About Liver Cancer

Liver cancer is a cancer that occurs in the liver either as a primary or a secondary cancer (spread from another organ). It can be caused by a number of things including hepatitis, fatty liver, alcohol and chemicals such as aflatoxins known to damage the DNA in liver cells. Studies have shown that aflatoxins can damage something called the TP53 tumor suppressor gene, which normally works to prevent cells from growing too much. Damage to the TP53 gene can lead to increased growth of abnormal cells and formation of cancer in the liver.

Infection of liver cells with hepatitis viruses can also damage DNA. These viruses actually have their own DNA that carries instructions on how to infect cells and produce more viruses. In some patients, this viral DNA can insert itself into a liver cell’s DNA where it may affect the cell’s genes. While this might lead to cancer, it doesn’t always.


Diagnosing Liver Cancer

Diagnosing liver cancer or metastatic liver cancer may include one or more of the following:

  • Abdominal ultrasound or sonography
  • Computed tomography scan (CT or CAT scan)
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy)
  • Laparoscopy
  • Liver biopsy
  • Liver function tests
  • Magnetic resonance cholangiopancreatography (MRCP)
  • Magnetic Resonance Imaging (MRI)
  • Percutaneous transhepatic cholangiography (PTC)
Learn More About Liver Cancer Diagnoses
3D Image of a Liver
Risk Factors

There are several risk factors that make a person more likely to develop hepatocellular carcinoma (HCC).

  • Gender
  • Race/ethnicity
  • Chronic viral hepatitis
  • Heavy alcohol use
  • Non-alcoholic fatty liver disease (NAFLD)
  • Cirrhosis
  • Obesity
  • Type 2 Diabetes
  • Inherited Metabolic Diseases
  • Other rare diseases

Learn More About Liver Cancer Risk Factors


Types of Liver Cancer

Tumors are abnormal masses of tissue that form when cells begin to reproduce at an increased rate. Both noncancerous (benign) and cancerous (malignant) tumors can develop in the liver.

Noncancerous tumors

Noncancerous tumors are known as benign. Believe it or not, they’re actually quite common and usually have no symptoms. In fact, if they’re found at all it’s because the patient has undergone an ultrasound, or a CT or MRI scan.

Benign tumors can sometimes grow large enough to cause problems, but they don’t grow into nearby tissues or spread to distant parts of the body like malignant or cancerous tumors might. If they need to be treated – and we will decide this together, based on our findings – the patient can usually be cured with surgery.

Types of benign liver tumors include:


The most common type of benign liver tumor, hemangiomas start in blood vessels. Most hemangiomas of the liver cause no symptoms and do not need treatment. But some may bleed or become so large they cause pain and may need to be removed surgically.

Hepatic adenoma

Hepatic adenoma is a benign tumor that starts from the main type of liver cell called hepatocytes. Most cause no symptoms and do not need treatment. But some eventually cause symptoms, such as pain or a mass in the stomach or blood loss. Because there is a risk that the tumor could rupture, leading to severe blood loss, as well as a small risk that it might eventually develop into liver cancer, we may recommend surgery to remove the tumor.

Focal nodular hyperplasia

Focal nodular hyperplasia (FNH) is a tumor-like growth made up of several cell types (hepatocytes, bile duct cells, and connective tissue cells). Although FNH tumors are benign, it can be hard to tell them apart from true liver cancers, and we often remove them when the diagnosis is unclear. If you have symptoms from an FNH tumor, it can be removed with surgery.

Liver cysts

An estimated five percent of the population develops liver cysts. These cysts are benign growths that contain fluid produced by the cell wall of the cyst. Most cysts do not need therapy but some can grow and be large enough to cause pain. These can be drained laparoscopically as an outpatient.

Cancerous liver tumors

Cancerous or malignant liver tumors can either originate in the liver (known as primary liver cancer) or spread to the liver from another cancer elsewhere in the body (metastatic liver cancer). Most cancerous tumors in the liver are metastatic.

Types of malignant liver cancer tumors include

1. Hepatocellular carcinoma:
    Or hepatocellular cancer Known as HCC, this is the most common form of liver cancer in adults. It is also sometimes called hepatoma. About 4 of 5 cancers that start in the liver are this type.
Hepatocellular cancer can have different growth patterns:
  • Some begin as a single tumor that grows larger. Only late in the disease does it spread to other parts of the liver.
  • A second type consists of a number of small cancer nodules throughout the liver, not just a single tumor. This is seen most often in people with cirrhosis (chronic liver damage).

