Overview
Liver cancer (most often hepatocellular carcinoma, HCC) usually develops after years of liver damage from chronic hepatitis B or C, alcohol-related liver disease, or metabolic disease that leads to cirrhosis. Preventing the underlying liver damage—and catching cancer early—are the biggest levers for better outcomes.
Liver Cancer by the Numbers
- 4th leading cause of cancer death worldwide (WHO, 2024).
- 900,000 new cases and 830,000 deaths each year globally.
- >80% of cases occur in regions with high hepatitis B or C prevalence (Asia, sub-Saharan Africa).
- Up to 90% of hepatocellular carcinoma arises in patients with underlying cirrhosis.
- 5-year survival: ~18% overall, but >50% if detected early and treated with surgery or transplant.
Key Points
- Chronic hepatitis B is a major global cause of liver cancer; vaccination prevents many cases.
- Risk rises sharply with cirrhosis, regardless of cause.
- Surveillance (ultrasound ± AFP every 6 months) for at-risk people finds tumors earlier.
- Early-stage tumors may be cured with surgery, ablation, or transplant.
- Advanced disease is managed with embolization and systemic therapies (targeted agents, immunotherapy).
Symptoms & Signs
Many patients have no symptoms early on. Possible signs include:
- Right upper abdominal pain or fullness
- Unexplained weight loss or fatigue
- Jaundice, dark urine, pale stools
- Abdominal swelling (ascites)
Causes & Risk Factors
- Chronic HBV or HCV infection
- Cirrhosis from any cause (alcohol, metabolic, viral)
- Heavy alcohol use
- Aflatoxin exposure (certain food contaminants)
- Family history of liver cancer
- Metabolic dysfunction (obesity, type 2 diabetes)
Diagnosis
- Imaging: Ultrasound, CT, or MRI to identify and stage lesions.
- Blood tests: Alpha-fetoprotein (AFP) and liver function tests.
- Biopsy: Sometimes needed when imaging is inconclusive.
Treatment Options
- Surgery: Resection for localized tumors with adequate liver reserve.
- Liver transplant: For eligible patients within transplant criteria.
- Local therapies: Ablation (radiofrequency, microwave) or transarterial embolization/chemoembolization (TACE).
- Systemic therapy: Targeted agents and immunotherapy for advanced disease.
- Supportive care: Symptom control, nutrition, and management of liver failure complications.
Treatment depends on tumor stage, liver function (e.g., Child-Pugh), performance status, and transplant eligibility.
Prevention & Surveillance
- Vaccinate against hepatitis B.
- Treat chronic HBV/HCV to reduce progression to cirrhosis and cancer.
- Reduce alcohol and manage metabolic risks (weight, diabetes).
- Surveil high-risk groups every 6 months with ultrasound ± AFP.
Prognosis
Outcomes vary widely by stage at diagnosis and underlying liver function. Early detection via surveillance offers the best chance of curative treatment.
FAQ
Q: What causes most liver cancers?
A: Most primary liver cancers develop on a background of chronic hepatitis B or C and cirrhosis.
Q: How is it detected?
A: Imaging tests (ultrasound, CT, MRI) plus AFP blood tests; at-risk people should have 6-monthly surveillance.
Q: Is liver cancer curable?
A: Early-stage liver cancer can be cured with surgery, transplant, or ablation. Advanced stages are treated with embolization or systemic therapy.
Q: How can I reduce my risk?
A: Vaccinate against hepatitis B, treat HBV/HCV, avoid heavy alcohol, maintain healthy weight, and manage diabetes.