Hepatic cancer, also known as liver cancer, is a serious condition where abnormal cells grow uncontrollably in the liver. The liver, one of the largest and most vital organs in the body, performs over 500 essential functions including filtering toxins from the blood, producing bile for digestion, and regulating blood clotting. When cancer develops in this organ, it can threaten these life-sustaining processes.

Understanding Hepatic Cancer

Hepatic cancer refers primarily to cancer that begins in the liver itself, which is called primary liver cancer. This is different from cancer that spreads to the liver from another part of the body, which is known as secondary or metastatic liver cancer.^[1] The liver sits in the upper right side of the abdomen, beneath the rib cage and diaphragm, next to the stomach. It is roughly the size of a football and plays a critical role in keeping the body functioning properly.^[2]

There are several types of primary liver cancer, but the most common form is hepatocellular carcinoma, often abbreviated as HCC. This type accounts for about 85 to 90 percent of all primary liver cancers.^[3] Hepatocellular carcinoma develops in the main functional cells of the liver called hepatocytes. Another type is cholangiocarcinoma, which is cancer of the bile ducts inside the liver. This represents roughly 10 to 20 percent of primary liver cancer cases.^[3] A much rarer form is hepatic angiosarcoma, which starts in the blood vessel lining of the liver and accounts for only about one percent of cases.^[3]

How Common Is Hepatic Cancer?

Hepatic cancer is a significant health problem worldwide. It is the sixth most common cancer globally and the third leading cause of cancer-related deaths.^[4] In the United States, approximately 24,500 men and 10,000 women are diagnosed with liver cancer each year.^[1] The disease is becoming more common in the United States, largely because of the spread of hepatitis C virus infection.^[4]

Men are affected more often than women, with rates in men more than twice as high.^[5] The disease is most often diagnosed in people who are 60 years old or older.^[13] Geographically within the United States, liver cancer rates are highest in the southern and western regions.^[7] Among different ethnic groups, Hispanic people have the highest rates of liver cancer diagnosis compared to other groups.^[7]

The five-year survival rate for liver cancer is only 17 percent, making it one of the deadliest forms of cancer.^[7] This low survival rate is largely because the cancer is often found at an advanced stage, when treatment options are limited. Less than half of patients are diagnosed early, when the cancer is still localized and easier to treat.^[7]

What Causes Hepatic Cancer?

Hepatic cancer develops when the DNA inside liver cells becomes damaged or mutated. DNA carries the instructions that tell cells how to grow, divide, and die. When these instructions change, cells can begin to multiply uncontrollably and form tumors.^[3] Certain genes normally help control cell growth and death. For example, oncogenes help cells grow and divide, while tumor suppressor genes keep cells from multiplying too much and ensure they die when they should. When mutations affect these genes, cancer can develop.^[3]

Most people who develop hepatocellular carcinoma have an underlying liver disease, usually cirrhosis, which is severe scarring of the liver. About 80 to 85 percent of liver cancer cases occur in people with cirrhosis.^[4] Cirrhosis develops when the liver is repeatedly damaged over many years, causing it to become scarred and unable to function properly. As the liver attempts to repair itself, errors can occur in DNA replication, which can lead to cancer.^[7]

The most common cause of cirrhosis and liver cancer worldwide is chronic infection with the hepatitis B or hepatitis C virus. These two viruses together account for more than 70 percent of hepatocellular carcinoma cases globally.^[4] Hepatitis B is responsible for about 56 percent of cases, while hepatitis C accounts for around 20 percent.^[4] Around 80 percent of liver cancer patients have a history of hepatitis infection, making it the first known cancer with a viral origin.^[7]

Hepatitis B is an enveloped virus with a circular DNA genome. When it infects the liver, parts of the viral genome can insert themselves into the DNA of liver cells. This insertion, particularly in areas that control cell growth, can cause mutations that lead to cancer.^[4] Importantly, hepatitis B can cause liver cancer even without cirrhosis, although more than 80 percent of hepatitis B-related liver cancers do involve underlying cirrhosis.^[4]

Risk Factors for Hepatic Cancer

Several factors increase a person’s risk of developing hepatic cancer. The most significant risk factor is chronic viral hepatitis, particularly hepatitis B and hepatitis C infections.^[4] People with elevated levels of hepatitis B virus in their blood, equal to or more than 10,000 copies per milliliter, face a particularly high risk of developing liver cancer.^[4]

Heavy alcohol consumption is another major risk factor. Long-term, excessive drinking can lead to alcoholic liver disease and cirrhosis, which significantly increases cancer risk.^[5] The liver works hard to process alcohol, and when overwhelmed by too much of it over many years, damage accumulates and scarring develops.^[3]

Metabolic dysfunction-associated steatotic liver disease, or MASLD, is an increasingly common risk factor for liver cancer. This condition occurs when excess fat builds up in the liver, not caused by alcohol. People who are overweight, have obesity, Type 2 diabetes, or inherited metabolic syndromes are more likely to develop MASLD.^[3] As MASLD progresses, it can lead to liver inflammation and scarring, and eventually to liver cancer.^[13] In fact, hepatocellular carcinoma is becoming more common in people with MASLD who have not yet developed cirrhosis.^[13]