Chronic infection with hepatitis B and C increases the risk of developing this type of cancer. In addition to cirrhosis, other causes include certain chemicals and alcoholism.

Under a microscope, we can distinguish several subtypes of HCC. Most often these subtypes do not affect treatment or the prognosis for survival. However, one of these subtypes, fibrolamellar, is important to recognize. This type is rare, making up less than one percent of HCCs. Patients with this type are usually younger than age 35, and the rest of their liver is not diseased. This subtype generally has a better outlook than other forms of HCC.

2. Bile duct cancer (Intrahepatic cholangiocarcinoma):

The bile duct starts in the liver. Within the liver, smaller tubes, similar to small blood vessels, drain bile from the cells in the liver into larger and larger branches, ending in a tube called the common bile duct. Outside of the liver, the bile duct drains into the small intestine. The gallbladder is a reservoir that holds bile until food reaches the intestines. It is attached by a small duct, called the cystic duct, to the common bile duct about one-third of the way down the bile duct from the liver. The end of the bile duct empties into the small intestine.

Bile duct cancer begins when normal cells in the bile duct change and grow uncontrollably forming a mass called a tumor. A tumor can be benign or malignant.

About 10 to 20 percent of liver cancers are bile duct cancers. Surgical removal of these tumors offers the best chance for cure.

3. Angiosarcoma and hemangiosarcoma

Angiosarcoma and hemangiosarcoma are both rare cancers that begin in cells lining the blood vessels of the liver. People who have been exposed to vinyl chloride or to thorium dioxide are more likely to develop these cancers. It’s also possible that exposure to arsenic or radium could lead to this type of liver cancer. And there is an inherited condition known as hemochromatosis that can also lead to these types of tumors.

These tumors grow quickly. By the time they’re found, these tumors are often too widespread to be removed surgically. Chemotherapy and radiation therapy may help slow the disease, but these cancers are usually very hard to treat.

4. Hepatoblastoma

This is a very rare kind of cancer that develops in children, usually in those younger than four years old. The cells of hepatoblastoma are similar to fetal liver cells. About two out of three children with these tumors are treated successfully with surgery and chemotherapy, although the tumors are harder to treat if they have spread outside of the liver. We don’t treat this type of cancer at Providence Saint Johns.

5. Secondary or metastatic liver cancer

Most of the time when cancer is found in the liver it did not start there but has spread or metastasized from somewhere else in the body, such as the pancreas, colon, stomach, breast, or lung. These tumors are named and treated based on where they started. For example, if your cancer started in the lung and spread to the liver it’s still called lung cancer with spread to the liver, not liver cancer, and it is treated as lung cancer.


Symptoms of Liver Cancer

Many patients with primary liver cancer have no symptoms. However, the following are the most common symptoms of a liver tumor or hepatoma:

  • Abdominal pain
  • Loss of appetite
  • Fatigue
  • Bloating
  • Weight loss
  • Nausea
  • Vomiting
  • Large mass that can be felt in upper, right part of abdomen
  • Fever
  • Jaundice or yellowing of the skin and eyes, and a darkening of urine
  • Persistent itching
  • Swelling of the legs
  • A general feeling of poor health and weakness

The symptoms of a liver hepatoma may resemble other medical conditions or problems. Always consult your surgeon for a diagnosis.

The following are the most common symptoms of metastatic liver cancer:

  • Weight loss
  • Poor appetite
  • Enlarged, hard, and tender liver
  • Fever
  • Enlarged spleen
  • Ascites or fluid buildup in the abdominal cavity
  • Jaundice or yellowing of the skin and eyes
  • Confusion
  • Drowsiness

The symptoms of metastatic liver cancer may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.


When we diagnose liver cancer, the next step is to determine how far the cancer cells have spread through a process called staging.

The National Cancer Institute defines the following stages for primary liver cancer:

Localized resectable

Cancer is in the liver only, has not spread, and can be removed completely with surgery.

Localized unresectable

Cancer is in the liver only, has not spread, but cannot be totally removed, usually due to its location near major blood vessels.


Cancer has spread throughout the liver or to other parts of the body.


Liver Cancer Prevention

The most significant risk factor for liver cancer is chronic infection with hepatitis B virus and hepatitis C virus.

These viruses can spread from person to person through sharing contaminated needles and through unprotected sex, so some of these cancers may be prevented by not sharing needles and by using safer sex practices (such as consistent use of condoms).


Liver Cancer Treatment

Our treatment plans are tailored to each patient, always with the goal of eliminating liver tumors and improving your quality of life.

Learn about liver cancer treatment options
Doctors walking through hallway