Quick answer

What is liver cancer?

Liver cancer can start in the liver (primary — most commonly hepatocellular carcinoma) or spread from elsewhere (secondary metastases). In the UK, secondary liver cancer is more common than primary. Primary liver cancer is strongly linked to cirrhosis from hepatitis B or C, alcohol, and fatty liver disease. Symptoms include jaundice, upper abdominal pain, weight loss, and swelling of the abdomen. Treatment depends on cancer type, liver function, and spread.

Liver cancer — primary and secondary

Liver cancer is not a single disease. Primary liver cancer starts in liver cells — hepatocellular carcinoma (HCC) accounts for most cases. Secondary liver cancer — metastases from cancers elsewhere — is actually more common in the UK than primary liver cancer.

Understanding which type you have determines treatment and outlook.

Primary liver cancer — hepatocellular carcinoma

HCC almost always develops in a liver already damaged by cirrhosis. The cirrhosis may result from:

  • Hepatitis B or C — chronic viral infection
  • Alcohol-related liver disease
  • Non-alcoholic fatty liver disease (NAFLD)
  • Haemochromatosis — iron overload
  • Primary biliary cholangitis

Without cirrhosis, HCC is uncommon but possible — particularly with hepatitis B infection.

Symptoms

Early liver cancer is often silent — especially in people used to living with chronic liver disease. As it progresses:

  • Jaundice — yellowing of skin and whites of eyes
  • Pain in the upper right abdomen
  • Unexplained weight loss and poor appetite
  • Abdominal swelling — ascites (fluid build-up)
  • Fatigue
  • Nausea

Anyone with known cirrhosis should have 6-monthly ultrasound surveillance — early HCC is treatable; late HCC is much harder to manage.

Diagnosis

  1. Blood tests — liver function, clotting, AFP tumour marker
  2. Ultrasound — first-line imaging; surveillance tool
  3. CT or MRI with contrast — characterises lesions using LI-RADS criteria
  4. Biopsy — when imaging is inconclusive
  5. Staging — tumour size, vascular invasion, spread, liver function

Treatment for primary liver cancer

Treatment depends on cancer stage, liver function, and overall fitness.

Curative options (early disease, good liver function):

  • Surgical resection — removing the tumour
  • Liver transplantation — selected patients within Milan criteria
  • Ablation — radiofrequency or microwave destroying small tumours

Locoregional therapy:

  • Transarterial chemoembolisation (TACE) — chemotherapy delivered directly to the tumour
  • Selective internal radiation therapy (SIRT)

Systemic therapy (advanced disease):

  • Sorafenib, lenvatinib — targeted drugs
  • Atezolizumab plus bevacizumab — immunotherapy combination
  • Best supportive care — symptom management

Secondary liver cancer

When cancer spreads to the liver from bowel, breast, lung, or pancreas, treatment follows the primary cancer pathway. Selected patients with bowel cancer metastases limited to the liver may be offered surgical resection or ablation.

Prevention

  • Treat hepatitis B and C — antiviral therapy reduces cirrhosis and HCC risk
  • Limit alcohol — stay within UK guidelines (no more than 14 units weekly)
  • Manage fatty liver disease — weight loss and diabetes control
  • Attend surveillance if you have cirrhosis

See liver cirrhosis for how chronic liver damage develops and hepatitis for viral liver infection management.

Common questions

What is the difference between primary and secondary liver cancer?
Primary liver cancer starts in the liver — hepatocellular carcinoma (HCC) is the most common type. Secondary liver cancer (liver metastases) has spread from another organ such as the bowel, breast, lung, or pancreas. Treatment differs significantly — secondary cancer is treated according to where it originated.
What are the symptoms of liver cancer?
Early liver cancer may cause no symptoms. As it grows, signs include jaundice (yellow skin and eyes), pain in the upper right abdomen, unexplained weight loss, loss of appetite, nausea, swelling of the abdomen from fluid (ascites), and fatigue. Symptoms may develop gradually in people with existing liver disease.
What causes primary liver cancer?
Most primary liver cancers develop in livers already damaged by cirrhosis. Causes of cirrhosis include long-term hepatitis B or C infection, heavy alcohol use, non-alcoholic fatty liver disease, haemochromatosis, and primary biliary cholangitis. Without cirrhosis, primary liver cancer is less common but can still occur.
How is liver cancer diagnosed?
Blood tests assess liver function and AFP (alpha-fetoprotein) — a tumour marker. Ultrasound, CT, and MRI characterise lesions. Biopsy or imaging criteria confirm diagnosis. Staging considers tumour size, liver function (Child-Pugh score), and spread.
Can liver cancer be cured?
Early hepatocellular carcinoma in patients with well-preserved liver function may be cured with surgical resection, liver transplant, or ablation. Advanced disease is harder to cure but treatments including transarterial chemoembolisation (TACE), targeted drugs such as sorafenib, and immunotherapy can extend survival.
Who needs liver cancer surveillance?
People with cirrhosis — from any cause — should have ultrasound every 6 months to detect early liver cancer when treatment is most effective. This includes people with hepatitis B or C, alcohol-related liver disease, and advanced fatty liver disease.
How is secondary liver cancer treated?
Treatment depends on the primary cancer type. Options may include chemotherapy, targeted therapy, immunotherapy, or in selected cases surgery to remove liver metastases — particularly from bowel cancer with limited spread.

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