Certain inherited or rare disorders also increase liver cancer risk. These include hemochromatosis, a condition where the body absorbs and stores too much iron; alpha-1 antitrypsin deficiency; glycogen storage disease; and Wilson disease, where copper accumulates in the liver.^[4]

Other risk factors include tobacco use, which roughly doubles the risk of liver cancer;^[4] being overweight or having obesity;^[5] having Type 2 diabetes;^[5] and exposure to aflatoxin, a fungus that can grow on grains and nuts that have not been stored properly.^[4] Age is also a factor, as most liver cancers are diagnosed in people over 60 years old.^[13]

Symptoms of Hepatic Cancer

One of the challenges with hepatic cancer is that it often does not cause noticeable symptoms in its early stages. Many people do not experience any signs of the disease until the cancer has grown larger or spread.^[2] When symptoms do appear, they can be vague and may be mistaken for other, less serious conditions.

Common symptoms of liver cancer include discomfort or pain in the upper right side of the abdomen, where the liver is located.^[2] Some people notice a hard lump or mass on the right side just below the rib cage.^[2] The abdomen may become swollen, a condition called ascites, which happens when fluid accumulates in the belly.^[2]

Jaundice is another important symptom. This is a yellowing of the skin and the whites of the eyes caused by a buildup of bilirubin, a bile pigment, in the blood.^[2] Jaundice can sometimes be the first and only sign of a liver tumor.^[10] Other symptoms include easy bruising or bleeding, unusual tiredness or weakness, nausea and vomiting, loss of appetite, and feeling full after eating only a small amount of food.^[2]

People with liver cancer may also experience unexplained weight loss, fever, pale or chalky-colored bowel movements, and dark-colored urine.^[2] Some individuals notice pain near the right shoulder blade or in the back.^[2] It is important to remember that these symptoms can be caused by many other health conditions as well. If any of these symptoms persist for more than two weeks, it is best to see a healthcare provider for evaluation.^[3]

Prevention of Hepatic Cancer

There are several ways to lower the risk of developing hepatic cancer. One of the most effective preventive measures is getting vaccinated against hepatitis B. The hepatitis B vaccine is safe and effective at preventing infection, which in turn reduces the risk of liver cancer.^[5] People should also get tested for hepatitis C, and if they have it, seek medical treatment. Direct-acting antiviral medications can cure hepatitis C infection and reduce the likelihood of liver cancer.^[7]

Maintaining a healthy weight and getting regular physical activity are important for liver health.^[5] Obesity and lack of exercise increase the risk of developing MASLD, which can progress to liver cancer. Eating a balanced diet rich in vegetables, fruits, whole grains, fish, and lean proteins supports overall liver health.^[10]

Avoiding excessive alcohol consumption is crucial. Heavy drinking over many years can lead to cirrhosis and liver cancer.^[5] If someone drinks alcohol, they should do so in moderation or avoid it entirely if they already have liver disease. Similarly, not smoking or quitting smoking is important, as tobacco use increases liver cancer risk.^[5]

For people who already have cirrhosis or other chronic liver conditions, regular screening can help detect liver cancer early, when it is most treatable. Healthcare providers may recommend blood tests and imaging studies at regular intervals to monitor liver health.^[13] Proper storage of grains and nuts to prevent contamination with aflatoxin is also a preventive measure, particularly in certain regions of the world.^[4]

How Hepatic Cancer Changes the Body

Understanding how hepatic cancer affects the body requires looking at what happens when normal liver function is disrupted. The liver performs many critical tasks, including producing bile to help digest fats, storing glycogen for energy, filtering harmful substances from the blood, and making proteins that help blood clot.^[2] When cancer develops, these functions can become impaired.

Hepatocellular carcinoma usually develops in the setting of chronic liver damage and inflammation. When the liver is repeatedly injured by viruses, alcohol, or metabolic disease, it tries to repair itself. During this repair process, liver cells divide more frequently. Each time cells divide, there is a small chance that DNA replication errors will occur. Over many years and countless cell divisions, the accumulation of these errors can lead to cancer.^[7]

As hepatic cancer grows, tumors can form in one or more areas of the liver. Some cancers begin as a single tumor that gradually spreads to other parts of the liver. In other cases, multiple small tumors develop throughout the organ from the start.^[10] As the cancer progresses, it can invade blood vessels, spread to nearby lymph nodes, or metastasize to distant organs such as the lungs or bones.^[1]

The presence of cancer and the underlying liver disease together can lead to liver failure. When the liver cannot perform its essential functions, toxins build up in the blood, causing confusion and other neurological symptoms in a condition called hepatic encephalopathy.^[3] The liver’s inability to produce clotting factors can lead to excessive bleeding. Fluid may accumulate in the abdomen, and the kidneys may begin to fail. Eventually, if untreated, advanced hepatic cancer and liver failure can be fatal.^[3]