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Primary liver cancer is a rare but serious type of cancer that begins in the liver. It mostly affects older people.
Symptoms are often vague and don't appear until the cancer is at an advanced stage. They include:
Read more about the symptoms of liver cancer.
The liver is one of the most complex organs in the human body. It performs more than 500 functions. Some of the liver’s most important functions include:
Liver cancer is a serious condition because it can disrupt these functions or cause them to fail completely.
Although the exact cause of liver cancer is unknown, it is thought to be related to damage to the liver, such as cirrhosis.
Cirrhosis can be caused by:
Read more about the causes of liver cancer.
Over the past few decades, rates of liver cancer have risen sharply as a result of increased levels of alcohol misuse and obesity.
Liver cancer is usually diagnosed after a consultation with a doctor and a referral to a hospital specialist for further tests.
However, regular check-ups for liver cancer (known as ‘surveillance’) are recommended for people known to have a high risk of developing the condition, such as those with a confirmed hepatitis C infection or those who have had cirrhosis.
If you are in a high-risk group for developing liver cancer, having regular check-ups will help ensure the condition is diagnosed early. The earlier liver cancer is diagnosed, the more effective treatment is likely to be.
Read more about diagnosing liver cancer.
Treatment for liver cancer depends on the stage the condition is at. If diagnosed early, it may be possible to treat.
Treatment options include:
If liver cancer is only discovered at an advanced stage, treatment is only used to relieve pain and discomfort.
Currently, only 1 in 10 people is diagnosed for liver cancer at an early stage. In most people who are diagnosed with liver cancer, the cancer has advanced too far to be cured. As a result, only 1 in 5 people live for a least a year after being diagnosed with liver cancer. Just 1 in 20 people live for at least five years.
Read more about treating liver cancer.
Many cases of liver cancer are preventable. Most steps to reduce the chances of liver cancer involve having a healthy lifestyle.
The risk of liver cancer can be reduced by:
Read more about preventing liver cancer.
Cancer of the liver does not usually cause noticeable symptoms until it has reached an advanced stage.
These symptoms include:
Visit your doctor if you are notice any of the symptoms listed above. Although they are more likely to be the result of a more common condition, such as an infection, rather than liver cancer, it's best to have them checked.
Also, you should contact your doctor if you have previously been diagnosed with a condition known to affect the liver, such as cirrhosis or a hepatitis C infection, and your health suddenly deteriorates.
Although the exact cause of liver cancer is unknown, it has been linked to damage and scarring of the liver (cirrhosis).
Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably, producing a lump of tissue known as a tumour.
In cases of liver cancer, it is uncertain why and how the cells of the liver are affected. However, it appears that damage to the liver, such as the condition cirrhosis, can increase the risk of liver cancer.
Cirrhosis is a medical term which means the tissue of the liver has become scarred and cannot perform many of its usual functions. However, it is important to point out most cases of cirrhosis do not lead to liver cancer.
The main causes of cirrhosis are, in the main:
These are discussed in more detail below.
The liver is a tough and resilient organ. It can endure a high level of damage that would destroy other organs. It is also capable of regenerating itself. But despite the liver’s resilience, prolonged alcohol misuse over many years can damage it.
Every time you drink alcohol, your liver filters out the poisonous alcohol from your blood and some of the liver cells die. The liver can regenerate new cells, but if you drink heavily for many years, your liver will lose the ability to do this.
It is estimated that one in three cases of liver cancer are related to alcohol misuse.
Read more about alcohol misuse](/condition/alcohol-misuse) and [alcoholic liver disease.
Non-alcoholic fatty liver disease occurs when small deposits of fat build up inside the tissue of the liver. It's a common condition and causes no noticeable symptoms in most people. However, in some people high levels of fat can make the liver inflamed. Over time, the inflammation will scar the liver.
A long term infection of hepatitis C can cause inflammation and scarring of the liver.
