Liver cancer: symptoms, stages, treatment and survival

Liver cancer develops when abnormal cells in the liver begin to grow uncontrollably and form a tumour. The most common type of primary liver cancer in adults is hepatocellular carcinoma (HCC), which begins in liver cells called hepatocytes. Other cancers can also develop in the liver, including intrahepatic cholangiocarcinoma, which starts in the bile ducts.

One of the challenges with liver cancer is that it may not cause noticeable symptoms in its early stages. This means a person can sometimes have liver cancer without knowing it, particularly when symptoms are mistaken for digestive problems or another liver condition.

As the cancer grows, symptoms such as upper abdominal discomfort, unexplained weight loss, loss of appetite, jaundice, abdominal swelling and unusual tiredness may appear.

Understanding the warning signs, risk factors, stages and treatment options can help people seek medical attention sooner.

What is liver cancer?

Liver cancer is cancer that starts in the liver. It is different from cancer that begins somewhere else in the body and later spreads to the liver. For example, if colon cancer spreads to the liver, it is still considered metastatic colon cancer rather than primary liver cancer.

The liver is located in the upper right part of the abdomen and performs several important functions. It helps process nutrients, produces bile, removes waste products from the blood and processes many substances, including medicines and alcohol.

The two major types of primary liver cancer in adults are:

• Hepatocellular carcinoma (HCC): The most common type, arising from hepatocytes.
• Intrahepatic cholangiocarcinoma: A cancer that begins in the bile ducts within the liver.

The treatment and outlook can vary considerably depending on the type of cancer, its stage and how well the liver is functioning.

What causes liver cancer?

Liver cancer does not always have one identifiable cause. Cancer develops when changes or mutations occur in the DNA of liver cells, causing them to grow and divide abnormally. Over time, these abnormal cells can form a tumour.

However, several conditions and lifestyle factors can increase the risk.

Important risk factors include:

• Chronic hepatitis B infection
• Chronic hepatitis C infection
• Liver cirrhosis
• Long-term excessive alcohol consumption
• Metabolic dysfunction-associated fatty liver disease and related liver inflammation
• Diabetes
• Obesity
• Smoking
• Certain inherited liver conditions
• Exposure to aflatoxins, toxins produced by certain moulds that can contaminate improperly stored foods

Not everyone with these risk factors develops liver cancer, and liver cancer can occasionally occur in people without an obvious underlying liver disease.

What are the five warning signs of liver cancer?

There is no single set of symptoms that proves someone has liver cancer. Many of these symptoms can occur with other liver, digestive or general health conditions.

However, five important warning signs to be aware of are:

1. Unexplained weight loss

Losing weight without deliberately changing your diet or exercise routine can sometimes be a sign of an underlying illness, including liver cancer. Loss of appetite may occur at the same time.

2. Pain or discomfort in the upper right abdomen

A tumour affecting the liver can cause discomfort or pain beneath the right ribs. The sensation may be persistent or become more noticeable as the tumour grows.

3. Jaundice

Jaundice causes the skin and whites of the eyes to become yellow. It can occur when the liver is unable to process bilirubin normally or when bile flow is obstructed.

4. Abdominal swelling or a lump

Some people develop a swollen abdomen due to fluid accumulation, known as ascites. A hard lump may also sometimes be felt beneath the right rib cage.

5. Unusual tiredness or weakness

Persistent fatigue or weakness can occur with liver cancer, although it is a very nonspecific symptom and is much more commonly caused by other conditions.

Other possible symptoms include nausea, vomiting, fever, easy bruising or bleeding, dark urine, pale stools and loss of appetite.

What does liver cancer pain feel like?

Liver cancer pain is often described as a dull ache, pressure or discomfort in the upper right side of the abdomen, beneath the ribs. Some people may experience a feeling of fullness or heaviness rather than sharp pain.

Pain can sometimes be felt in the back or around the right shoulder blade.

However, there is no specific type of pain that automatically means liver cancer.

The liver itself does not have the same type of pain sensation as many other organs. Pain may occur when a tumour enlarges the liver or affects the surrounding tissues.

Importantly, early liver cancer may cause no pain at all. This is one reason why people at higher risk, such as those with chronic hepatitis or cirrhosis, may need regular medical monitoring even when they feel well.

If persistent pain occurs in the upper right abdomen, especially when accompanied by weight loss, jaundice, abdominal swelling or loss of appetite, it should be evaluated by a doctor.

What is stage 1 of liver cancer?

The meaning of “stage 1” can vary because doctors use more than one staging system for liver cancer.

For hepatocellular carcinoma, the AJCC TNM staging system considers factors such as tumour size, whether blood vessels are involved, whether lymph nodes are affected and whether the cancer has spread to distant organs.

