Cancer of the Liver

Cancer of the liver is on the rise. It is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer-related deaths. A significant risk factor for liver cancer in the United States is chronic hepatitis C virus (HCV).^1,2

What is liver cancer?

Cancers can start in many places within the body and spread. “Liver cancer” refers to cancer that starts in the liver. The most common form of liver cancer is hepatocellular carcinoma (HCC). Hepatocytes are a type of cell in the liver. Like other cancers, as HCC advances, it can spread throughout the body and become life-threatening.³

Liver cancer and HCV

About 30 percent of all liver cancer cases in the United States are due to HCV. Almost all of these cases are in people with cirrhosis.^1,4,5

Cirrhosis is permanent scarring of the liver due to damage. Many things, including HCV, can cause cirrhosis. But it takes decades for this damage to occur. Only about 20 percent of all people with HCV will develop cirrhosis.^2-6

There are several ideas on why HCV causes liver cancer. First, the virus itself may increase the risk of cancer development.⁵

Another thought is related to liver cells constantly trying to repair themselves. As HCV progresses, liver cells become damaged and scarred. At first, this damage may be reversible (called fibrosis). But over time, the damage becomes permanent (cirrhosis).⁴

During all this, liver cells try to regenerate themselves to fight back against scarring. As cells replicate and repair themselves, they are more likely to develop mutations (errors) that can lead to cancer.⁴

What are the symptoms of liver cancer?

Liver cancer can be hard to spot early on. It does not have many symptoms until it progresses. Common symptoms a person might experience include:^2,3

• Weight loss
• Nausea, vomiting, or loss of appetite
• Swollen or painful belly
• Lump on the right side of the belly below the rib cage
• Back or right shoulder pain
• Yellowing of the skin and whites of eyes (jaundice)
• Easy bruising or bleeding
• Fatigue or severe tiredness
• Changes in the color of bowel movements

Talk to your doctor if you notice any of these symptoms and have concerns.

Liver cancer treatment

Liver cancer can be treated in a variety of ways. The choice of treatment depends on the stage (spread) of the cancer, its exact location, and other factors. Several standard treatment options include:³

• Surgery (to remove a tumor)
• Heating or freezing cancer cells (called local ablation)
• Chemotherapy
• Radiation
• Other drugs like targeted therapies or immunotherapies
• Liver transplant

Risk factors for liver cancer

Risk factors increase the chances that a person will develop a health condition. But having one or more risk factors does not mean a person will certainly have the condition. Each person’s liver cancer risk will be different, but several common risk factors are thought to play a role. These include:^1-6

• Cirrhosis of the liver (from a chronic infection, alcohol use, autoimmune conditions, or other causes)
• HCV or hepatitis B virus (HBV) infection
• History of liver conditions (nonalcoholic fatty liver disease or inherited conditions like Wilson disease)
• Diabetes
• Smoking
• Obesity
• Heavy, long-term alcohol use
• Exposure to toxins or molds
• Steroid use
• Family history of liver cancer

This is not a complete list of all potential risk factors for liver cancer. If you are concerned about your risk, talk with your doctor.

Preventing liver cancer

There is no guaranteed way to prevent liver cancer. But there are things you can do to reduce your risk. These include:^2,3,6

• Getting vaccinated against HBV
• Getting regular tests for HBV and HCV if you are at increased risk
• Practicing risk reduction strategies for hepatitis viruses
• Treating HBV or HCV if diagnosed
• Keeping a healthy weight
• Reducing or quitting smoking
• Reducing or stopping alcohol use

Treating HCV and liver cancer risk

Treating HCV to prevent cirrhosis from developing can also help reduce liver cancer risk. Treating HCV with direct-acting antiviral drugs (DAAs) may reduce risk even for those with cirrhosis. DAAs may also reduce the risk of death in those with early-stage HCC that has been treated.^4,7-9