Liver Cancer Causes, Symptoms and Types

Liver cancer is a serious disease that begins when abnormal cells grow uncontrollably in the liver, the body’s largest internal organ. The liver plays a vital role in digestion, detoxification, and energy storage, so cancer in this organ can significantly affect overall health.

Survival rates for liver cancer depend heavily on the stage at diagnosis. According to the American Cancer Society, the five-year relative survival rate for liver cancer that is localized (confined to the liver) is approximately 28 percent, while the rate drops to 11 percent for regional disease (spread to nearby organs or lymph nodes), and just 3 percent for distant metastatic disease. These statistics underscore the importance of early detection and coordinated care.

Causes of Liver Cancer

Common Causes 

• Hepatitis B — Most commonly acquired through sexual contact, intravenous drug use or in some countries, mother to baby transmission
• Hepatitis C — Most commonly acquired through needle sticks, intravenous drug use, or blood transfusions before 1992
• Alcoholic liver disease
• Metabolic dysfunction-associated steatotic liver disease (MASLD) - This is when fat builds up on the liver. Previously known as non-alcoholic fatty liver disease (NALFLD).

Less Common Causes

• Hemochromatosis (iron overload of the liver)
• Wilson disease (copper overload of the liver)
• Autoimmune liver diseases including primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH) and alpha-1 antitrypsin deficiency

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Liver Cancer Symptoms

Unfortunately, patients with primary liver cancer often do not experience any symptoms until the disease is at an advanced stage. When symptoms do appear, they can include:

• Jaundice — The first, and sometimes only, sign of a liver tumor is a yellow discoloration of the skin and whites of the eyes caused by high levels of bile pigment (bilirubin) in the blood.
• Unintended weight loss and loss of appetite.
• Pain or discomfort in the upper right abdomin.
• Abdominal swelling or bloating.
• Nausea and vomiting.
• Fatigue and weakness.
• Abdominal distention caused by ascites (fluid accumulation in the abdomen).

Types of Liver Cancer

Liver cancer is generally classified into two main types: primary and secondary. Primary liver cancer originates within the liver itself, most often as hepatocellular carcinoma (HCC), which develops from the liver’s main cells called hepatocytes. Other forms of primary liver cancer include cholangiocarcinoma (bile duct cancer) and rare types such as angiosarcoma or hepatoblastoma. 

In contrast, secondary liver cancer — also called metastatic liver cancer — occurs when cancer from another part of the body, such as the colon, breast, or lung, spreads to the liver. While primary liver cancers are more common in regions with high rates of hepatitis and cirrhosis, secondary liver cancers are frequently diagnosed in Western countries, where the liver often serves as a site for metastasis.  

Primary Liver Cancer

Primary liver cancer originates in the liver and is most commonly diagnosed as hepatocellular carcinoma (HCC), accounting for approximately 85 percent of cases.

Primary liver cancer refers to malignancies that begin in the liver itself, rather than spreading from other organs. The most prevalent form is hepatocellular carcinoma (HCC), followed by intrahepatic cholangiocarcinoma (iCCA. Risk factors include chronic infection with hepatitis B or C viruses, cirrhosis, excessive alcohol use, and nonalcoholic fatty liver disease.

More than 24,000 new cases of primary liver cancer are diagnosed in the U.S. every year. Most primary liver tumors are the result of chronic liver disease.

Over the last 20 years, primary liver cancer has become much more common in the United States, mainly because of the spread of chronic viral hepatitis. Men are more than twice as likely as women to develop this cancer. Because the liver is made up of different types of cells, several types of cancer can form within the liver. 

Hepatocellular Carcinoma (HCC) or Hepatoma

HCC is a primary cancer that begins in the hepatocytes, the cells that make up the main functional part of the liver. Approximately three out of four primary liver cancers are hepatocellular carcinoma (HCC), sometimes referred to as hepatoma. Some hepatocellular carcinomas begin as a single tumor that grows and later spreads to other parts of the liver. In other cases, hepatomas begin as many small tumors scattered throughout the organ. This cancer may spread elsewhere in the body.

