Having hepatitis B or hepatitis C Overview of Hepatitis Hepatitis is inflammation of the liver. (See also Overview of Acute Viral Hepatitis and Overview of Chronic Hepatitis.) Hepatitis is common throughout the world. Hepatitis can be Acute (short-lived) read more or fatty liver disease Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms... read more , or drinking alcohol to excess Alcohol-Related Liver Disease Alcohol-related liver disease is liver damage caused by drinking too much alcohol for a long time. In general, the amount of alcohol consumed (how much, how often, and for how long) determines... read more
increases the risk of developing hepatocellular carcinoma, especially in people with cirrhosis of the liver.People may have abdominal pain, lose weight, and feel a large mass in the upper right part of the abdomen.
Doctors base the diagnosis on results of a blood test and imaging tests.
This cancer is usually fatal unless it is diagnosed early.
(See also Overview of Liver Tumors Overview of Liver Tumors Liver tumors may be noncancerous (benign) or cancerous (malignant). Cancerous liver tumors are classified as primary (originating in the liver) or metastatic (spreading from elsewhere in the... read more .)
Hepatocellular carcinoma is the most common type of cancer originating in the liver. It usually occurs in people who have severe scarring of the liver (cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more ).
In certain areas of Africa and East Asia, hepatocellular carcinoma is more common than it is in the United States and is a common cause of death. In these areas, many people have chronic infection with the hepatitis B virus Overview of Chronic Hepatitis Chronic hepatitis is inflammation of the liver that lasts at least 6 months. Common causes include hepatitis B and C viruses and certain drugs. Most people have no symptoms, but some have vague... read more . The presence of this virus in the body increases the risk of hepatocellular carcinoma more than 100-fold. Hepatitis B can cause cirrhosis, but it can lead to hepatocellular carcinoma whether cirrhosis develops or not. Cirrhosis due to chronic hepatitis C Hepatitis C, Chronic Chronic hepatitis C is inflammation of the liver that is caused by the hepatitis C virus and that has lasted more than 6 months. Hepatitis C often causes no symptoms until after it has badly... read more , fatty liver disease Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms... read more , or excessive alcohol use Alcohol-Related Liver Disease Alcohol-related liver disease is liver damage caused by drinking too much alcohol for a long time. In general, the amount of alcohol consumed (how much, how often, and for how long) determines... read more also increases the risk of this cancer.
Having hemochromatosis Hemochromatosis Hemochromatosis is a hereditary disorder that causes the body to absorb too much iron, causing iron to build up in the body and damage organs. In the United States, over 1 million people have... read more 
(a hereditary disorder that causes the body to absorb too much iron) also increases the risk of developing hepatocellular cancer. In hemochromatosis iron may accumulate in the liver and damage it.
Hepatocellular carcinoma sometimes results from exposure to certain cancer-causing substances (carcinogens). In subtropical regions where hepatocellular carcinoma is common, food is often contaminated by carcinogens called aflatoxins, substances that are produced by certain types of fungi.
In North America, Europe, and other geographic areas where hepatocellular carcinoma is less common, the most common cause is chronic hepatitis C. Cirrhosis, most commonly long-standing cirrhosis related to chronic hepatitis C, fatty liver disease Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms... read more , or chronic alcohol use Alcohol-Related Liver Disease Alcohol-related liver disease is liver damage caused by drinking too much alcohol for a long time. In general, the amount of alcohol consumed (how much, how often, and for how long) determines... read more , can also lead to hepatocellular carcinoma. The risk is lower with primary biliary cholangitis Primary Biliary Cholangitis (PBC) Primary biliary cholangitis (PBC) is inflammation with progressive scarring of the bile ducts in the liver. Eventually, the ducts are blocked, the liver becomes scarred, and cirrhosis and liver... read more than with other types of cirrhosis.
Symptoms of Hepatocellular Carcinoma
Most commonly, there are no symptoms of hepatocellular carcinoma before diagnosis, and tumors are found during a routine screening. Usually, the first symptoms are abdominal pain, weight loss, and a large mass that can be felt in the upper right part of the abdomen. People who have had cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more for a long time may unexpectedly become much more ill. A fever may occur. Occasionally, the first symptoms are sudden abdominal pain and shock (dangerously low blood pressure) caused by rupture or bleeding of the cancer.
Diagnosis of Hepatocellular Carcinoma
Physical examination
Blood and imaging tests
Detecting hepatocellular carcinoma early is difficult because at first, the symptoms do not provide many clues. If a doctor feels an enlarged liver or if an imaging test detects a mass in the upper right part of the abdomen during an examination done for other purposes, the doctor may suspect this cancer, especially in people with long-standing cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more . However, screening programs often enable doctors to detect this cancer before symptoms develop.
If hepatocellular carcinoma is suspected, the following are done:
Blood tests to measure levels of alpha-fetoprotein (AFP): This protein is normally produced by the fetus, and levels decrease markedly by age 1 year. Levels are high in about half the people with hepatocellular carcinoma.
Physical examination: Doctors feel the upper right part of the abdomen to check for an enlarged liver or mass. They may place a stethoscope over the liver to check for sounds caused by the cancer. For example, they occasionally hear rushing sounds (hepatic bruits, which are due to blood rushing through blood vessels inside the cancer) or scratchy sounds (friction rubs, which are due to the cancer rubbing against the liver surface and surrounding structures).