If you smoke and have hepatitis C, your risk of developing liver cancer further increases.
Other risk factors for liver cancer include:
Hepatitis B is a virus that can be spread via contaminated blood and other types of bodily fluids, such as saliva, semen and vaginal fluids.
A small number of people have severe symptoms similar to those of liver cancer, and can develop extensive scarring of their liver.
The risk of someone with a hepatitis B infection developing liver cancer appears to be influenced by ethnicity. People of Asian origin infected with hepatitis B have a higher-than-average chance of developing liver cancer, regardless of whether they have also developed cirrhosis of the liver.
People of other ethnic backgrounds only seem to have an increased risk of liver cancer if they also develop cirrhosis or another related liver condition, such as hepatitis C.
If you smoke and have hepatitis B, your risk of developing liver cancer further increases.
Haemochromatosis is a genetic condition where the body stores too much iron from food. The excess levels of iron have a poisonous effect on the liver and cause scarring.
People with haemochromatosis-related cirrhosis have a 1 in 10 chance of developing liver cancer. This risk decreases to 0.1 in 10 once treatment to remove the excess iron from the body begins.
Autoimmune hepatitis is a rare, genetic condition thought to affect 1 in every 7,150 people.
In autoimmune hepatitis, your immune system (the body’s natural defence against infection) attacks the cells of the liver as if they are a ‘foreign’ infection. Exactly what triggers the attack is unknown.
If you have autoimmune hepatitis, the risk of developing liver cancer is smaller than if you have cirrhosis from one of the other common causes. This may be because most cases of autoimmune hepatitis can be treated with immunosuppressant drugs that help prevent your immune system from damaging your liver.
Primary biliary cirrhosis is a rare and poorly understood liver condition.
One of the main functions of the liver is to create a fluid called bile, used by the body to help break down fat. The bile is transported to the digestive system via a series of tubes called bile ducts.
For reasons that are unclear, in cases of primary biliary cirrhosis, the bile ducts are gradually damaged. This eventually leads to a build-up of bile inside the liver, which damages the liver and causes cirrhosis.
People with advanced primary biliary cirrhosis are estimated to have a 1 in 20 chance of developing liver cancer in any given year.
For many people, the first stage of diagnosing liver cancer is a consultation with a doctor, although people at risk are usually tested regularly for the condition.
If you visit your doctor, they will ask about your symptoms, when they started, and when they are noticeable, as well as examining you. If they feel you need further tests, they will refer you to a hospital specialist.
See below for information about these tests.
If you are in a high-risk group for developing liver cancer, regular screening, known as surveillance, is recommended. This is because the earlier the cancer is diagnosed, the greater the chance of curing it.
Surveillance is usually carried out every six months and is a two-stage process. These stages are:
Surveillance is usually recommended if you have cirrhosis, although there are other factors that can also affect your risk of liver cancer. The potential benefits of surveillance should be discussed with you before you enter any screening programme.
There are several tests that can be used to confirm a diagnosis of liver cancer, although it would be unusual for someone to need all the tests to confirm the diagnosis. The tests are:
Staging is a term used to describe how far a particular cancer has spread. There are a number of different systems used to stage liver cancer. Many liver cancer specialists use combination staging systems that include features of both the cancer and the underlying liver function to stage a person’s condition.
This is because the length of time a person lives, and how well they tolerate potential treatments, will be determined not only by how advanced their cancer is, but also by their level of health and how good their underlying liver function is.
One combination system for staging liver cancer is known as the Barcelona Clinic Liver Cancer (BCLC) staging system. The BCLC staging system consists of five stages. These are:
The treatment for liver cancer depends on the stage of the condition. Treatment can include surgery and medication.
Many hospitals use multidisciplinary teams (MDTs) to treat liver cancer. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.
Deciding what treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
Your recommended treatment plan will depend on the stage your liver cancer is at (see diagnosing liver cancer for more information about staging).
