Liver Cancer Symptoms

What Is Liver Cancer?

Primary liver cancer is fast-growing cancer that starts in the liver. In contrast, secondary liver cancer is the type of cancer that starts in another body part but spreads to the liver.

The liver is the second largest organ (after the skin) in the body and plays an important role in;

Filtering blood
Storing nutrients
Converting fat into energy
Making bile

Breaking down and removing toxins from the body. [¹] [²]

In primary liver cancer, malignant cells form in the liver tissues. Adult primary liver cancer has many different types. The most important ones are:

Hepatocellular carcinoma.
Bile duct cancer, or cholangiocarcinoma
Angiosarcoma.

Hepatocellular carcinoma is the most prevalent form of primary liver cancer, and in 2020, liver cancer caused almost 28,227 deaths. [³] Hepatocellular carcinoma commonly appears in older individuals who have been suffering from chronic liver disease for a long time. This type of liver cancer is also strongly associated with chronic HBV and HCV infections. Environmental exposure to certain toxins, ethanol abuse, and metabolic syndrome also leads to the development of liver cancer. [⁴]

Types of Liver Cancer

Primary lung cancer can occur in children and adults, but the treatment protocol is different for both groups.

There are 5 main types of primary lung cancer. These are:

Hepatocellular Carcinoma (HCC)

HCC develops from hepatocytes, which are the main liver cells. It is more prevalent in people with cirrhosis. Hepatocellular carcinoma has different growth patterns, and almost 73% of all primary liver cancers appearing in adults are hepatocellular carcinomas. Men are more likely to develop HCC than women.

Bile Duct Cancer

Bile duct cancer, or cholangiocarcinoma, develops from bile duct cells. Bile duct cancer is a rare type of liver cancer; it accounts for almost 18% of adult primary liver cancer cases.

Angiosarcoma

Angiosarcoma is a type of soft tissue sarcoma and starts in liver blood vessels. Angiosarcoma is again a rare type of liver cancer (almost 1% of all primary liver cancer cases). It commonly occurs in older individuals and grows very rapidly.

Fibrolamellar Carcinoma

Fibrolamellar carcinoma develops in teens and adults who are in their 20s and 30s. Fibrolamellar carcinoma is not associated with hepatitis B or C infection or liver cirrhosis. [⁵]

Hepatoblastoma

Hepatoblastoma is a type of liver cancer that is common in children who are younger than 3 years. [⁷] [⁸]

How Is Liver Cancer Diagnosed?

Liver cancer is diagnosed by tests that examine the liver and blood. These include:

Physical Examination

Physical examination involves checking the body for lumps and other abnormal signs like swelling. The patient’s family and medical history, habits, and lifestyle are also taken into account.

Alpha-Fetoprotein (AFP) Tumor Marker Test

AFP tumor marker test is done in conjugation with ultrasonography to detect hepatocellular carcinoma. Elevated levels of AFP in the bloodstream indicate the presence of cancer. However, even non-cancerous conditions can result in high levels of AFP in the blood. [¹³]

LFTs

Liver function tests measure the amount of protein and enzymes produced or cleared by the liver. Higher than usual amounts of these substances in the liver indicate that the liver isn’t working properly.

CT Scan

CT or CAT scans find many liver tumors and give information about their size, shape, and location.

MRI Scan

An MRI scan can create detailed images using magnetism and radio waves and help find out the presence of cancer in the liver. [¹⁴]

Biopsy

A biopsy is done when imaging tests like a CT scan or MRI don’t confirm the diagnosis of liver cancer. A sample of liver tissues is removed and then examined under a microscope to detect signs of cancer. [¹⁵]

Liver Cancer Staging

The TNM staging system classifies liver cancer on 3 factors:

T: Size of tumor and its growth into nearby structures.
N: Spread of cancer to nearby lymph nodes.
M: Metastasis of cancer to distant organs and lymph nodes.

Is Liver Cancer Hereditary?

The chances of developing liver cancer in an individual increase if there is a family history of the disease. Many risk factors are associated with the development of HCC, which include transmitting HBV infection from mother to child during childbirth, through semen during sexual contact, or by sharing needles, in which the virus is transited through blood.

Certain genetic conditions may also increase the risk of developing cancer in the liver, which includes alpha-1 antitrypsin deficiency and Wilson disease. [¹⁷]

Liver Cancer Symptoms

Adult primary liver cancer can cause many symptoms in affected individuals, which resembles symptoms caused by other diseases as well. It is essential to get yourself checked by a doctor as soon as you spot any abnormality in your body.

Discomfort on the upper right side of the abdomen.
Swelling in the abdomen.
Formation of a hard and painful lump on the right side of the abdomen below the ribcage.
Pain in the back and near the right shoulder blade.
Weakness, nausea, and vomiting.
Jaundice.
Weight loss.
Dark urine.
Pale-colored stools. [⁹]

What Are the Symptoms of Liver Cancer?

The liver cancer symptoms differ for every affected individual, and many symptoms may point towards other conditions. This means getting proper checkups, and diagnostic tests are essential to detect liver cancer at an early stage.

