What is liver cancer
Liver cancer occurs when liver cells develop changes in their DNA. Cellular DNA is the material that provides instructions for every chemical process that occurs in our body. Mutations in DNA can cause changes in these instructions. As a result, cells can begin to grow uncontrollably and form a tumor, which is simply a cluster of cancer cells.
The liver, roughly the size of an American football, is located in the upper right part of the abdomen. There are two types of cancer that can affect it: one that starts in the liver itself, called a primary tumor, and one that originates in another organ and, as it progresses, spreads to the liver, known as secondary or metastatic.
Liver Cancer: Statistics
Liver cancer is much more common in sub-Saharan African and Southeast Asian countries, but the American Cancer Society estimates that in 2023, about 41,630 new cases (28,000 in men and 13,630 in women) of primary liver cancer and intrahepatic cholangiocarcinoma were diagnosed in the United States.
The incidence rates (new cases) of liver cancer have more than tripled since 1980, while mortality rates have more than doubled during this period. According to INCA, the estimated number of new cases of liver cancer for Brazil, for each year from 2023 to 2025, is 10,700 cases, ranking 15th among the most frequent types of cancer, with the highest incidence rates observed in the Southern Region, for both men and women.
Worldwide, more than 900,000 people are diagnosed with this type of neoplasm annually. It also leads in the number of cancer-related deaths, accounting for more than 830,000 deaths per year.
The risk factors for liver cancer include:
- Chronic infection caused by hepatitis B or C viruses;
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- Cirrhosis (chronic inflammation in the liver);
- Some inherited liver diseases, such as hemochromatosis and Wilson’s disease;
- Diabetes;
- Non-alcoholic fatty liver disease (NAFLD), which causes fat buildup in the liver;
- Exposure to aflatoxins (poisons produced by fungi that grow on improperly stored foods exposed to moisture, such as some grains and nuts);
- Excessive alcohol consumption;
- Smoking;
- Use of anabolic steroids.
Factors that may protect against liver cancer include:
- Hepatitis B vaccination;
- Proper treatment of viral hepatitis;
- Avoiding alcohol and tobacco use;
- Healthy lifestyle habits such as a quality diet and regular physical activity.
Types of liver cancer
Hepatocellular carcinoma, which begins in hepatocytes (cells located in the liver), is the most common type of liver cancer. It occurs most frequently in individuals with chronic liver diseases, such as cirrhosis, which can be caused by infection from hepatitis B or hepatitis C, steatohepatitis, alcoholism, among other factors.
Other neoplasms can also occur:
Most people do not show signs and symptoms in the early stages of primary liver cancer. When they are present, they can manifest in the following ways:
- Unexplained weight loss;
- Loss of appetite;
- Pain in the upper abdomen;
- Nausea and vomiting;
- Feeling of weakness and fatigue;
- Abdominal swelling (ascites);
- Presence of an abdominal mass;
- Onset of jaundice, which is characterized by yellowing of the skin and the whites of the eyes; and
- Pale, chalky stools.
Diagnosis of liver cancer
Diagnosis of liver cancer is often challenging because signs and symptoms usually don’t appear until the disease is in an advanced stage.
Screening tests for liver cancer are not widely recommended for the general population. This means that tests should not be requested (a process called screening) for people who do not have symptoms. However, tests may be recommended for some individuals at higher risk, such as those with cirrhosis, hemochromatosis (excess iron buildup in the body), or chronic hepatitis B infection.
Depending on the symptoms and medical suspicion, tests typically include:
- Laboratory tests, such as blood tests, to evaluate alpha-fetoprotein (AFP, a tumor marker);
- Imaging tests, such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), to visualize tumors, their extent, and whether they have spread to other parts of the body;
- Liver biopsy, where a needle is inserted into the lesion to remove a piece for microscopic analysis to determine if it is malignant or benign;
- Exploratory laparoscopic surgery, which allows direct visualization of the organ and biopsy.
Treatment
Once liver cancer is diagnosed and assessed by initial tests, it can be classified into stages ranging from very early disease to advanced. Treatment varies depending on the stage of the disease.
Disease in earlier stages can be curable with procedures such as:
- surgery;
- ablation;
- embolization;
- liver transplant.
The most appropriate approach when the tumor is restricted to only one part of the liver (primary tumor) is its resection (surgical removal). However, some patients with cirrhosis do not tolerate the removal of part of the liver and, in these cases, other types of treatment may be necessary (ablation, chemoembolization, radiation therapy, liver transplant), depending on the size, number of lesions, and other characteristics.
In some cases, metastases from other tumors that have spread to the liver can also be operated on with the intention of cure, usually after the resection of the initial tumor from which the metastasis arose.
Other important treatment options include:
For advanced-stage disease, treatments aim to control the disease, improve symptoms, and quality of life, prolonging the patient’s life. These treatments include:
- Immunotherapy – involves the use of medications that help the person’s own immune system identify and destroy cancer cells;
- Targeted therapies – medications that enter the bloodstream and spread throughout the body, fighting cancer. They are often more effective than chemotherapy in primary liver cancer;
- Chemotherapy – one or more specific medications enter the bloodstream to eliminate cancer cells by attacking their DNA, but in a more specific way, meaning they can also attack other non-cancerous cells (which causes more side effects).
Prevention
To prevent any type of cancer, it is important to avoid its risk factors. In the case of liver cancer, it is important to be vaccinated against hepatitis B, prevent hepatitis C (by using condoms during sexual intercourse),
As well as by not sharing sharp objects, such as needles, taking care with hygiene and sterilization measures in manicures and tattoo artists), and avoiding factors that can trigger cirrhosis, such as excessive alcohol consumption and being overweight.
