In English | En español
Questions About Cancer? 1-800-4-CANCER

What You Need To Know About™

Liver Cancer

  • Posted: 04/29/2009

Page Options

  • Print This Document
  • Email This Document
  • View/Print PDF
  • Order Free Copy

About This Booklet

This National Cancer Institute (NCI) booklet (NIH Publication No. 09-5009) is about cancer that starts in the liver (primary liver cancer). In 2013, about 23,000 men and 8,000 women in the United States will be diagnosed with primary liver cancer. Most will be over 64 years old.
This booklet is only about cancer that begins in the liver. It isn't about cancer that spreads to the liver from somewhere else.

It's common for cancer to spread (metastasize) to the liver from the colon, lungs, breasts, or other parts of the body. When this happens, the disease is not liver cancer. Instead, the cancer in the liver is named for the organ or the tissue in which it began. For example, colon cancer that spreads to the liver is metastatic colon cancer. It is not liver cancer.

In the United States, metastatic cancer in the liver is far more common than primary liver cancer.

People with metastatic cancer in the liver have different treatment options than those with primary liver cancer. Treatment depends mainly on where the cancer started. Instead of this booklet, you may want to read the NCI fact sheet Metastatic Cancer. The NCI Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) can send you this fact sheet, as well as other information.

Learning about medical care for liver cancer can help you take an active part in making choices about your care. This booklet tells about:

  • Diagnosis and staging
  • Treatment and supportive care
  • Taking part in research studies


This booklet is mainly about adult liver cancer. It does not deal with childhood liver cancer. Information about childhood liver cancer is available on the NCI Web site and from the NCI Cancer Information Service. Call 1-800-4-CANCER (1-800-422-6237) or instant message us through LiveHelp.

The Liver


The liver does important work to keep you healthy:

  • It removes harmful substances from the blood.
  • It makes enzymes and bile that help digest food.


This picture shows the liver and nearby organs.

Cancer Cells





  • Benign tumors:
    • are rarely a threat to life
    • can be removed and usually don't grow back
    • don't invade the tissues around them
    • don't spread to other parts of the body
  • Malignant growths:
    • may be a threat to life
    • sometimes can be removed but can grow back
    • can invade and damage nearby tissues and organs (such as the stomach or intestine)
    • can spread to other parts of the body

Most primary liver cancers begin in hepatocytes (liver cells). This type of cancer is called hepatocellular carcinoma or malignant hepatoma.


Risk Factors

When you get a diagnosis of cancer, it's natural to wonder what may have caused the disease. Doctors can't always explain why one person gets liver cancer and another doesn't. However, we do know that people with certain risk factors may be more likely than others to develop liver cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for liver cancer:

  • Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV): Liver cancer can develop after many years of infection with either of these viruses. Around the world, infection with HBV or HCV is the main cause of liver cancer.

    HBV and HCV can be passed from person to person through blood (such as by sharing needles) or sexual contact. An infant may catch these viruses from an infected mother. Although HBV and HCV infections are contagious diseases, liver cancer is not. You can't catch liver cancer from another person.

    HBV and HCV infections may not cause symptoms, but blood tests can show whether either virus is present. If so, the doctor may suggest treatment. Also, the doctor may discuss ways to avoid infecting other people.

    In people who are not already infected with HBV, hepatitis B vaccine can prevent HBV infection. Researchers are working to develop a vaccine to prevent HCV infection.

  • Heavy alcohol use: Having more than two drinks of alcohol each day for many years increases the risk of liver cancer and certain other cancers. The risk increases with the amount of alcohol that a person drinks.
  • Aflatoxin: Liver cancer can be caused by aflatoxin, a harmful substance made by certain types of mold. Aflatoxin can form on peanuts, corn, and other nuts and grains. In parts of Asia and Africa, levels of aflatoxin are high. However, the United States has safety measures limiting aflatoxin in the food supply.
  • Iron storage disease: Liver cancer may develop among people with a disease that causes the body to store too much iron in the liver and other organs.
  • Cirrhosis: Cirrhosis is a serious disease that develops when liver cells are damaged and replaced with scar tissue. Many exposures cause cirrhosis, including HBV or HCV infection, heavy alcohol use, too much iron stored in the liver, certain drugs, and certain parasites. Almost all cases of liver cancer in the United States occur in people who first had cirrhosis, usually resulting from hepatitis B or C infection, or from heavy alcohol use.
  • Obesity and diabetes: Studies have shown that obesity and diabetes may be important risk factors for liver cancer.

The more risk factors a person has, the greater the chance that liver cancer will develop. However, many people with known risk factors for liver cancer don't develop the disease.



  • Pain in the upper abdomen on the right side
  • A lump or a feeling of heaviness in the upper abdomen
  • Swollen abdomen (bloating)
  • Loss of appetite and feelings of fullness
  • Weight loss
  • Weakness or feeling very tired
  • Nausea and vomiting
  • Fever




You may have one or more of the following tests:



A biopsy usually is not needed to diagnose liver cancer, but in some cases, the doctor may remove a sample of tissue. A pathologist uses a microscope to look for cancer cells in the tissue.

The doctor may obtain tissue in one of several ways:

  • A needle through the skin: The doctor inserts a thin needle into the liver to remove a small amount of tissue. CT or ultrasound may be used to guide the needle.
  • Laparoscopic surgery: The surgeon makes a few small incisions in your abdomen. A thin, lighted tube (laparoscope) is inserted through the incision. The laparoscope has a tool to remove tissue from the liver.
  • Open surgery: The surgeon can remove tissue from the liver through a large incision.
  • How will the biopsy results affect my treatment plan?
  • What kind of biopsy will I have?