Cholangiocarcinoma (Bile Duct Cancer)

Cholangiocarcinoma is a primary cancer that starts in the bile ducts — the tubes that connect the liver and the gallbladder to the small intestine. About 10 to 20 percent of primary liver cancers are cholangiocarcinomas. These tumors are classified as:

• Intrahepatic cholangiocarcinoma — tumors that arise from the bile duct system that is inside the liver.
• Extrahepatic cholangiocarcinoma — tumors that arise in the part of the biliary system outside the liver. About 90 percent of bile duct tumors fall in this category.

There are also several kinds of non-cancerous tumors and that can arise in the liver, including hemangiomas, adenomas and cysts. Some of these carry a risk of becoming a cancer.

Secondary (Metastatic) Liver Cancer

Secondary, or metastatic, liver cancer occurs when cancer cells spread to the liver from other parts of the body, most commonly the colon, pancreas, breast, or lungs.

Unlike primary liver cancer, which originates in liver tissue, secondary liver cancer reflects the liver’s role as a common site for metastasis due to its rich blood supply and filtration function. These tumors often develop after the primary cancer has been diagnosed, but in some cases, liver metastases may be the first sign of disease. Treatment focuses on controlling the spread and alleviating symptoms, and may include systemic therapies, surgical resection, or localized interventions such as ablation or embolization. Prognosis depends on the type and extent of the primary cancer, as well as the number and size of liver lesions.

Liver Cancer Diagnosis

Physicians use a variety of tests to diagnose liver cancer and determine the extent of a patient’s disease.

• CT and MRI imaging may be used to determine the number, size and location of liver tumors and to find out if the cancer has spread outside the liver.
• Blood tests are used to evaluate the overall health of a patient’s liver and also to detect proteins that can indicate the presence of liver cancer.
• Needle biopsy may be performed to obtain a small sample of liver tissue to test for the presence of liver cancer cells. Local anesthesia is used to numb the skin where a needle is inserted through the skin. Ultrasound or CT imaging guides the biopsy of the liver.

Learn more about Froedtert & MCW advanced liver cancer diagnostic techniques.

Managing Liver Disease

Many patients with liver cancer may also have underlying liver disease, such as cirrhosis. Our liver cancer specialists include physicians in the Gastroenterology/Hepatology Program who specialize in managing liver disease and preventing liver cancer. In addition, our nationally known Palliative Care Program provides support and services for patients with complex symptoms.

Liver Cancer Second Opinion Program

When you are diagnosed with any serious disease, it makes sense to get a second opinion. Our liver cancer team will confirm your diagnosis, talk to you about your alternatives and make sure you are receiving the most effective care for your specific condition.

Our physicians will talk about concerns, reexamine the diagnosis and take a fresh look at all options. They are able to offer a full range of the most sophisticated treatments available:

• Advanced liver cancer surgery options (including unique laparoscopic procedures) performed by some of the nation’s top liver surgeons.
• The latest evidence-based drug therapy protocols delivered in our state-of-the-art Day Hospital.
• New techniques for effectively treating liver tumors with radiation therapy.
• Minimally invasive interventional radiology procedures that concentrate therapy at the site of the cancer.
• Many patients are able to access new drug therapies through participation in clinical trials.
• Patients who are eligible for an organ transplant benefit from working with our nationally recognized Liver Transplant Program.

Learn more about our Cancer Second Opinion program. 

Multidisciplinary Liver Cancer Team Dedicated to Personalized Care

The Froedtert & MCW liver cancer team is a group of specialists who have extensive experience in treating patients with challenging liver malignancies. Because they focus on liver cancer, they understand the many nuances of the disease, including diagnosis, and are up-to-date on the most current and advanced liver cancer treatment options.

Every patient in the program receives a multidisciplinary treatment plan. Our team includes surgical oncologists, medical oncologists, radiation oncologists, interventional radiologists, hepatologists, transplant surgeons, and specialized diagnostic radiologists and pathologists. These experts meet weekly to discuss patients and ensure every individual is receiving the most effective care.

Committed to clinical excellence, our team members provide the full range of standard and innovative therapies for liver cancer. Their dedication to research and education ensures patients benefit from the latest knowledge of liver cancer treatment.

 Liver Cancer Clinical Treatment Trials