Remembering David Bowie: What Liver Cancer Really Is

What was actually announced

David Bowie died on 10 January 2016, at 69. The statement posted to his official social media accounts said he "died peacefully, surrounded by his family" after an "18-month battle with cancer." The BBC and the Guardian both reported that wording the next day.

His son, the director Duncan Jones, wrote on Twitter: "Very sorry and sad to say it's true. I'll be offline for a while. Love to all."

The announcement did not name a type of cancer, and the family asked for privacy. This article does not speculate.

What it can do is explain liver cancer. Most people know little about it, and one of its central facts gets misread constantly.

Two completely different things share the phrase "liver cancer"

MedlinePlus, from the National Library of Medicine, draws the line in two sentences. Primary liver cancer starts in the liver. Metastatic liver cancer starts elsewhere and spreads there.

Those are not the same disease, and they are not treated alike. Breast cancer that has spread to the liver is still breast cancer. It is made of breast cells and treated with breast cancer drugs. Colon cancer in the liver is colon cancer.

Only the first kind is what oncologists mean by liver cancer. Its most common form is hepatocellular carcinoma, or HCC, which starts in the main working cells of the liver.

This is not pedantry. When a scan finds spots in the liver, the whole question is whether they started there or arrived from elsewhere. The answer changes everything that follows.

What the liver does, and what damages it

The liver is the largest organ inside the body. MedlinePlus lists its jobs: digesting food, storing energy, and removing poisons.

Primary liver cancer usually grows in a liver that has been injured for years. The National Cancer Institute lists these risk factors for hepatocellular cancer:

• Long-term infection with hepatitis B or hepatitis C.
• Cirrhosis, meaning scarring of the liver.
• Heavy alcohol use.
• Food contaminated with aflatoxin B1, a mold toxin.
• Fatty liver disease with inflammation, known as nonalcoholic steatohepatitis.
• Tobacco use.
• Certain inherited disorders, including hemochromatosis and Wilson disease.

NCI adds that rising age is the most important risk factor for most cancers. HCC rates in the United States have been climbing, mainly with the spread of hepatitis C. Worldwide, NCI reports that in 2022 liver cancer was the sixth most common cancer and the third leading cause of cancer death.

When to get checked

MedlinePlus is blunt about the timing. You may not have symptoms until the cancer is advanced, which makes it harder to treat. The symptoms it names are a lump or pain on the right side of the abdomen, and yellowing of the skin.

Practical thresholds:

• Yellowing of the eyes or skin in an adult, with no fever, needs medical attention within days.
• A dull ache or firm lump under the right ribs, lasting more than two weeks.
• Swelling of the abdomen, or legs that swell with no other cause.
• Weight loss or appetite loss you did not intend, over one to two months.
• If you have ever had hepatitis B or C, or been told you have cirrhosis or fatty liver disease, ask whether you should be in a liver surveillance program. That is a different conversation from general screening.

Hepatitis B and C can be tested for. Hepatitis C can be cured with antiviral drugs. That is the most useful preventive fact on this page.

The screening question, answered honestly

Liver cancer is one of the few cancers where a defined high-risk group is monitored. The evidence is not what most people assume.

NCI's screening guidance is plain. Based on fair evidence, it says, screening people at elevated risk does not lower death rates from hepatocellular cancer. It gives the magnitude of effect as no reduction in mortality.

It also lists real harms. Needle aspiration can seed tumor cells along the needle track, more so with lesions larger than 2 cm. Bleeding and a collapsed lung are on the list too.

Surveillance for people with cirrhosis is still widely practiced. But the evidence for it is weaker than the evidence behind mammography or colonoscopy.

How a diagnosis is made

Imaging does more of the work here than in most cancers. Take someone at risk with a liver lesion larger than 1 cm. NCI describes the standard approach: a triple-phase, contrast-enhanced CT or MRI, which images the liver in separate phases of blood flow.

HCC has a distinctive signature. It lights up brightly in the arterial phase. Then it fades against the surrounding liver in the venous phase, a pattern called washout. NCI states that arterial uptake followed by washout in one dynamic study is highly specific, at 95% to 100%, for HCC of 1 to 3 cm, and virtually diagnostic.

For lesions smaller than 1 cm found on screening, NCI says no further workup is required, because most will not be cancer. Follow-up every three months is common.

What treatment involves

A partial hepatectomy removes the affected part of the liver, plus a margin of healthy tissue. The rest of the liver takes over the work and may regrow.

A liver transplant removes the whole liver and puts a donated one in its place. NCI notes this may be done when the disease is confined to the liver and a donor liver can be found.

Ablation destroys tumor tissue in place. NCI lists radiofrequency ablation, microwave therapy, alcohol injection, freezing, and electroporation.

What the numbers show

These are group figures and describe no individual.

SEER, the federal cancer statistics program, publishes an American Cancer Society forecast of 42,340 new liver and bile duct cancers in the United States in 2026 and 30,980 deaths. That is about 2.0% of new cancers and 4.9% of cancer deaths. Five-year relative survival across all stages is 21.9% for people diagnosed from 2016 to 2022. It is diagnosed most often between ages 65 and 74.

By stage, across the same 2016 to 2022 group, SEER records five-year relative survival of 37.4% for localized disease, 13.4% for regional disease, and 3.6% for distant disease. About 45% of cases are found while localized. That is a higher share than in pancreatic or esophageal cancer, and the overall survival figure still stays low.

That mix, found fairly early and still hard to treat, is what makes liver cancer different. The liver it grows in is usually already damaged, and that damage limits what treatment it can survive.

Sources

• NCI: Adult Primary Liver Cancer Treatment (PDQ) — Health Professional Version
• NCI: Liver Cancer Treatment (patient version)
• NCI: Liver (Hepatocellular) Cancer Screening (PDQ) — Health Professional Version
• MedlinePlus: Liver Cancer
• SEER Cancer Stat Facts: Liver and Intrahepatic Bile Duct Cancer
• BBC News: David Bowie dies of cancer aged 69
• The Guardian: David Bowie dies of cancer at 69