Liver Cancer

Liver cancer makes up 11% of all GI cancer cases. While many cancers spread to the liver, there are also cases where the cancer originates in the liver. The most common type of primary liver cancer is hepatocellular carcinoma (HCC). Liver cancer rates have tripled since 1980. HCC is much easier to treat when caught early, however many cancers are caught at advanced stages where survival rates are low.

What is liver cancer?

The liver is the largest organ in the body and one of the most critical. It’s located in the upper right side of the abdomen, near the ribs between the diaphragm and the stomach. It performs hundreds of critical functions serving as a filter to the blood. It also makes bile, breaks down fat, makes lymph, and processes sugar. Fun fact: The liver can regenerate.

The liver consists of two sections (called right and left lobes), blood vessels, smaller lobes (lobules), hepatic veins, and bile ducts. 

Cholangiocarcinoma (bile duct cancer) is cancer that forms in the network of small ducts that carry bile away from the liver. While similar, it’s not the same as primary liver cancer (HCC).

Liver metastasis is also different from primary liver cancer and treated with a unique treatment plan.

Types of liver cancer

The majority of primary liver cancers (up to 85%) are hepatocellular carcinoma (HCC). This cancer begins in the liver cells called hepatocytes. It’s a fast-growing, aggressive cancer. 

A small subset of HCC cases are called fibrolamellar hepatocellular carcinoma. This usually affects teens and young adults. 

Intrahepatic cancer (IHC) is technically bile duct cancer (cholangiocarcinoma), but it’s inside your liver. Around 10-25% of all primary liver cancer cases are IHC.

Rare types of liver cancer

A few other very rare types of liver cancer include hepatoblastoma (in children) and several forms of sarcoma that occur in the liver’s blood vessels.

Staging liver cancer

Staging helps you understand the size of your tumor, where the cancer is now, and the best treatment plan for your unique situation. Doctors use a variety of staging systems to determine the extent of liver cancer and plan treatment, there is not a single system used in every health care facility.

Some prefer the TNM staging system that scales solid tumors 0-4 (0-IV), and others use a system with letters A-D.

Learn more about the liver cancer staging systems from the American Cancer Society.

What causes liver cancer?

Risk factors put you at a higher risk of getting cancer. Some risk factors can be controlled with lifestyle changes, and others cannot. Older age, smoking, and obesity increase your risk of many cancers.

Up to 80% of primary liver cancers are caused by long-term hepatitis B (HBV) or hepatitis C (HCV) infections — which can lead to scar tissue in the liver (cirrhosis). 

Just because you have a risk factor, that doesn’t mean you will get cancer. 

These are scenarios researchers have found that can increase your risk: 

• Chronic liver disease and cirrhosis (from hepatitis B or C, alcohol, or fatty liver disease)
• Type 2 diabetes
• Metabolic dysfunction-associated steatotic liver disease (MASLD)
• Certain inherited syndromes like hemochromatosis and Wilson’s disease
• Too much intake of male hormones or anabolic steroids
• Exposure to arsenic or aflatoxins

Preventing liver cancer

There are several steps you can take toward reducing your risk of liver cancer. Protect yourself from viruses like HBV or HCV; there is a HBV vaccine available for both children and adults and several HCV treatments exist. 

As with every cancer, there are steps you can take to adopt a healthy lifestyle and reduce your overall cancer risk, such as maintaining a healthy weight, not smoking, and limiting or eliminating alcohol. 

Learn more about cancer prevention from the American Institute for Cancer Research.

How common is liver cancer? 

The 2025 American Cancer Society estimated rates for liver cancer in the United States:

About 42,240 new cases (28,220 in men and 14,020 in women) will be diagnosed

About 30,090 people (19,250 men and 10,840 women) will die of these cancers

It is more common in men than women, and the average age of diagnosis is 67.

What are my odds of surviving it?

Doctors use what’s called “survival statistics” to understand the likelihood of a patient beating the disease.

Detailed survival statistics are based on where the cancer is located and if it has spread:

Localized

The cancer hasn’t spread

• 45% of cases
• 37.6% alive five years after diagnosis 

Regional

The cancer spread to nearby structures or lymph nodes

• 24% of cases
• 13.2% alive five years after diagnosis 

Distant

The cancer has spread to other organs

• 21% of cases
• 3.5% alive five years after diagnosis 

What types of tests should I expect to undergo?

Doctors will likely use these tests to diagnose primary liver cancer:

• Blood test checking for alpha fetoprotein (AFP)
• Blood tests checking bilirubin, liver enzymes, and tumor markers
• Ultrasound
• Biopsy

Angiogram, CT scan, MRI, PET scan, bone scan, and ERCP test may also be used to identify and diagnose liver cancer.

Ask your doctor about these additional tests—ideally before you begin treatment.

• Biomarker testing
• Genetic testing

I’m facing a diagnosis: What are my next steps?

If you’re facing a diagnosis, the GI Cancers Alliance is here for you. 

If you’re newly diagnosed, work with your doctor to create a treatment plan. It’s important to find an expert who specializes in primary liver cancer and visit a major cancer center if possible. Some major cancer centers will be able to operate on you, even if you’ve been told you’re inoperable.

For doctors planning liver cancer treatment, an analysis called performance status will impact the recommended treatment. This evaluates your ability to perform daily tasks and your level of fitness. If you have a lower performance status, you might not be recommended for certain treatments.

Liver cancer treatment plans may include:

• Surgery (possible liver transplant)
• Ablation
• Embolization
• Chemotherapy 
• Radiation 
• Targeted therapy
• Immunotherapy

We strongly encourage you to get a second opinion from another trusted doctor so you feel confident moving forward.