In general, stage I liver cancer refers to a single tumour that has not invaded major blood vessels and has not spread to lymph nodes or distant organs.

Doctors may also use the Barcelona Clinic Liver Cancer (BCLC) system, which is particularly important for HCC. BCLC staging takes into account not only the tumour but also liver function, general health and symptoms. Its categories include very early, early, intermediate, advanced and terminal disease.

Therefore, a report saying “stage 1” should always be interpreted according to the specific staging system used by the treating team.

Is stage 1 liver cancer curable?

Stage 1 liver cancer can potentially be cured, particularly when the tumour is detected early, has not spread and the patient has enough healthy liver function to undergo definitive treatment.

Depending on the individual situation, potentially curative treatments may include:

• Surgical resection: Removing the part of the liver containing the tumour.
• Liver transplantation: Removing the diseased liver and replacing it with a healthy donor liver in appropriately selected patients.
• Ablation: Destroying a small tumour using techniques such as radiofrequency or microwave ablation.

The best treatment is not the same for everyone. Doctors consider tumour size and location, the number of tumours, blood-vessel involvement, liver function, cirrhosis and the person’s overall health before recommending treatment.

Early diagnosis is therefore extremely important. A small, localised tumour in a person with good liver function may offer substantially more treatment options than an advanced tumour.

How is liver cancer diagnosed?

There is no single test that can diagnose every case of liver cancer.

A doctor may begin with a medical history, physical examination and blood tests. Depending on the findings and the person’s risk factors, imaging tests may be recommended.

Common investigations include:

• Liver function tests: These assess how well the liver is functioning.
• Alpha-fetoprotein (AFP): This blood test may be useful in some people with suspected HCC, although AFP alone cannot diagnose or rule out liver cancer.
• Ultrasound: Often used to examine the liver and identify suspicious lesions.
• CT scan: Provides detailed images of the liver and surrounding structures.
• MRI: Can provide highly detailed images and help characterise liver lesions.
• Biopsy: In selected cases, a small tissue sample may be examined under a microscope.

The exact combination of tests depends on the suspected cancer type and the patient’s individual circumstances.

What are the treatment options for liver cancer?

Treatment depends heavily on the stage of the cancer and the condition of the liver.

Surgery

A partial hepatectomy removes the portion of the liver containing the tumour while preserving as much healthy liver tissue as possible.

The liver has a remarkable ability to regenerate, but surgery is only suitable for selected patients. The location and size of the tumour and the remaining liver function are important considerations.

Liver transplant

A liver transplant can treat both the cancer and certain underlying liver diseases. It may be considered for carefully selected people with early liver cancer who meet transplant criteria.

Ablation

Ablation destroys cancer cells without removing the entire tumour surgically. Radiofrequency ablation and microwave ablation are among the techniques used for selected liver tumours.

Embolization and chemoembolization

For some patients with liver cancer that cannot be removed surgically, doctors may use procedures such as transarterial embolization (TAE) or transarterial chemoembolization (TACE). These treatments aim to reduce the blood supply to the tumour, sometimes delivering chemotherapy directly to the tumour area.

Targeted therapy and immunotherapy

Advanced liver cancer may be treated with medicines that target specific pathways involved in cancer growth or medicines that help the immune system attack cancer cells.

Depending on the circumstances, treatment may include medicines such as sorafenib, lenvatinib, cabozantinib, or combinations involving immunotherapy. The choice depends on factors such as cancer type, liver function, previous treatment and overall health.

Radiation therapy

Radiation may be considered in selected situations, particularly when surgery or other local treatments are not suitable or when radiation can help control symptoms or specific areas of disease.

How long will you survive with liver cancer?

There is no single answer to how long someone will survive with liver cancer.

Survival depends on several factors, including:

• The stage at diagnosis
• Whether the cancer has spread
• The size and number of tumours
• Whether the tumour can be removed
• Liver function
• Presence and severity of cirrhosis
• Overall health
• Response to treatment

Current US SEER data for liver and intrahepatic bile duct cancers show a 5-year relative survival of about 37.4% for cancers that are localized to the primary site, compared with about 13.4% when the disease has spread regionally and 3.6% when it has spread to distant sites.

These figures are population statistics, not predictions for an individual patient. Someone with a small, treatable early-stage HCC may have a much better outlook than the overall localized-stage statistic suggests. The American Cancer Society notes that selected people with early-stage liver cancer who undergo liver transplantation can have 5-year survival rates in the range of 60% to 70%.

It is also important to remember that survival statistics are based on people diagnosed in previous years. Treatments continue to improve, so newer patients may have better outcomes than older statistics indicate.

Who is at higher risk of liver cancer?

