Liver Cancer and Liver Tumors Information, Facts and Resources

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Liver cancer is cancer that begins in the tissues of the liver. Sometimes it’s called primary liver cancer. “Primary” means the liver was the starting point.

Cancer that starts somewhere else in the body can spread to the liver. Physicians often refer to this type of cancer by where it started.

For example, a person may have colon cancer that has spread (metastasized) to the liver. This would be called metastatic colon cancer, and tumors in the liver would be called liver metastases, or liver “mets” for short. Sometimes, physicians refer to this as secondary liver cancer. In this case, “secondary” lets you know the cancer started from cells in a different part of the body.

Physicians at Fred Hutch Cancer Center and UW Medicine treat all types of liver cancer and liver metastases. They also treat cancer in related organs, like the gallbladder and the bile ducts outside the liver, and other liver conditions that aren’t cancer, like benign tumors and cysts.

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Types of Liver Cancer

When you see the term “liver cancer” in the rest of this section, we mean primary liver cancer.

The two most common types of liver cancer are hepatocellular carcinoma (HCC) and cholangiocarcinoma, which grows in the bile ducts of the liver.

Knowing the type of cancer is important because it helps your physician better understand which treatments are best for you and if they are working. It also helps your care team know which side effects you might have during treatment.

Hepatocellular carcinoma (HCC)

About 80% of liver cancers are hepatocellular carcinoma. HCC starts in liver cells called hepatocytes. Here are some facts about HCC:

  • HCCs occur most often in people whose liver has been damaged. Causes include chronic infection with the hepatitis B or C virus or alcohol abuse.
  • People with diabetes, hyperlipidemia and obesity (metabolic syndrome) are also at higher risk, often because they develop metabolic dysfunction-associated steatotic liver disease, MASLD (also known as nonalcoholic fatty liver disease, NAFLD) or the subtype metabolic dysfunction-associated steatohepatitis, MASH (also known as nonalcoholic steatohepatitis, NASH).
  • Some cases of HCC are caused by benign (noncancerous) tumors called hepatic adenomas.
  • HCC is also called hepatocellular cancer or hepatoma.

Intrahepatic Cholangiocarcinoma (ICC)

Most other liver cancers are intrahepatic cholangiocarcinoma, also called intrahepatic bile duct cancer. Here are some facts about ICC:

  • ICC starts in the bile ducts inside the liver. The cancer cells are similar to cells that line the ducts.  
  • People are at higher risk for ICC if they have chronic inflammation and damage to their liver (such as from cirrhosis, sclerosing cholangitis, pyogenic cholangiohepatitis or choledochal cysts).
  • Treatment for ICC is often similar to treatment for HCC.

Rare Liver Cancers

There are several other types of liver cancer that are much less common.

  • Angiosarcoma, hemangiosarcoma, hemangiopericytoma and hepatic epithelioid hemangioendothelioma: These start in the liver’s blood vessels. 
  • Hepatoblastoma: This is a disease that affects children.
  • Biliary cystadenocarcinoma: This type occurs mainly in women.
  • Fibrolamellar hepatocellular carcinoma: Usually, this cancer affects people younger than 40.

Cancer in Related Organs and Structures

Cancer may develop in other organs and structures related to the liver. Fred Hutch experts treat all these types of cancer, including:

  • Extrahepatic cholangiocarcinoma: Begins in the bile duct outside the liver that drains into the intestine. 
  • Hilar cholangiocarcinoma: Begins in the bile ducts, where the right and left hepatic ducts meet to form the common hepatic duct. These are sometimes called Klatskin tumors. 
  • Gallbladder carcinoma: A rare cancer, often linked with gallstones. It begins in the lining of the gallbladder.

Other Conditions Related to the Liver

Physicians at the Liver Tumor Clinic at UW Medical Center – Montlake treat conditions that are not cancer but may affect the liver. Some of these conditions can turn into cancers.

Benign Liver Tumors

Many liver tumors are benign (noncancerous). Still, sometimes they need treatment because they cause symptoms or can turn into cancers. These benign tumor types include:

  • Hemangioma: Tumors made up of a tangle of blood vessels. They rarely cause symptoms or require treatment, and there is no evidence that they turn into cancer. These are the most common benign liver tumors.
  • Focal nodular hyperplasia: Tumor-like masses that are usually found when a physician is diagnosing, monitoring or treating some other condition. They usually do not cause symptoms or require treatment.
  • Liver adenoma: These tumors may form in people who have used contraceptives that are high in estrogen for a long time. They can also be caused by other hormone imbalances, like those that happen with polycystic ovarian syndrome. Most of these tumors do not cause symptoms, but they may bleed. They can also turn into hepatocellular carcinoma, but this is rare.

Liver Cysts

Cysts are benign fluid-filled structures. Liver cysts are common, but they rarely cause symptoms, so most people do not know they have them.