When liver cancer spreads, the cancer cells may be found in the lungs. Cancer cells also may be found in the bones and in lymph nodes near the liver.


To learn whether the liver cancer has spread, your doctor may order one or more of the following tests:

  • CT scan of the chest: A CT scan often can show whether liver cancer has spread to the lungs.
  • Bone scan: The doctor injects a small amount of a radioactive substance into your blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.


Treatment options for people with liver cancer are surgery (including a liver transplant), ablation, embolization, targeted therapy, radiation therapy, and chemotherapy. You may have a combination of treatments.

The treatment that's right for you depends mainly on the following:

  • the number, size, and location of tumors in your liver
  • how well your liver is working and whether you have cirrhosis
  • whether the cancer has spread outside your liver

Other factors to consider include your age, general health, and concerns about the treatments and their possible side effects.

At this time, liver cancer can be cured only when it's found at an early stage (before it has spread) and only if people are healthy enough to have surgery. For people who can't have surgery, other treatments may be able to help them live longer and feel better. Many doctors encourage people with liver cancer to consider taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of liver cancer. See the Taking Part in Cancer Research section.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat liver cancer include surgeons (especially hepatobiliary surgeons, surgical oncologists, and transplant surgeons), gastroenterologists, medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.



Surgery is an option for people with an early stage of liver cancer. The surgeon may remove the whole liver or only the part that has cancer. If the whole liver is removed, it's replaced with healthy liver tissue from a donor.


Removal of part of the liver

Surgery to remove part of the liver is called partial hepatectomy. A person with liver cancer may have part of the liver removed if lab tests show that the liver is working well and if there is no evidence that the cancer has spread to nearby lymph nodes or to other parts of the body.

The surgeon removes the tumor along with a margin of normal liver tissue around the tumor. The extent of the surgery depends on the size, number, and location of the tumors. It also depends on how well the liver is working.



It's common to feel tired or weak for a while. Also, you may have diarrhea and a feeling of fullness in the abdomen.

The health care team will watch you for signs of bleeding, infection, liver failure, or other problems.

Liver transplant



While you wait for donated liver tissue to become available, the health care team monitors your health and provides other treatments.

When healthy liver tissue from a donor is available, the transplant surgeon removes your entire liver (total hepatectomy) and replaces it with the donated tissue. After surgery, your health care team will give you medicine to help control your pain. You may need to stay in the hospital for several weeks. During that time, your health care team monitors how well your body is accepting the new liver tissue. You'll take medicine to prevent your body's immune system from rejecting the new liver. These drugs may cause puffiness in your face, high blood pressure, or an increase in body hair.


Methods of ablation destroy the cancer in the liver. They are treatments to control liver cancer and extend life. They may be used for people waiting for a liver transplant. Or they may be used for people who can't have surgery or a liver transplant. Surgery to remove the tumor may not be possible because of cirrhosis or other conditions that cause poor liver function, the location of the tumor within the liver, or other health problems.

Methods of ablation include the following:

  • Radiofrequency ablation: The doctor uses a special probe that contains tiny electrodes to kill the cancer cells with heat. Ultrasound, CT, or MRI may be used to guide the probe to the tumor. Usually, the doctor can insert the probe directly through your skin, and only local anesthesia is needed.

    Sometimes, surgery under general anesthesia is needed. The doctor inserts the probe through a small incision in your abdomen (using a laparoscope) or through a wider incision that opens your abdomen.

    Some people have pain or a slight fever after this procedure. Staying overnight in the hospital is not usually needed.

    Radiofrequency ablation is a type of hyperthermia therapy. Other therapies that use heat to destroy liver tumors include laser or microwave therapy. They are used less often than radiofrequency ablation.

    You may have fever and pain after the injection. Your doctor can suggest medicines to relieve these problems.





You'll need to be sedated for this procedure, but general anesthesia is not usually needed. You'll probably stay in the hospital for 2 to 3 days after the treatment.

Embolization often causes abdominal pain, nausea, vomiting, and fever. Your doctor can give you medicine to help lessen these problems. Some people may feel very tired for several weeks after the treatment.

Targeted Therapy



Side effects include nausea, vomiting, mouth sores, and loss of appetite. Sometimes, a person may have chest pain, bleeding problems, or blisters on the hands or feet. The drug can also cause high blood pressure. The health care team will check your blood pressure often during the first 6 weeks of treatment.


Radiation Therapy


Doctors use two types of radiation therapy to treat liver cancer:


The side effects from radiation therapy include nausea, vomiting, or diarrhea. Your health care team can suggest ways to treat or control the side effects.






Some drugs lower the levels of healthy blood cells, and you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. Some side effects may be relieved with medicine.

You may wish to read the NCI booklet Chemotherapy and You.

  • What is the stage of the disease? Has the liver cancer spread?
  • Do I have cirrhosis?
  • Do I need any more tests to determine whether I can have surgery?
  • What are the expected benefits of each kind of treatment?
  • How will you treat my pain?
  • How will treatment affect my normal activities?
  • How often will I need checkups?

Second Opinion








Supportive Care





Pain Control






Sadness and Other Feelings




However, you may be uncomfortable or tired, and you may not feel like eating. You also may have side effects of treatment such as poor appetite, nausea, vomiting, or diarrhea. Your doctor, a registered dietitian, or another health care provider can advise you about ways to have a healthy diet.

Careful planning and checkups are important. Liver cancer and its treatment may make it hard for you to digest food and maintain your weight. Your doctor will check you for weight loss, weakness, and lack of energy.


Follow-up Care





Sources of Support


Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities. Here's where you can go for support:



Taking Part in Cancer Research



Doctors are studying many types of treatment and their combinations:




