Liver Cancer: Risk Factors, Warning Signs, and Care Options

Liver cancer can develop without causing any noticeable symptoms, making it easy to overlook in its early stages. A person may feel perfectly well until symptoms such as yellowing of the skin and eyes begin to appear. By then, the disease may be more advanced, which can make treatment more challenging. This is why knowing what increases the risk of liver cancer and which warning signs to look out for matters. In this article, we explore both to help you understand what to watch for.

What is Liver Cancer?

Liver cancer develops when abnormal cells in the liver grow uncontrollably and form a tumour. It can begin in the liver itself or spread to the liver from another part of the body. These are known as primary and secondary liver cancer, respectively, and the distinction matters because the treatment approach depends on where the cancer originated.

The most common types of liver cancer include:

• Hepatocellular Carcinoma (HCC): The most common type of primary liver cancer, HCC begins in hepatocytes, the main cells of the liver.

• Intrahepatic Cholangiocarcinoma: This cancer develops in the small bile ducts within the liver, which carry bile to aid digestion.

• Secondary Liver Cancer: This occurs when cancer that began in another organ, such as the colon, breast or pancreas, spreads to the liver. It is treated according to the original cancer and its characteristics.

Liver cancer can affect people with existing liver disease, although it can also develop in those without a known history of liver problems. 

What are the Risk Factors for Liver Cancer?

Liver cancer can develop for several reasons, and some of the most significant risk factors are linked to long-term liver damage or chronic infection. Having one or more of these factors does not mean a person will necessarily develop cancer, but it can increase their risk. The main factors associated with liver cancer include: 

• Chronic Hepatitis B and C: Long-term infection with hepatitis B or hepatitis C viruses can cause persistent inflammation and damage to liver cells. Over time, this can increase the risk of liver cancer. Hepatitis B can also increase the risk in people who have not developed cirrhosis.

• Cirrhosis: This condition occurs when healthy liver tissue is replaced by scar tissue, often due to chronic liver disease. Cirrhosis is one of the strongest risk factors for hepatocellular carcinoma, regardless of its underlying cause.

• Fatty Liver Disease: Metabolic dysfunction-associated steatohepatitis (MASH), a form of fatty liver disease involving inflammation and liver cell injury, can progress to cirrhosis and increase the risk of liver cancer. In some cases, cancer develops even without cirrhosis.

• Heavy Alcohol Consumption: Long-term heavy drinking can damage liver cells and lead to cirrhosis, raising the risk of cancer. Alcohol use may further increase the risk in people with chronic hepatitis infections.

• Smoking: Tobacco use is associated with an increased risk of liver cancer, alongside its many other health effects.

• Other Factors: Obesity, type 2 diabetes, certain inherited conditions and exposure to aflatoxins can also contribute to the risk. Aflatoxins are toxic substances produced by certain moulds that can contaminate improperly stored grains, nuts and other foods.

What are the Early Warning Signs of Liver Cancer?

One of the challenges with liver cancer is that its early stages may not cause noticeable symptoms. As the disease progresses, changes may become more apparent, although these symptoms can also occur with other medical conditions. Potential warning signs include: 

• Unexplained Weight Loss: Losing weight without making changes to diet or physical activity can be a warning sign that warrants medical assessment.

• Upper Abdominal Pain: Persistent discomfort or pain in the upper right side of the abdomen, near the liver, may occur. Some people may also experience pain near the right shoulder blade or back.

• Jaundice: Yellowing of the skin and the whites of the eyes can occur when bilirubin builds up in the boy. Dark urine and pale stools may accompany it.

• Abdominal Swelling: The abdomen may become enlarged due to fluid accumulation, known as ascites, or an enlarged liver.

• Loss of Appetite: A reduced appetite, nausea or feeling unusually full after eating a small amount of food may develop.

• Persistent Fatigue: Unusual tiredness, weakness or a general decline in energy can occur as the disease affects overall health.

• Easy Bruising or Bleeding: Some people may notice that they bruise or bleed more easily than usual.

These symptoms do not automatically indicate liver cancer, and it is important not to draw conclusions based on them alone. However, persistent or unexplained changes should be assessed by a doctor.

How is Liver Cancer Diagnosed?