If your cancer is at Stage A when diagnosed, a complete cure may be possible. The three main ways this can be achieved are:
If your cancer is at Stage B or C, a cure is not usually possible. However, chemotherapy can slow the progression of the cancer, relieve symptoms and prolong life for months or, in some cases, years.
There is also a medication called sorafenib, which can help prolong life.
If your cancer is at Stage D when diagnosed, it is usually too late to slow down the spread of the cancer. Instead, treatment focuses on relieving symptoms of pain and discomfort you may have.
Each treatment option is discussed in more detail below.
If damage to your liver is minimal and the cancer is contained in a small part of your liver, it may be possible to remove the cancerous cells during surgery. This procedure is known as surgical resection.
As the liver can regenerate itself, it may be possible to remove a large section of it without seriously affecting your health. However, in the majority of people with liver cancer, their liver’s regenerative ability may be significantly impaired and resection may be unsafe.
Whether or not a resection can be performed is often determined by estimating the severity of the cirrhosis.
If a liver resection is recommended, it will be carried out under a general anaesthetic, which means you will be asleep during the procedure andnot feel any pain.
Most people are well enough to leave hospital six to 12 days after surgery. However, depending on how much of your liver was removed, it may take up to three or four months for you to fully recover.
Liver resection is a complicated surgery and can have a considerable impact on your body. There is a one in four chance of complications after surgery.
Possible complications of liver resection include:
Liver resection can sometimes cause fatal complications, such as a heart attack. It is estimated that 1 in every 30 people who have liver resection surgery will die during or shortly after the operation.
One type of liver resection surgery, which involves the temporary removal of the liver (ex-vivo hepatic resection), is a possible treatment for liver cancer.
However, the National Institute for Health and Clinical Excellence (NICE) has recently released guidance about this procedure which raises concerns about how safe and effective this treatment is.
Your doctor should discuss the benefits and dangers of this surgery before any decision is made.
If you only have a single tumour less than 5cm (50mm) in diameter, you may be suitable for a liver transplant. However, if you have multiple tumours, or a tumour larger than 5cm, the risk of the cancer returning is usually so high a liver transplant will be of no benefit.
Some people who have three or fewer small tumours, each less than 3cm (30mm) in diameter may be offered a transplant. Occasionally, if a person has a tumour that responds exceptionally well to treatment, with no evidence of tumour growth for a six-month period, they may also be offered a transplant.
There can be a long time until a suitable liver becomes available, so you may be put on a waiting list.
In some cases, a small part of the liver of a living relative can be used. This is known as a living donor liver transplant.
The advantage of using a living donor liver transplant is that the person receiving the transplant can plan the procedure with their medical team and relative, and will not usually have to wait very long.
However, there are also disadvantages, such as higher complication rates. Research has also found results of live donor liver transplants tend not to be as good as transplants using a liver from someone who has died.
Read more about liver transplants.
Radiofrequency ablation may be recommended as an alternative to surgery to treat liver cancer at an early stage where the tumour or tumours are smaller than 2cm (20mm) in diameter.
Radiofrequency ablation involves passing small needles that contain electrodes through your skin and into your liver. Your skin is numbed with a local anaesthetic so you will not feel pain when the needles are inserted.
When the needles are in place, an electrical current is passed through them. The current generates heat, which kills the cancerous cells.
Radiofrequency ablation takes around 10 to 30 minutes to complete. You may need several sessions, depending on how much of your liver has been affected by cancer.
The most common complication of radiofrequency ablation is flu-like symptoms, such as chills and muscle pains. These usually begin three to five days after the procedure, and last for around five days.
Less common complications of radiofrequency ablation include:
Chemotherapy involves using a combination of powerful cancer-killing medications to slow the spread of liver cancer.
A type of chemotherapy called transcatheter arterial chemoembolisation (TACE) is usually recommended to treat cases of stage B and C liver cancer. This is a palliative treatment that can prolong your life but is not curative. TACE is not recommended for Stage D liver cancer because it can make the symptoms of liver disease worse.
