Liver cancer is more common in:

Overview

• The liver is the largest internal organ in the body and sits under the right side of the rib cage, it performs vital functions including filtering toxins from the blood, producing digestive bile and storing energy
• Primary liver cancer starts when cells in the liver itself begin to grow in an uncontrolled way, forming a tumour

How common is liver cancer?

• Liver cancer is the 6th most commonly diagnosed cancer and the 3rd leading cause of cancer-related death worldwide
• Liver cancer causes 7.8% of all cancer deaths worldwide, making it a major global health burden
• In India, alcohol misuse and fatty liver disease (MASLD) are emerging as the leading causes, overtaking hepatitis B, particularly in urban populations

Who is commonly affected?

Liver cancer is more common in:

• Men, approximately two to three times more often than women
• People over the age of 50, with most diagnoses made in those aged 60–70
• People with long-term (chronic) liver disease, particularly liver scarring (cirrhosis)
• Those with chronic hepatitis B or hepatitis C infection
• People who drink heavily over many years, or who have fatty liver disease
• Individuals with diabetes or obesity

Causes of liver cancer

• Chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection
• Liver cirrhosis from any cause (heavy alcohol use, viral hepatitis, fatty liver disease, or inherited conditions), cirrhosis is the single strongest predictor of liver cancer risk
• Heavy alcohol use over many years, directly causes liver damage and cirrhosis
• Non-alcoholic fatty liver disease (now known as MASLD or Metabolic dysfunction-associated steatotic liver disease): A condition where fat builds up in the liver, increasingly common due to obesity and diabetes
• Diabetes: associated with fatty liver disease and independently raises HCC risk
• Obesity: Increases the risk of fatty liver disease and cirrhosis
• Aflatoxin exposure: A toxin produced by mould that can grow on stored foods such as groundnuts and maize; more relevant in parts of Africa and Asia
• Inherited conditions such as haemochromatosis (iron overload) or Wilson's disease (copper overload)
• Smoking: People who smoke have a higher risk of HCC than non-smokers
• Family history: Having a parent or sibling with primary liver cancer increases personal risk

Symptoms of liver cancer

Common symptoms

• Pain or discomfort in the upper right side of the abdomen
• A feeling of fullness even after eating a small amount
• Loss of appetite and unexplained weight loss
• Nausea or vomiting
• Swelling or bloating of the abdomen (which can be caused by fluid build-up, a condition called ascites)
• Extreme tiredness or weakness
• Yellowing of the skin and whites of the eyes (jaundice)
• Pale or chalky stools and dark-coloured urine
• Itchy skin

Warning signs of a serious condition

• Sudden worsening of symptoms in someone already diagnosed with cirrhosis or chronic hepatitis — seek medical attention promptly
• Rapid increase in abdominal swelling or severe abdominal pain
• Vomiting blood or passing black, tarry stools (possible sign of internal bleeding)
• Confusion, drowsiness, or difficulty thinking clearly (can indicate liver failure)
• High temperature (fever) with no clear cause

Diagnosis and investigations

Routine clinical evaluation

People with known risk factors (such as cirrhosis or chronic hepatitis B or C) are usually offered surveillance every 6 months with an ultrasound scan and blood test. This helps detect any tumour at an early, more treatable stage. If your doctor suspects liver cancer based on symptoms or abnormal surveillance results, further tests will follow.

• Liver ultrasound scan: A painless scan using sound waves to create an image of the liver, showing the size and location of any abnormal areas
• AFP blood test (Alpha-fetoprotein): An elevated AFP level in the blood can suggest liver cancer, though it can also be raised in other liver conditions such as hepatitis or cirrhosis
• Liver function blood tests: To assess how well the liver is working, which also helps determine suitability for treatment

Further tests

• CT scan (Computed Tomography): Detailed cross-sectional X-ray images that show the size, location and extent of the tumour and whether it has spread to nearby blood vessels or other organs
• MRI scan (Magnetic Resonance Imaging): In many cases, MRI can confirm a diagnosis of liver cancer without the need for a biopsy, particularly when combined with a characteristic pattern of blood flow in the tumour
• Liver biopsy: A small sample of tissue is taken from the liver with a needle under local anaesthetic and examined in a laboratory
• Endoscopic ultrasound or laparoscopy: Occasionally used to assess whether the cancer has spread, or to plan treatment more precisely

Understanding staging: The BCLC system

Liver cancer is most commonly staged using the Barcelona Clinic Liver Cancer (BCLC) system, which considers the size and number of tumours, whether the cancer has spread, how well the liver is functioning overall and the patient's general health. This staging directly guides the choice of treatment, from curative surgery to medicines that control symptoms.

