Liver Cancer: Signs and Symptoms

Liver cancer often causes no symptoms in its earliest stages. That's largely because the liver has a lot of spare capacity — it can lose a lot of function before you'd notice.

When symptoms do appear, they usually mean one of two things: the tumor has grown large enough to feel, or the liver's function is being affected. Often, that second part is tangled up with liver disease that was already there before the cancer. About 42,340 people in the U.S. will be diagnosed with liver cancer this year. Cases have roughly tripled over the past four decades.

A hard lump or area of fullness on the right side of the belly, just below the rib cage, is one of the more distinctive signs. That's where the liver sits.

Pain or discomfort in the upper right belly is common too, sometimes spreading to the right shoulder. General belly swelling can happen as well. It can come from the tumor itself, or from fluid building up in the belly — a sign of impaired liver function doctors call ascites.

Liver cancer often grows in a liver already damaged by cirrhosis. Because of this, several symptoms come from the liver struggling to do its job, not from the tumor directly:

• Jaundice — yellow skin and yellow whites of the eyes, from a buildup of a substance called bilirubin that the liver isn't clearing properly.
• Easy bruising or bleeding, since the liver makes proteins your blood needs to clot.
• Fever with no clear infection.
• Weight loss and loss of appetite, without trying.
• Nausea and vomiting.
• Fatigue and weakness.

Each of these can have other causes. Many overlap with symptoms of cirrhosis or hepatitis on their own, with no cancer involved. That overlap is exactly why people with known cirrhosis or chronic hepatitis get monitored closely, instead of waiting for new symptoms. More on that below.

Most liver cancer grows in a liver already affected by cirrhosis, chronic hepatitis B or C, or fatty liver disease. This matters for symptoms in two ways.

First, many of the symptoms above can come from the liver disease itself, cancer or no cancer. That can hide a new cancer's symptoms inside symptoms someone already has.

Second, it's why people with known cirrhosis or chronic viral hepatitis usually get regular surveillance. This is often an ultrasound every six months, sometimes with a blood test for a marker called AFP. The goal is to catch a new liver cancer before it causes any symptoms at all.

Because of that surveillance, and because scans done for other reasons increasingly catch it, a real share of liver cancer is found before it causes symptoms. This is usually the best-case scenario. Liver cancer found early, especially in a liver that's still working well, has meaningfully better treatment options — including surgery and transplant — than liver cancer found after symptoms show up.

If you have cirrhosis, chronic hepatitis B or C, or another chronic liver condition, ask your doctor if you're due for liver cancer surveillance. Don't skip scheduled ultrasounds.

For anyone: new jaundice, a new lump, or ongoing pain in the upper right belly needs prompt evaluation. So does unexplained belly swelling, or weight loss combined with fatigue. Don't chalk these up to stress or diet on your own — especially if you have a history of liver disease, heavy alcohol use, or hepatitis.

• National Cancer Institute — What Is Liver Cancer?.
• National Cancer Institute — Liver Cancer Causes and Risk Factors.
• American Cancer Society — Key Statistics for Liver Cancer.