Liver cancer: symptoms, diagnosis and treatment

Liver cancer is a malignant growth arising in liver tissue, most often from cells that make up the liver.

The common primary form is hepatocellular carcinoma, also called HCC. Liver cancer is different from cancer that starts elsewhere and spreads to the liver. The liver processes nutrients, makes proteins involved in clotting and helps remove waste, so a tumour or underlying liver disease can affect several body functions.

Liver cancer can present with abdominal swelling, jaundice and persistent abdominal pain. These symptoms also occur with non-cancer liver and digestive conditions, so they need medical assessment rather than self-diagnosis.

Other possible changes include reduced appetite, nausea, unintentional weight loss, unusual tiredness, a lump or fullness under the ribs, and itching. Jaundice may make the skin or whites of the eyes look yellow and can darken urine.

Liver cancer develops when liver cells acquire changes that allow uncontrolled growth. Long-term inflammation or scarring can create an environment in which these changes are more likely. Hepatitis B infection, Hepatitis C infection and Liver Cirrhosis are important conditions clinicians consider when assessing risk.

The course varies with tumour size, number and location, liver function, blood-vessel involvement and whether disease is present outside the liver. Some tumours are found while still localised; others are discovered after liver function changes or spread. These features help the team choose treatment and follow-up.

Risk is higher with long-standing hepatitis B or hepatitis C, liver cirrhosis, heavy alcohol-related liver injury, metabolic liver disease and some inherited conditions. A person can develop liver cancer without a recognised risk factor. People with chronic liver disease may be offered regular liver checks, depending on their clinical history.

Evaluation may include a medical history, examination, liver blood tests and imaging such as ultrasound, CT or MRI. Imaging can show a lesion, its blood supply and its relationship to vessels and nearby structures.

A biopsy is sometimes needed to examine cells, although characteristic imaging findings may be enough in selected people with chronic liver disease. Tests also assess liver reserve and whether disease has spread, because both affect treatment choices.

Treatment depends on the tumour and the remaining liver function. Liver resection removes the tumour with a margin of liver when surgery is suitable. Tumour ablation destroys selected tumours using heat or another local technique. Some people are treated with immunotherapy or targeted therapy to influence immune activity or block signals used by cancer cells.

Care may combine local and systemic treatments, with monitoring of liver function, symptoms and scan findings. A multidisciplinary team reviews the options and explains expected benefits and possible side effects.

Take medicines exactly as prescribed and tell the team about supplements, alcohol use, appetite changes or increasing sleepiness. Balanced nutrition, activity matched to energy, and support for anxiety or practical needs can help maintain daily function while treatment is planned or delivered.

Liver cancer or advanced liver disease may cause jaundice, fluid in the abdomen, bleeding problems, confusion, pain or reduced appetite. Rapidly increasing abdominal swelling, vomiting blood, black stools, new confusion or severe pain needs urgent medical attention.

Vaccination against hepatitis B, testing and treatment for hepatitis infections, limiting alcohol and managing metabolic health can reduce liver injury. People with cirrhosis or chronic hepatitis should follow the surveillance plan advised by their clinician, because early changes may not cause symptoms.

A hepatologist, gastroenterologist, medical oncologist, surgical oncologist or interventional radiologist may contribute to care. Ask how liver function and tumour features shape the recommendation, whether more than one treatment is appropriate, and which symptoms should prompt an urgent call.