  • Simple cysts: The most common and the least likely to cause symptoms.
  • Complex cysts: Have features that may be signs of an underlying disease. They may need treatment.
  • Polycystic liver disease: A rare, inherited condition that causes many cysts to grow in the liver. If there are too many or if they grow too large, they may cause symptoms and need treatment.
  • Echinococcal cysts: Form because a person has a disease caused by a type of tapeworm.
  • Choledochal cysts: Part of a condition that appears at birth (congenital). It blocks the flow of bile from the liver to the gallbladder and intestine. It is usually treated in childhood. Children who have these cysts are at higher risk for a type of bile duct cancer called cholangiocarcinoma.
  • Biliary cystadenomas: Rare fluid-filled tumors linked with the bile ducts that occur mainly in women. They may become cancerous and often need surgery.

How Often Liver Cancer Occurs

Most cancers found in the liver in the U.S are secondary liver cancers — meaning they started somewhere else in the body and spread to the liver. Primary liver cancer is less common. Each year, about 42,000 people in the U.S. are diagnosed with primary liver cancer.

Understanding Liver Cancer

Stages 

Your Fred Hutch care team's treatment for liver cancer will be based partly on the stage of your disease. The stage depends on:

  • How far the cancer has spread in your liver or other parts of your body 
  • How well your liver is working 
  • What symptoms you have 
  • Your overall health 

For liver cancer, Fred Hutch mainly uses the Barcelona Clinic Liver Cancer staging system.

Learn About Liver Cancer Stages

Symptoms

Many symptoms of liver cancer — like pain, swelling or a feeling of fullness in your belly — are not specific to this disease. Other conditions (that aren’t cancer at all) may cause the same symptoms.

If you have any concerns about your liver health, or your health in general, start with letting your primary care provider know. They can ask you questions, do an exam and order any tests needed to tell what’s happening in your body and why.

Read About Liver Cancer Symptoms

Risk Factors, Causes and Prevention

There’s no straightforward way to prevent all cases of liver cancer because physicians don’t know exactly why the disease starts. But there are ways to lower your risk. Some of the factors that increase risk include heavy alcohol use, chronic infection with hepatitis B or C virus or other conditions that cause cirrhosis (when scar tissue replaces healthy liver tissue).

Learn About Liver Cancer Risk Factors and Prevention

Diagnosis and Testing

For many cancers, physicians need to do a biopsy to make the diagnosis. In a biopsy, a physician removes a small sample of tissue to check under a microscope for cancer cells. But this is not usually needed for liver cancer. Imaging tests, like a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may be enough to tell that cancer is present. Blood tests can give your care team further details about your liver health.

Read About Liver Cancer Diagnosis and Testing

Liver Cancer FAQ

Some conditions that can damage the liver appear to raise the risk for liver cancer. These include conditions that can lead to cirrhosis, like chronic hepatitis B or C infection and nonalcoholic steatohepatitis (NASH). Heavy alcohol use raises risk too, especially if it causes cirrhosis. There are several other factors that also affect your risk, including having a family history of liver cancer.

Learn about liver cancer risk factors.

If you have any signs or symptoms that you worry might be from liver cancer, talk with your primary care provider — or your liver specialist if you have one. Your symptoms may be caused by something else, like a different liver problem. Whatever the cause, it’s important to find out so you can get treatment to help. If it is cancer, finding it earlier may mean it’s easier to treat.

Your primary care provider is a good place to start if you have questions or concerns about your risk for getting cancer. They can also help with any symptoms that might be from cancer or another condition. Before you visit your provider, write down your questions. Bring the list to your appointment.

If you’re concerned about risk, here are some questions you may want to ask:

  • Do I have any risk factors for cancer? 
  • Is there any reason to think I’m at higher risk than the average person? 
  • If I am at higher risk, what does this mean for me? 
  • Do I need any tests or procedures to check for cancer even if I feel fine? 
  • Is there anything I can do to lower my risk? 

If you have symptoms that concern you, here are some questions to ask:

  • What could be causing my symptoms? 
  • Do these symptoms mean I might have a serious condition? 
  • How can we find out the cause? Do I need any tests? 
  • What should I do if my symptoms don’t get better or if I get new symptoms?

When physicians and scientists talk about cancer survival rates, they typically mean the percentage of people expected to survive their cancer for at least five years after being diagnosed. (The rate doesn’t include the risk of dying during that time for some other reason.) 

This rate comes from looking at a large, varied group of people. The chance of surviving cancer at least five years can vary greatly from one person to another. It depends on many factors, like how far the cancer has spread. Your Fred Hutch care team can explain how statistics like survival rates might apply to you.

Learn about liver cancer survival rates.

Liver cancer starts when cells in the liver or bile ducts grow out of control. Normally, cells in the body grow and multiply to form new cells as the body needs them. When cells get old or damaged, they die and are replaced. Sometimes, this normal process breaks down. Abnormal or damaged cells grow and multiply when they shouldn’t, forming tumors. Some tumors are cancer, and others are benign (noncancerous). 

Liver cancer spreads by growing into, or invading, nearby tissues. If the cancer cells invade nearby lymph nodes or blood vessels, they can travel through the lymph or blood to distant parts in the body. Then they can form new tumors in these places. 

The Fred Hutch patient and family education team works with other Fred Hutch experts to create reliable resources and select materials from trusted cancer organizations.

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