Primary liver cancer is a malignant (cancerous) tumour that starts in the liver. The most common type of primary liver cancer in adults is hepatocellular carcinoma (HCC), which starts in the hepatocytes, the main type of liver cell.
Less common types of primary liver cancer include:
Cancers in the liver can either be a primary or secondary cancer. The two types of cancer are different. Secondary liver cancer is cancer that has started in another part of the body and spread to the liver. It is more common than primary liver cancer in Australia. If you are unsure if you have primary or secondary liver cancer, check with your doctor.
Function and anatomy of the liver
The largest organ inside the body, the liver is about the size of a football. It is part of the digestive system, working with the gall bladder and pancreas to help break down food and turn it into energy. The liver has many important jobs, including:
- storing sugars and fats, so they can be used for energy
- producing bile to help dissolve fat so it can be easily digested
- making proteins to help blood clot and to balance fluid in the body
- breaking down harmful substances, such as drugs and alcohol.
The liver is found on the right side of the abdomen (belly), sitting just above the stomach and under the rib cage. It is divided into two main sections – the right and left lobes.
How the liver works
Blood flows into the liver from the hepatic artery and the portal vein. The hepatic artery carries blood from the heart. The portal vein carries blood from the digestive organs to the liver.
Bile is carried between the liver, the gall bladder and the first part of the small bowel (the duodenum) by a series of tubes called bile ducts. The common bile duct carries bile from the liver and the gall bladder to the bowel, where the bile helps to break down and absorb fats and other nutrients from food.
The liver can continue to work when only a small part is healthy. A healthy liver may be able to repair itself if it is injured or part of it is surgically removed during cancer treatment.
How common is liver cancer?
In Australia, more than 2800 people are diagnosed with primary liver cancer each year, with about three times more men than women affected.
The rate of primary liver cancer has almost doubled since 2002, which is possibly due to increasing rates of obesity, type 2 diabetes, hepatitis B and C infections, drinking too much alcohol, and an ageing population. More than 70% of cases occur in people aged 60 and over.
Learn more about liver cancer statistics and trends
Symptoms
Liver cancer often doesn’t cause any symptoms in the early stages, and cancer that is diagnosed and treated before symptoms appear often has very good outcomes. As the cancer grows or spreads, it may cause symptoms, such as:
- weakness and tiredness (fatigue)
- pain in the abdomen (belly) or below the right shoulder blade
- hard lump on the right side of the abdomen
- appetite loss, feeling sick (nausea), or unexplained weight loss
- yellowing of the skin and eyes (jaundice)
- dark urine (wee) and pale faeces (poo)
- itchy skin
- a swollen abdomen caused by fluid build-up (ascites).
Risk factors
Primary liver cancer most often develops in people with underlying liver disease, usually cirrhosis. In cirrhosis, healthy liver cells are replaced by scar tissue, and benign nodules (non-cancerous lumps) form throughout the liver. As this gets worse (advanced cirrhosis), the liver stops working properly. Cirrhosis may be caused by:
- long-term (chronic) infection with hepatitis B or C virus
- drinking too much alcohol
- metabolic-associated fatty liver disease (MAFLD) as a result of obesity and/or type 2 diabetes
- having too much iron in the bloodstream (haemochromatosis).
A small but increasing number of people are developing liver cancer without cirrhosis. This may occur in people with long-term hepatitis B infection, or with liver disease related to obesity or type 2 diabetes.
Other risk factors for liver cancer are smoking tobacco or having a family history of HCC. Aboriginal and Torres Strait Islander peoples and migrants from countries with higher rates of hepatitis B infection (including Asia, the Pacific Islands and Africa) are also at greater risk. The more risk factors a person has, the greater the chance of developing liver cancer.
The link between hepatitis and liver cancer
Worldwide, up to 8 in 10 cases of liver cancer (HCC) can be linked to infection with the hepatitis B or C virus (viral hepatitis). This is changing as vaccinations and effective treatments for viral hepatitis are helping to reduce the rates of hepatitis-related liver cancer.
Hepatitis B and C spread through contact with infected blood, semen or other body fluids. The most common way hepatitis B spreads is from an infected mother to a baby during birth. Hepatitis B can also be transmitted during unprotected sex with an infected partner, or by sharing personal items, such as razors or needles, with an infected person.
Hepatitis C is usually transmitted through the sharing of needles during illicit drug use, tattooing, sharing personal items, or contaminated medical equipment.