What to expect:

• Ultrasound scans and blood tests are painless
• CT and MRI scans are non-invasive; you may be given a dye (contrast) through a vein in your arm to improve image quality
• A biopsy may cause brief discomfort; results usually take 1–2 weeks
• Your specialist will explain all findings and discuss next steps with you

Treatment options

Surgery (liver resection)

• Surgical removal of the tumour: Suitable when the tumour is small, confined to one area and the rest of the liver is healthy enough to continue functioning after removal

Liver transplantation

• Replacing the diseased liver with a healthy donor liver

Ablation (heat or cold treatment to destroy tumours)

• Radiofrequency ablation (RFA): a needle-thin probe is guided into the tumour using ultrasound or CT imaging and heat is used to destroy the cancer cells
• Microwave ablation (MWA): Similar to RFA but uses microwave energy; can treat slightly larger tumours more rapidly

Targeted therapy and immunotherapy

• Sorafenib and Lenvatinib: oral targeted therapy tablets that slow tumour growth by blocking the signals cancer cells use to multiply. Used for advanced liver cancer
• Immunotherapy drugs such as nivolumab, pembrolizumab or atezolizumab help the body's own immune system recognise and attack cancer cells

Lifestyle and prevention

Recommended diet

• Eat a balanced diet rich in fresh fruits, vegetables and whole grains
• Maintain a healthy body weight
• Avoid or strictly limit alcohol
• Reduce intake of processed, salty and high-fat foods

Exercise

• Regular physical activity helps maintain a healthy weight and supports liver health
• At least 150 minutes of moderate activity per week (e.g. walking, cycling, swimming)
• Discuss the right level of activity with your doctor if you are receiving treatment

Vaccination and infection prevention for Hepatitis B and C

When to contact a doctor?

• Sudden worsening of tiredness, abdominal pain, or swelling
• New or worsening jaundice (yellow skin or eyes)
• Vomiting blood, or passing black or bloody stools
• Confusion or difficulties with concentration or memory
• Any new symptoms while on or after treatment

Myths and facts

Myth 1: Only people who drink heavily get liver cancer

Fact: While heavy alcohol use is a significant risk factor, many people who develop liver cancer have never consumed alcohol. Hepatitis B, hepatitis C, fatty liver disease, diabetes and obesity are equally important causes.

Myth 2: Liver cancer always causes obvious symptoms early on

Fact: Most people with early liver cancer have no symptoms at all. This is why regular screening is essential for those with known liver disease, such as cirrhosis or chronic hepatitis — it can detect cancer before it causes any problems.

Myth 3: Liver cancer cannot be treated

Fact: When detected early, liver cancer can often be cured with surgery or a liver transplant. Even when a cure is not possible, treatments such as ablation, TACE and targeted therapy can effectively control the disease and maintain quality of life for extended periods.

Myth 4: If I have hepatitis B or C, I will definitely get liver cancer

Fact: Most people with hepatitis B or C do not develop liver cancer. However, the infection does increase risk and effective antiviral treatments — when taken as prescribed — can significantly reduce this risk and prevent progression to cirrhosis.

Frequently asked questions (FAQs)

Q1. Can liver cancer be prevented?

Yes, in many cases. Getting vaccinated against hepatitis B, avoiding heavy alcohol use, maintaining a healthy weight, getting tested and treated for hepatitis C and having regular check-ups if you have cirrhosis are all effective preventive measures.

Q2. Is liver cancer hereditary?

A family history of liver cancer modestly increases risk, particularly if it is associated with an inherited liver condition such as haemochromatosis or Wilson's disease. However, the vast majority of liver cancers are related to preventable risk factors such as hepatitis infection, alcohol and obesity.

Q3. Can I live normally after liver surgery?

Many people live well after partial liver removal (resection), as the liver can regenerate. Recovery may take several weeks and dietary adjustments are usually recommended. Your doctor and dietitian will guide you through this process.

Q4. What is the difference between primary and secondary liver cancer?

Primary liver cancer starts in the liver itself. Secondary (metastatic) liver cancer occurs when cancer from another organ — such as the bowel, lung, or breast — spreads to the liver. These are different conditions that require different treatments. Your specialist will confirm which type you have based on your test results.