you are and build up slowly, and check with your team if you have pain, balance problems or are recovering from surgery or a procedure.

Mental health and emotional wellbeing

A cancer diagnosis can bring shock, fear, anger, sadness and a sense of uncertainty, and these feelings can come and go in waves. Anxiety often peaks around scan results, and some people find it hard to sleep or concentrate. Partners, children and friends are affected too, and may need support of their own. Talking helps — to your specialist nurse, your GP, a counsellor, or others who have been through similar experiences. There is no 'right' way to feel, and asking for emotional support is a sign of strength, not weakness. If at any point you have thoughts of harming yourself or feel you cannot go on, contact your local emergency number or a crisis support line in your country straight away, or tell someone you trust and ask them to stay with you.

Prevention

Not every case can be prevented, but a great deal can be done to lower the risk. The most powerful steps are protecting the liver from lasting damage: avoiding or stopping alcohol excess, keeping to a healthy weight, not smoking, and getting tested and treated for hepatitis B or C. People who already have cirrhosis or chronic hepatitis are usually offered regular ultrasound surveillance, because finding a tumour when it is small makes curative treatment much more likely.

Vaccines

There is a safe and effective vaccine against hepatitis B, which is given as part of routine childhood immunisations in many countries and is also recommended for adults at higher risk. Preventing hepatitis B prevents a large share of liver cancer worldwide. There is no vaccine against hepatitis C, but modern treatment can cure the infection in most people, so testing matters. Your doctor can tell you whether hepatitis A and B vaccination is recommended for you, particularly if you have liver disease. There is no vaccine against liver cancer itself.

Screening programmes

There is no general population screening test for liver cancer. Instead, people at higher risk — usually those with cirrhosis or chronic hepatitis B — are often offered a liver ultrasound every six months, sometimes with a blood test, as 'surveillance'. This is not the same as screening the whole population; it is targeted monitoring for people known to be at risk. If you have a liver condition, ask your care team whether you should be on a surveillance programme and how often.

Complications

If left untreated

• The cancer can grow larger and spread within the liver, making curative treatment harder
• It can spread to other parts of the body, most often the lungs, bones or lymph nodes
• The liver may stop working properly, causing jaundice, swelling of the abdomen or legs, confusion and bleeding problems
• Pressure can build up in the veins around the liver, which can lead to serious internal bleeding
• Fluid can collect in the abdomen and become infected, which needs urgent treatment
• Weight loss, poor appetite and tiredness can gradually wear you down, affecting strength and independence
• Pain and other symptoms can increase without supportive care to manage them

Long-term outlook

The outlook for primary liver cancer varies widely depending on how early it is found, how well the liver is working and what treatments are possible. When the cancer is small and can be removed or destroyed, many people live for years and some are cured. Even when cure is not possible, treatments can control the cancer, ease symptoms and help people live well for a long time — sometimes for many months or years. Research into liver cancer treatments is moving quickly, with new options becoming available. Everyone's situation is different, so ask your own specialist team what is realistic for you; they know your case best, and they can also tell you what support is available to help you live as fully as possible.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.