Viral hepatitis infects the liver cells (hepatocytes). When the body’s immune system attacks the virus, the liver becomes inflamed. Infection that lasts for more than six months may lead to liver damage (cirrhosis), which increases the risk of primary liver cancer.
All babies in Australia are offered the hepatitis B vaccine at birth. To further prevent the spread of hepatitis B, at-risk people should also be vaccinated. If you already have hepatitis B, vaccination won’t be helpful, but you will usually have regular tests to ensure you don’t develop cancer or other liver problems. If you also have signs of liver damage, you may be offered antiviral medicines to help prevent further damage.
There is no vaccine for hepatitis C infection, but effective medicines are available and the virus can often be cured. While this treatment can lower the risk of primary liver cancer, it does not eliminate it. Importantly, people with cirrhosis should have long-term monitoring for liver cancer.
Bile duct cancer (cholangiocarcinoma)
This uncommon form of primary liver cancer accounts for about 10–15% of all liver cancers worldwide. Bile duct cancer (cholangiocarcinoma) starts in the cells lining the ducts that carry bile between the liver, gall bladder and bowel. Most risk factors are similar to those of HCC, but exposure to certain chemicals in the print industry may also increase the risk of developing bile duct cancer.
Learn more
Health professionals
Your GP will arrange the first tests to assess your symptoms or to follow up abnormal results from ultrasound or blood tests that have been done to check for liver cancer.
If these tests show that you have liver cancer – or there is concern about possible cancer – you will usually be referred to a specialist, who will arrange further tests. This is likely to be a hepatobiliary surgeon, gastroenterologist or hepatologist.
If liver cancer is diagnosed, the specialist will consider treatment options. Often these will be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting.
During and after treatment, you will see a range of health professionals who specialise in different aspects of your care, including an interventional radiologist, hepatology nurse, occupational therapist and dietician, among others. Primary liver cancer is challenging to treat and it is recommended that you are treated in a specialist treatment centre if possible.
Questions to ask your doctors
Asking your doctor questions will help you make an informed choice. You may want to include some of the questions below in your own list.
Diagnosis
- What type of liver cancer do I have? Is it a primary or a secondary cancer?
- Has the cancer spread? If so, where has it spread? How fast is it growing?
- Are the latest tests and treatments for primary liver cancer available in this hospital?
- Will a multidisciplinary team be involved in my care?
- Are there clinical guidelines for this type of cancer?
Treatment
- What treatment do you recommend? What is the aim of this treatment?
- Are there other treatment choices for me? If not, why not?
- If I don’t have the treatment, what should I expect?
- How long do I have to make a decision?
- I’m thinking of getting a second opinion. Can you recommend anyone?
- How long will treatment take? Will I have to stay in hospital?
- Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it?
- How will we know if the treatment is working?
- Are there any clinical trials or research studies I could join?
Side effects
- What are the risks and possible side effects of each treatment?
- Will I have a lot of pain? What will be done about this?
- Can I work, drive and do my normal activities while having treatment?
- Will the treatment affect my sex life and fertility?
- Should I change my diet or physical activity during or after treatment?
- Are there any complementary therapies that might help me?
After treatment
- How often will I need check-ups after treatment?
- If the cancer returns, how will I know? What treatments could I have?
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for liver cancer can help you make sense of what should happen. It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
Understanding Liver Cancer
Download our Understanding Liver Cancer booklet to learn more and find support.
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Expert content reviewers:
A/Prof Simone Strasser, Hepatologist, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital and The University of Sydney, NSW; A/Prof Siddhartha Baxi, Radiation Oncologist and Medical Director, GenesisCare, Gold Coast, QLD; Prof Katherine Clark, Clinical Director of Palliative Care, NSLHD Supportive and Palliative Care Network, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Anne Dowling, Hepatoma Clinical Nurse Consultant and Liver Transplant Coordinator, Austin Health, VIC; A/Prof Koroush Haghighi, Liver, Pancreas and Upper Gastrointestinal Surgeon, Prince of Wales and St Vincent’s Hospitals, NSW; Karen Hall, 131120 Consultant, Cancer Council SA; Dr Brett Knowles, Hepato-Pancreato-Biliary and General Surgeon, Royal Melbourne Hospital, Peter MacCallum Cancer Centre and St Vincent’s Hospital, VIC; Lina Sharma, Consumer; David Thomas, Consumer; Clinical A/Prof Michael Wallace, Department of Hepatology and Western Australian Liver Transplant Service, Sir Charles Gairdner Hospital Medical School, The University of Western Australia, WA; Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT
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The information on this webpage was adapted from Understanding Liver Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in July 2022.