Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Of every 100 people with primary liver cancer worldwide, 75 to 90 have HCC. HCC starts in the main liver cells called hepatocytes. It is more likely to develop in men than women and is more common in older people. HCC usually occurs in people who have a liver that is damaged from cirrhosis (scarring of the liver due to previous damage, often caused by hepatitis B and hepatitis C infections or alcohol abuse).

Other types of primary liver cancer include cholangiocarcinoma, which starts in the cells lining the bile duct; angiosarcoma; hepatoblastoma and fibrolamellar HCC.

Risks factors for primary liver cancer

A risk factor is anything that increases your chance of developing a cancer.

Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you to make more informed lifestyle and health care choices.

Risk factors for primary liver cancer (or HCC) include:

  • Cirrhosis, which is scarring of the liver due to previous damage, often a consequence of long-term infection with hepatitis B or C viruses, or alcohol abuse
  • Persistent infection with hepatitis B or C viruses
  • Non-alcoholic fatty liver disease (NAFLD), which is caused by fat deposited in the liver due to obesity and diabetes
  • Haemochromatosis 
  • Age, liver cancer tends to appear more in people older than 60
  • Gender, HCC occurs more often in men than women
  • Environmental factors, exposure to arsenic, aflatoxin
  • Medication, like some types of the contraceptive pills
  • Family history of liver cancer

Symptoms of primary liver cancer

Liver tumours do not function like normal liver tissue. However, the liver function is not usually compromised by tumour tissue until most of the healthy liver has been replaced by the cancer cells. But in a person with cirrhosis of the liver, this might already be the case if less than one-half of the liver has been replaced by tumour.

Liver cancer is sometimes called a silent killer because the majority of patients can seem healthy and have any early signs or symptoms.

Small tumours in the liver are impossible to feel as the liver is shielded by the ribs. Pain is uncommon until the tumour is quite large and even some large tumours do not cause pain or other symptoms.

Later stages of liver cancer when the cancer is very large or when it impairs the functions of the liver the cancer can produce more obvious symptoms. These can include:

  • Pain over the top right of the abdominal area
  • Unexplained weight loss
  • Weakness or tiredness
  • A hard lump under the ribs on the right side of the body
  • Itching
  • Lack of appetite
  • At a late stage, yellowing of the eyes and skin (jaundice) and abdominal swelling (ascites)


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