Liver Cancer

Liver cancer happens when abnormal cells grow inside the liver, one of the largest organs in your body. It is one of the leading causes of cancer worldwide. If you have cancer in the bile ducts--a series of thin tubes that go from the liver to the small intestine--you will also be treated by liver cancer doctors.

Your liver lives in your upper abdomen just under your ribcage. It’s made of lobules, each with their own blood supply. Your liver cleans your blood of toxins like alcohol and medication byproducts, helps digest fats, and helps maintain blood sugar balance. Your liver also produces proteins to help your blood clot and breaks down old or damaged cells.

Bile ducts move bile, a liquid that helps digest fats, from your liver and gallbladder to the small intestine. Bile duct cancer is a rare disease. 

Types of Liver Cancer

There are several types of cancer that can form in the liver. The types are broken down into two categories: primary liver cancer and secondary liver cancer.

Primary liver cancer occurs when the abnormal cells start in the liver. Secondary liver cancer ioccurs whhen cancer cells spread to the liver from another part of your body, such as your pancreas, colon, stomach, breast, or lung. Most people who have primary liver cancer also have an ongoing chronic liver condition.

Two common types of primary liver cancer are:

  • Hepatocellular carcinoma (HCC). This is the most common form of liver cancer. Some of these cancer types start as a single tumor, while others begin as small nodules throughout the liver. Primary liver cancer that starts out as multiple small nodules is often seen in people with chronic liver damage (cirrhosis). HCC is the third leading cause of cancer death worldwide.
  • Cholangiocarcinoma (bile duct cancer). This form of cancer develops from the bile cells of the liver. If the tumor is inside of the liver, originating from small bile duct cells, it’s called intrahepatic cholangiocarcinoma. If the tumor forms in larger bile ducts of the liver, it often causes blockage of the bile flow. If the tumor is at the hilum of the liver (where bile duct exits the liver), it is called Klatskin tumor or perihilar bile duct cancer. If the tumor is in the bile duct below the hilum of the liver, it’s called distal bile duct cancer. It’s important that specially trained bile duct cancer specialists including oncologists, radiologists, gastroenterologists and pathologists identify the type of bile duct cancer you have because they have different risk factors and genetic makeups.

Secondary liver cancer:

Secondary liver cancer occurs when cancer has spread to the liver from another area of the body  (e.g. breast, colon, pancreas, melanoma, lymphoma, and others). Also referred to as metastatic cancer, the treatment options may depend on where the cancer originated from. If the cancer has spread from the colon, your liver will have colon cancer cells, and the treatment protocol will align as such.  Specific treatments including surgical resection an liver transplantation are available for secondary liver cancer from the colon or some others.

Risk Factors

Liver cancer and bile duct cancer can develop from factors that are out of your control. Gender, race, and chronic diseases like hepatitis B acquired from your mother at birth all play in liver cancer incidence. People of all ages get primary liver and bile duct cancers.

You can lower your risk of liver and bile duct cancer by preventing damage to your liver. This can include limiting alcohol consumption, stopping use of tobacco products, maintaining a healthy weight, and limiting your exposure to particular toxic chemicals.

Risk factors for liver cancer include:


People from Asia and sub-Saharan Africa have a high incidence of hepatitis B infection, which puts them at high risk for liver cancer. Bile duct cancer is most common in parts of Asia where people have high rates of liver parasite infections.


Most people who develop liver cancer have a history of cirrhosis. Cirrhosis is a condition where liver cells are damaged and replaced by scar tissue.

Chronic Viral Hepatitis

Long-term infection of the hepatitis B or C viruses can lead to cirrhosis of the liver and eventually to liver cancer. Hepatitis C is the more common cause of liver and bile duct cancer in the US.

Heavy Alcohol Use

Heavy drinking can cause cirrhosis.


People who are obese can develop fatty liver disease, which can lead to cirrhosis.

Type II Diabetes

This condition can lead to inflammation, then cirrhosis.

Inherited Metabolic Diseases

People with hereditary hemochromatosis absorb too much iron from their food. They have a higher risk of developing cirrhosis and liver cancer. Other rare diseases that increase the risk of liver cancer include tyrosinemia, alpha1-antitrypsin deficiency, porphyria cutanea tarda, glycogen storage diseases, and Wilson disease.

Chemical Exposure

Exposure to certain chemicals, such as vinyl chloride, can increase liver cancer risk. Arsenic, which naturally occurs in some drinking water, can also increase your risk. 

Anabolic Steroids

Some athletes use these male hormones to increase strength and muscle mass. Long-term use of anabolic steroids can slightly increase your risk of liver cancer.


Parasites can cause liver damage, as well as inflammation that is linked to bile duct cancer. These parasites are primarily found in Asia, Africa, and South America.


Tobacco use is linked to many forms of cancer, including liver cancer.

How to prevent liver cancer

There is no  method to guarantee liver cancer prevention, but there are preventive measures that you can take to reduce your risk, including:

  • Avoid excessive alcohol use, or any behaviors that can lead to cirrhosis.
  • Quit using tobacco, including cigarettes, pipes, vapes, cigars, and chewing tobacco.
  • Avoid contracting hepatitis B, C. Ask your physician about getting a hepatitis B vaccine.
  • Maintain a healthy weight and diet.
  • Cancer screenings. If you are obese, drink heavily, have diabetes, or have cirrhosis, ask your doctor about preventive screenings for liver cancer.

Signs of Liver Cancer

Most people don’t have signs or symptoms of liver cancer until it’s in a later stage. Many of the symptoms of liver and bile duct cancer can look like other illnesses. They include:

  • Unexplained weight loss or loss of appetite
  • Feeling very full after eating very little
  • Nausea or vomiting
  • An enlarged liver
  • An enlarged spleen
  • Pain in the abdomen or near the right shoulder blade
  • Swelling or fluid build-up in the abdomen
  • Itching
  • Yellowing of the skin and eyes (jaundice)
  • Fever
  • Enlarged veins on the belly that are visible through the skin
  • Abnormal bruising or bleeding


For people who are at high risk for liver cancer, it’s possible to diagnose the disease through screening tests. But most liver cancers are diagnosed with the following tests:

  • Liver function tests (LFTs), blood tests that assess how the liver is working.
  • Blood clotting tests that check for proteins that allow the blood to clot and prevent bleeding. A damaged liver may not make enough.
  • Viral hepatitis tests that look for hepatitis B or C virus infection. Both infections are linked to cirrhosis and liver cancer.
  • Kidney function tests, blood tests that assess how well your kidneys are working.
  • Complete blood count (CBC), which measures the levels of red blood cells, white blood cells (which fight infection), and platelets (which help your blood clot) and how well your bone marrow is making new blood cells.
  • Blood chemistry tests, which check the levels of minerals and other things in your blood that might be affected by liver cancer.
  • Alpha-fetoprotein blood (AFP) test, which is the most commonly used tumor marker for hepatocellular carcinoma (HCC), it also can help determine your best treatment options. Or, during treatment, how well the therapy is working or if the cancer has come back.
  • CA 19-9 test, which looks for this marker for bile duct cancers and can help predict prognosis for people with all kinds of liver cancer.