Symptoms of Hepatocellular Carcinoma

HCC carries a lesser fiver year survival rate because this type of liver cancer is usually diagnosed at an advanced stage. The multiple symptoms appearing in HCC patients are;

Pain in abdomen
Weight loss
Obstructive symptoms, like jaundice and ascites. [¹²]

Symptoms of Fibrolamellar Carcinoma

Fibrolamellar carcinoma is a rare subtype of liver cancer, and many patients do not realize that they have the disease until the tumor gets larger and symptoms start to appear, such as;

Pain in the shoulder, abdomen, and back.
Malaise.
Jaundice. [⁵]

Symptoms of Hepatoblastoma

A child can start showing symptoms of hepatoblastoma as the tumor gets bigger in size. The symptoms of hepatoblastoma include;

Swelling in abdomen
A painful lump formed in the abdomen
Loss of appetite and weight. [⁶]

Symptoms of Bile Duct Cancer

The symptoms of bile duct cancer mostly appear due to blockage of the bile duct. These include;

Jaundice
Pale colored stools
Darker urine
Itchy skin
Fever, nausea, and vomiting. [¹⁰]

Symptoms of Angiosarcoma

When angiosarcoma grows in a deep organ of the body, like the liver, it doesn’t show any obvious symptoms. Most symptoms of hepatic angiosarcoma are non-specific, such as:

Pain in the right upper portion of the abdomen
Distention
Jaundice
Weight loss
Fatigue [¹¹]

What Are Some Signs of Liver Cancer?

When liver cancer causes symptoms, a doctor orders several tests that confirm the diagnosis of the disease.

Blood Test Results

LFTs are important blood tests that detect any abnormality in the liver. Blockage of the bile duct can raise the levels of certain enzymes and proteins in the liver, such as;

Alanine aminotransferase (ALT)
Alkaline phosphatase (ALP)
Aspartate aminotransferase (AST), etc.

LFTs also measure the amount of bilirubin and albumin in the blood. [¹⁸]

Imaging Tests

Imaging tests like MRI, CT, and CEUS have replaced the more invasive methods for diagnosing liver cancer. The arterial phase enhancement is considered a definitive imagining feature of hepatocellular carcinoma.

Imaging tests play an important role in diagnosing HCC. But when the imaging features don’t lead to a confirmed diagnosis, other non-invasive imaging tests like DWI and hepatocyte-specific MRI are used to diagnose cancer and assess post-treatment outcomes. [¹⁹]

Symptoms of Liver Cancer in Women vs. Symptoms of Liver Cancer in Men

The deaths caused by hepatocellular carcinoma per year have increased by 2.8 percent for males and 3.4% for females. Men have an incidence rate of 11.5 per 100,000 cases as compared to 3.9 for women1. [⁴]

1 Note that here, we are using the terms “women” and “men” to refer to female and male biological sex at birth, respectively.

In this study, [²⁰] gender-based differences in HCC patients were evaluated to assess the individuals at high risk for the disease.

Females were likely to develop HCC at older ages (> 65 years old), but they had a lesser incidence of HBV surface Ag and HCV positivity. Older females were more likely to have NASH/NAFLD-related hepatocellular carcinoma.

Males are more likely to develop chronic hepatitis, acquire HBV and HCV, and cirrhosis, thus leading to hepatocellular carcinoma. These gender differences in hepatitis infections also influence the male predominance of the disease.

The symptoms of liver cancer in males include:

Feeling swollen or sore in the upper right abdomen area.
Yellow eyes.
Joint pain.
Fatigue.
Skin rashes.
Confusion and disorientation.

The symptoms of liver cancer in females include:

Abdomen swelling.
The feeling of fullness after a small meal.
Losing weight.
Feeling sick.
Enlarged and swollen veins on the abdomen are visible through the skin.
Abnormal bruising and bleeding.

Risk Factors for Liver Cancer

The known risk factors of liver cancer include:

Chronic viral hepatitis leads to cirrhosis and cancer of the liver.
Gender, with hepatocellular carcinoma being more prevalent in men.
Cirrhosis, which damages liver cells and replaces them with scar tissue, increases the risk of liver cancer.
Heavy alcohol abuse is a leading cause of cirrhosis.
Obesity also increases the chances of developing liver cirrhosis and cancer. [²¹]

Liver Cancer Prevention

The prevention of liver cancer includes avoiding the risk factors and encouraging protective factors;

Getting proper treatment for chronic hepatitis B infections.
Reducing exposure to aflatoxin B1 by reducing consumption of foods containing this poison.
Vaccinating newborns against HBV. [¹⁷]

Liver Cancer Prognosis and Treatment

Liver cancer is curable if a patient successfully receives a liver transplant. However, it is not possible to transplant the liver in most cases. Surgery is also a successful way to remove part of the liver which has cancer, thus improving the survival rates of the patients.

The Liver Cancer Survival Rate

According to SEER cancer, the five-year survival rate of liver cancer patients according to the disease stages are:

Localized: 35.3%
Regional: 12.3%
Distant: 2.7%. [²²]

Liver Cancer Treatment Options

The treatment of liver cancer mainly depends on whether the cancer can be cured or if the survival rate can be improved.

The most common treatment procedures for liver cancer include:

Surgery
Radiation therapy
Targeted therapy
Immunotherapy
Radiofrequency ablation, etc. [²³]

Conclusion

Takeaway

Primary liver cancer is a serious and life-threatening disease. Cancer doesn’t often produce symptoms until it has advanced to a later stage. This is why many treatment procedures focus on relieving symptoms and slowing cancer growth to improve the quality of life of a patient.