TACE may also be used to help prevent cancer spreading out of the liver in people waiting for a liver transplant.
TACE uses a combination of two techniques:
TACE usually takes one to two hours to complete. After the procedure, you will stay in hospital overnight before returning home. Your response to the treatment will be assessed a month or so after the procedure, usually by having a CT scan. If you remain well, further TACE treatment may be requested for you.
People who have TACE often receive three to four sessions, with a period of about one month in between each session.
Injecting chemotherapy medications directly into the liver, rather than into the blood, has the advantage of avoiding the wide range of side effects associated with ‘traditional chemotherapy’, such as hair loss and fatigue.
However, the procedure is not free of side effects and complications. The most common being post-chemoembolisation syndrome, which occurs in around one in three cases.
Post-chemoembolisation syndrome can cause the following symptoms:
These symptoms may last for one to two weeks after having a session of TACE.
Less common complications of TACE include:
If you only have a few small tumours, alcohol injections may be used as a treatment. This involves using a needle that passes through the skin to inject alcohol into the cancerous cells. This dehydrates the cells and stops their blood supply.
In most cases, this is carried out under a local anaesthetic, meaning you will be awake, but the affected area is numbed so you won't feel any pain.
Sorafenib is a tablet sometimes used to treat liver cancer. Whether or not you are eligible for sorafenib will be decided by your medical team and will depend on whether it is likely to do you more good than harm.
In cases of advanced liver cancer, NICE does not recommend the use of sorafenib because the cost is high for the limited benefit it brings.
Common side effects include:
Treatment for advanced liver cancer focuses on relieving the symptoms of pain and discomfort, rather than attempting to slow down the progression of the cancer.
Some people with advanced liver cancer require strong painkillers, such as codeine or possibly morphine. These will be given to you if they are needed. Nausea and constipation are common side effects of these types of painkillers, so you may also be given an anti-sickness tablet and a laxative.
Lifestyle and self-care measures are the most effective ways to reduce the chances of liver cancer developing.
Giving up drinking alcohol altogether is the most effective way of reducing your risk of developing liver cancer, particularly if you have been drinking for many years.
As a minimum preventative measure, you should not regularly drink more than the recommended daily amounts:
A unit of alcohol is approximately half a pint of normal-strength lager, a small glass of wine or a single measure (25ml) of spirits.
Visit your doctor if you are finding it difficult to moderate your alcohol consumption. Counselling services and medication are available to help you reduce your alcohol intake.
Read more about alcohol and treating alcohol misuse.
If you regularly inject drugs, such as heroin, the best way of avoiding a hepatitis C infection is to not share any of your drug-injecting equipment with other people. This does not just apply to needles but to anything that could come into contact with other people's blood, such as:
Hepatitis C does not cause noticeable symptoms for several years, so many people may be unaware they are infected. It is therefore safer to assume anyone may have the infection.
Even if you are not a drug user, it is important to take common-sense precautions to minimise your exposure to other people’s blood. This includes avoiding sharing any object that could be contaminated with blood, such as razors or toothbrushes.
There is less risk of getting hepatitis C by having sex with someone who is infected. However, as a precaution, it is recommended you use a barrier method of contraception during sex, such as a condom.
It may also be possible to get hepatitis C by sharing banknotes or ‘snorting tubes’ to snort drugs, such as cocaine or amphetamine with an infected person. These types of drugs can irritate the lining of your nose and small particles of contaminated blood could be passed on to the note or tube which you could then inhale.
Read more about getting tested and treated for hepatitis C and preventing hepatitis C.
There is a vaccine that protects against hepatitis B.
Vaccination is usually only recommended for people in high-risk groups, such as:
People who have an occupation that increases their exposure to hepatitis B should also be vaccinated. These occupations include:
Contact your doctor for advice if uncertain about whether you should be vaccinated against hepatitis B.
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.