Diagnosis involves assessing the liver, identifying suspicious growths and determining whether cancer is present. The investigations may include:

Medical History and Physical Examination

The doctor reviews symptoms, existing liver conditions, family history and other risk factors. A physical examination may help identify abdominal swelling, an enlarged liver or other signs that require further investigation.

Blood Tests

Blood tests help assess liver function and identify abnormalities that may need further investigation. An alpha-fetoprotein (AFP) test may also be used, as elevated levels can occur in some people with liver cancer. However, AFP alone cannot confirm or rule out the disease.

Imaging Tests

Ultrasound, CT scans and MRI scans help identify suspicious growths, assess their size and location, and determine whether the cancer may have spread. In people with certain risk factors, characteristic findings on multiphasic CT or MRI may be sufficient to diagnose hepatocellular carcinoma without a biopsy.

Liver Biopsy

A liver biopsy involves collecting a small tissue sample for examination under a microscope. Doctors may recommend it when imaging results are inconclusive or when tissue confirmation is needed to establish the type of cancer.

What are the Treatment Options for Liver Cancer?

Liver cancer treatment depends on several factors, including the type and stage of the cancer, whether it has spread, the liver's remaining function and the patient's overall health. The main treatment options include: 

Surgery

A partial hepatectomy involves removing the part of the liver containing the tumour. It may be suitable when the cancer is localised and enough healthy liver tissue remains to maintain normal function.

Liver Transplant

A liver transplant replaces the diseased liver with a donor liver. It may be an option for selected patients whose cancer meets established transplant criteria and whose overall health supports the procedure.

Ablation Therapy

Ablation uses techniques such as radiofrequency or microwave energy to destroy cancer cells. Doctors may recommend it for certain smaller tumours, particularly when surgery is unsuitable or as part of a broader treatment plan.

Embolisation

Embolisation treatments target the tumour through its blood supply. Transarterial chemoembolisation (TACE) delivers chemotherapy and restricts blood flow to the tumour, while radioembolisation uses radioactive particles to target cancer cells. These procedures may be considered for selected patients whose cancer is confined mainly to the liver.

Targeted Therapy

Targeted therapy uses medicines that act on specific molecules or pathways involved in cancer growth. These treatments may be recommended for advanced liver cancer, depending on the tumour's characteristics and the patient's overall health.

Immunotherapy

Immunotherapy helps the immune system recognise and attack cancer cells. Certain immunotherapy medicines, sometimes combined with targeted drugs, are used to treat advanced or unresectable hepatocellular carcinoma.

Radiation Therapy

Radiation therapy uses carefully directed radiation to damage cancer cells. It may help control liver tumours in selected cases, depending on the tumour's location, the surrounding healthy tissue and the patient's liver function.

The treating team considers the potential benefits, risks and goals of care before recommending a treatment plan. 

Can Liver Cancer be Prevented?

Liver cancer cannot always be prevented, but addressing certain risk factors can reduce the likelihood of developing the disease. Some practical measures include: 

• Get Vaccinated: Hepatitis B vaccination helps prevent infection with a virus that can cause chronic liver disease and increase liver cancer risk.

• Treat Hepatitis Infections: Testing and appropriate treatment for hepatitis B and C can help reduce liver damage and the associated cancer risk. People with chronic hepatitis B may still require long-term monitoring even when receiving treatment.

• Limit Alcohol Consumption: Avoiding alcohol or reducing consumption can help prevent alcohol-related liver damage. People with existing liver disease should discuss alcohol use with their doctor.

• Maintain a Healthy Weight: Regular physical activity, a balanced diet and appropriate weight management can help reduce the risk of metabolic conditions associated with liver disease.

• Avoid Smoking: Not smoking helps reduce exposure to a known liver cancer risk factor and supports overall health.

• Follow Medical Monitoring: People with cirrhosis and certain other high-risk conditions may need regular liver cancer surveillance, commonly with ultrasound every six months, with or without an AFP blood test depending on clinical guidance. A doctor can determine the appropriate schedule based on individual risk.

Final Words

Taking care of your liver starts with knowing what puts it at risk, so if you have a condition that raises your chances of liver cancer, ask your doctor about regular monitoring, even if you feel well. The same applies if you notice a symptom that sticks around or has no clear cause, because getting it checked early, rather than waiting for it to get worse, gives you the best chance of acting while treatment options are still open.