People with chronic liver disease deserve particular attention because liver cancer can develop before obvious symptoms appear.

Higher-risk groups include people with:

• Chronic hepatitis B
• Chronic hepatitis C
• Cirrhosis
• Long-term heavy alcohol use
• Fatty liver disease
• Diabetes
• Obesity
• Certain inherited liver disorders
• Previous exposure to aflatoxins

Hepatitis B vaccination, testing and treatment for hepatitis infections, maintaining a healthy weight, being physically active, avoiding smoking and limiting alcohol can help reduce liver cancer risk.

People who already have chronic liver disease should discuss appropriate monitoring with their doctor rather than waiting for symptoms to appear.

Can liver cancer be prevented?

Not every case can be prevented, but several measures can lower the risk.

Getting vaccinated against hepatitis B is an important preventive step. People at risk of hepatitis C should consider testing because chronic infection can increase the risk of liver cancer.

Maintaining a healthy weight and regular physical activity can help reduce the risk associated with metabolic liver disease. Avoiding excessive alcohol consumption and not smoking are also important.

Managing conditions such as diabetes and chronic hepatitis is equally important.

When should you see a doctor?

You should speak with a healthcare professional if you develop persistent or unexplained symptoms such as:

• Upper right abdominal pain or discomfort
• Unexplained weight loss
• Loss of appetite
• Yellowing of the skin or eyes
• Persistent abdominal swelling
• A lump beneath the right ribs
• Unusual tiredness or weakness
• Dark urine or pale stools
• Easy bruising or bleeding

These symptoms do not necessarily mean you have liver cancer. Many other conditions can cause similar symptoms. However, persistent or unexplained changes deserve proper evaluation.

People with chronic hepatitis, cirrhosis or other significant liver disease should also follow their doctor’s recommended monitoring schedule, even if they have no symptoms.

Frequently asked questions about liver cancer

Is stage 1 liver cancer curable?

Yes, stage 1 liver cancer can potentially be cured in appropriately selected patients. Surgery, liver transplantation and ablation can be potentially curative treatments for certain early liver cancers. The choice depends on tumour size and location, liver function, cirrhosis, overall health and other factors.

What does liver cancer pain feel like?

Liver cancer pain may feel like a dull ache, pressure or discomfort in the upper right abdomen beneath the ribs. It can sometimes extend toward the back or right shoulder blade. However, early liver cancer may cause no pain at all.

How long will you survive with liver cancer?

Survival varies significantly. It depends on the stage, whether the cancer can be treated, liver function, general health and response to treatment. Current SEER data report approximately 37.4% 5-year relative survival for localized liver and intrahepatic bile duct cancer, but this figure does not predict the outcome of an individual patient.

What are the five warning signs of liver cancer?

Five important warning signs are unexplained weight loss, upper right abdominal pain or discomfort, jaundice, abdominal swelling or a lump, and persistent unusual tiredness. Other symptoms can include nausea, loss of appetite, fever, easy bruising, dark urine and pale stools.

What is stage 1 of liver cancer?

Stage 1 generally refers to a cancer that is still localized and has not spread to lymph nodes or distant organs. For HCC, the exact definition depends on the staging system used. Under AJCC staging, stage I generally describes a single tumour without major vascular invasion or distant spread. Doctors may also use the BCLC system, which classifies HCC differently and incorporates liver function and overall health.

Can liver cancer be detected early?

Yes. Liver cancer can sometimes be detected before symptoms develop, particularly in people who are already at high risk because of conditions such as cirrhosis or chronic hepatitis. Appropriate surveillance can help identify suspicious changes earlier, when more treatment options may be available.

Is liver cancer always painful?

No. Liver cancer may not cause pain, particularly during its early stages. Some people have few or no noticeable symptoms until the disease has progressed.

Does having cirrhosis mean you will get liver cancer?

No. Cirrhosis increases the risk of liver cancer, but not everyone with cirrhosis develops cancer. Regular medical follow-up is important because liver cancer can sometimes develop without obvious symptoms.

The importance of early evaluation

Liver cancer can be a serious disease, but an early diagnosis can make a significant difference. Small, localized tumours may be suitable for potentially curative treatments such as surgery, transplantation or ablation.

Because early liver cancer may produce few or no symptoms, people with chronic hepatitis, cirrhosis or other significant risk factors should discuss appropriate monitoring with their doctor.

If you notice unexplained weight loss, persistent upper abdominal discomfort, jaundice, abdominal swelling or other concerning symptoms, do not ignore them. These symptoms may have many possible causes, but getting them checked promptly is the safest approach.

For liver cancer, finding the disease early can open the door to more treatment choices and a better chance of long-term control or cure.

To get tested and treated at Sparsh Diagnostic Centre, call our helpline number 9830117733.

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