Imaging tests Imaging Tests of the Liver and Gallbladder Imaging tests of the liver, gallbladder, and biliary tract include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography... read more : Doctors may use ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) of the abdomen to check for hepatocellular carcinoma. CT and MRI tend to be more accurate than ultrasonography. Before CT or MRI is done, a contrast agent Radiographic Contrast Agents Radiographic contrast agents are substances used to distinguish between internal structures in medical imaging, such as various types of x-rays and magnetic resonance imaging (MRI). During imaging... read more may be injected into a vein. The contrast agent helps make abnormalities, if present, easier to see.
If the diagnosis is still unclear, a liver biopsy Biopsy of the Liver Doctors can obtain a sample of liver tissue during exploratory surgery, but more often they obtain a sample by inserting a hollow needle through the person's skin and into the liver. This type... read more (removal of a small sample of liver tissue with a needle for examination under a microscope) can confirm the diagnosis. To improve the chances of obtaining cancerous tissue, doctors often use ultrasonography or CT to guide the placement of the biopsy needle. The risk of bleeding or other injury during a liver biopsy is usually low.
Staging
If cancer is diagnosed, doctors determine how large the cancer is and whether it has spread to nearby structures or other parts of the body. The imaging tests used for diagnosis can provide some of this information.
The cancer is classified ranging from stage I (a single tumor that has not spread) to stage IV (spread to distant parts of the body). Staging helps doctors decide on treatment and estimate survival.
Screening
In some areas where the hepatitis B Hepatitis B, Chronic Chronic hepatitis B is inflammation of the liver that is caused by the hepatitis B virus and that has lasted more than 6 months. Most people with chronic hepatitis B have no symptoms, but some... read more virus is common, ultrasonography is used to screen people with hepatitis B for liver cancer. Doctors may periodically screen people with cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more , regardless of cause. Screening usually involves ultrasonography every 6 or 12 months and, sometimes, measurement of the AFP level.
Treatment of Hepatocellular Carcinoma
Surgery or liver transplantation
Radiofrequency ablation, chemoembolization, or internal radiation therapy
Chemotherapy and immunotherapy
Treatment of hepatocellular carcinoma depends on the extent of the cancer. Small tumors limited to the liver can be treated with liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more .
Only liver transplantation or surgical removal of the cancer offers any hope of cure. However, when the cancer is surgically removed, it often recurs. Also, removing the cancer in people who have cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more may not be possible because too much of their liver is damaged.
When transplantation or surgery is not possible or when people are waiting for a liver transplant, treatments that focus on the tumor and areas around it can be used. These treatments may help slow the cancer's growth and relieve symptoms. For example, doctors may inject a chemical that destroys cancer cells into blood vessels to the cancer. Or they may use treatments that apply energy to cancer cells and thus destroy them. Three such treatments are
Radiofrequency ablation (which uses electrical energy)
Chemoembolization (which uses chemotherapy)
Selective internal radiation therapy (which uses radiation)
However, these treatments do not destroy all the cancer cells.
Chemotherapy drugs can be injected into a blood vessel that supplies a tumor (called chemoembolization). For example, chemotherapy drugs can be injected into a vein or into the hepatic artery. Injecting chemotherapy drugs directly into the hepatic artery delivers a large amount of the drugs directly to the cancer cells in the liver. The chemotherapy drug sorafenib is effective against hepatocellular carcinoma. Other chemotherapy drugs (for example, lenvatinib, regorafenib) and some combinations that can include immunotherapy drugs (for example, tremelimumab plus durvalumab, or atezolizumab plus bevacizumab) are now being used in some people with this cancer.
Prognosis for Hepatocellular Carcinoma
Most people with hepatocellular carcinoma do not live for more than a few years because the cancer is detected at a late stage. Screening and early detection result in a better prognosis. If the cancer is small and has not spread and liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more or surgical removal can be done, the person can often live a number of years.
Prevention of Hepatocellular Carcinoma
Use of the vaccine against hepatitis B virus Hepatitis B Vaccine The hepatitis B vaccine helps protect against hepatitis B and its complications ( chronic hepatitis, cirrhosis, and liver cancer). Generally, hepatitis B is more serious than hepatitis A and... read more eventually reduces the incidence of hepatocellular carcinoma, especially in areas where the virus is common. Preventing the development of cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more regardless of cause can also help. For example, treating chronic hepatitis B Hepatitis B, Chronic Chronic hepatitis B is inflammation of the liver that is caused by the hepatitis B virus and that has lasted more than 6 months. Most people with chronic hepatitis B have no symptoms, but some... read more , chronic hepatitis C Hepatitis C, Chronic Chronic hepatitis C is inflammation of the liver that is caused by the hepatitis C virus and that has lasted more than 6 months. Hepatitis C often causes no symptoms until after it has badly... read more , fatty liver disease Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms... read more , or hemochromatosis Hemochromatosis Hemochromatosis is a hereditary disorder that causes the body to absorb too much iron, causing iron to build up in the body and damage organs. In the United States, over 1 million people have... read more and treating or preventing alcohol-related liver disease Alcohol-Related Liver Disease Alcohol-related liver disease is liver damage caused by drinking too much alcohol for a long time. In general, the amount of alcohol consumed (how much, how often, and for how long) determines... read more can help prevent the cancer from developing.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
American Cancer Society: Provides comprehensive information about liver cancer, including its symptoms, diagnosis, staging, and survival rates.
American Liver Foundation: Hosts community education programs that give an overview of all aspects of liver disease and wellness. Also provides access to support groups, information on finding a physician, and opportunities to participate in clinical trials.
