Main Points

• Liver Cancer is a tumour within liver cells.
• The major causative factors are: Hepatitis B or C infections, Alcohol and Tobacco abuse as well as obesity
• Treatment involves chemotherapy, immunotherapy and radiation therapy.

Maria’s Journey(fictional)

Maria sat in her doctor’s office, staring at the floor, then the window, the middle-aged doctor and back at the floor.  At 52, she thought her fatigue and weight loss were just the price of a busy life. But when the doctor mentioned the words “liver cancer”, her world stopped.

For years, Maria had battled chronic hepatitis B, but between raising her kids and running a busy office, she often put her own health on the back burner. She felt tired more often but attributed it to stress and long hours.

One day, her skin developed a slight yellow tinge. At first, she ignored it, thinking it was just bad lighting or the new cream, more so because her colleague at the office had mentioned she noticed her eyes were not their normal colour. However, she explained she had been up all night working on some documents and couldn’t get enough sleep. But when abdominal pain started and wouldn’t just go away with the usual Buscopan, followed by unexplained weight loss, she visited her doctor.

Maria’s liver cancer had been caught quite early, the doctor told her. The medical and surgical team would plan a treatment strategy accordingly.

Today, Maria shares her story to encourage others. She urges people with hepatitis B or C, heavy alcohol use, or fatty liver disease to get regular checkups and not deny those little signs the body uses to nudge us.

“If I had gone earlier, maybe they could’ve caught it sooner”, she says.

What is the Liver?

Your liver is the largest of all organs in your body. It sits in the upper right part of your abdomen, just under your ribs, mostly on the right side, but stretches slightly toward the middle, near your stomach. 

It acts as the body’s in-built filter and energy station, removing toxins, making bile to help in fat digestion, storing vitamins and sugar for later use, turning food into energy and helping your immune system fight infections.

What is Liver Cancer?

Liver cancer is a life-threatening tumour that forms within liver cells. It is the most frequent cause of cancer deaths across the globe, and in the United States, it stands as the fifth most common cancer.[1]

Types of Liver Cancer

There are two kinds of liver cancer. Primary- which starts directly from your liver, and secondary- which is cancer that spreads from another part of your body, like your intestine, skin, esophagus, stomach, breast, to your liver to cause liver cancer.
Primary liver cancer (PLC) is the sixth most common cancer worldwide and the second most common cause of cancer death.[2]

There are three types of primary liver cancer:

Hepatocellular carcinoma(HCC). HCC is the most common type of liver cancer, accounting for about 80% of cases.
Intrahepatic cholangiocarcinoma(iCCA). This is liver cancer affecting the bile ducts. It usually accounts for 10% to 20% of all cases of primary liver cancer.
Hepatic angiosarcoma. This affects the lining of blood cells in the liver, especially hepatocytes. It is the rarest form, found in just about 1% of all cases of liver cancer

The incidence of primary LC is very diverse in different countries . The highest incidence can be seen in Eastern Asia, South-Eastern Asia, Northern Africa and Southern Africa . In general, it has a high incidence in developing countries, so that more than 85% of cases occur in these countries . This cancer is significantly more common in men. In 2012, there were 745,533 deaths from liver cancer, of which 52,104 (69.89%) were males and 224,492 cases (30.11%) were females worldwide.[3]

Symptoms of Liver Cancer

Hepatocellular carcinoma may not present with any specific signs or symptoms. Symptoms may include:[4]

• Pain in the right upper abdomen
• Abdominal swelling and unexplained weight loss
• Body itch(pruritus)
• Jaundice (yellow discoloration of the eyes and skin)
• Eating very little but feeling full(early satiety)
• Loss of appetite
• Bloating
• Constant tiredness
• Unexplained bruising
• Dark-colored urine
• Grey-colored or pale-looking stool

Causes/risk factors of liver cancer

Liver cancer happens when something like a mutation of genes affects healthy liver cells’ DNA. Our genes are in charge of telling the cells in our body when to grow, multiply and subsequently die.[5]

What are the Risk Factors for Liver Cancer?

The most common risk factor for liver cancer is long-standing hepatitis B or C viral infections( HBV or HCV).

These infections can also cause liver cirrhosis, which can, in turn, lead to liver cancer.

Although viral hepatitis infection is strongly correlated with liver cancer progression, other non-viral risk factors play important roles in enhancing liver cancer development.

 Chief amongst these is obesity. 

Obesity is defined as an individual having a body mass index (BMI) equal to or above 30 kg/m2, and is associated with the development of the metabolic syndrome, which covers a constellation of features including overweight/obesity, insulin resistant type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease and non-alcoholic fatty liver disease(NAFLD)-the more severe inflammatory form, NASH.[6]

 Other risk factors include

• Aflatoxin exposure
• Heavy alcohol consumption
• Tobacco use

Diagnosis and treatment

How is Liver Cancer Diagnosed?

Your doctor would ask about your symptoms, do a physical examination and may do the following tests:

• Blood tests. Healthcare providers may do blood tests for cancer, especially liver function tests.
• Tumour marker/biomarker test. A tumor marker is anything present in or produced by cancer cells or other cells of the body in response to cancer or certain benign (noncancerous) conditions that provides information about a cancer, such as how aggressive it is, whether it can be treated with a targeted therapy.
• Angiogram. This test examines your liver’s blood vessels.
• CT scan. A detailed image of your liver gives providers information regarding the size of the tumour in your liver  and where exactly it is located. It is recognized as the image of choice for detecting primary liver cancer because of such advantages like being able to evaluate the body’s responses to locoregional treatment.[8]
• ERCP test. To diagnose bile cancer in your liver.
• Liver ultrasound. Seen as the easiest and most common way of obtaining pictures of the inside of your liver.
• MRI. This test uses a large magnet, radio waves and a computer. It produces a well-delineated image of your liver’s insides.

A  liver biopsy would be done if blood and other tests detect cancer in the liver. Biopsies are the most reliable way to confirm a liver cancer diagnosis. A liver biopsy is a procedure that involves taking a tiny piece of the liver using a biopsy needle for examination under the microscope. Liver biopsy also helps in determining the nature of the tumour and the molecular classification of the cancer, and can provide useful information about what possibly caused the liver disease. Knowing the cause guides treatment, determines prognosis, and helps in research purposes. However, the need for a liver lesion biopsy is usually assessed based on the patient’s benefit, potential risks, and the operating experience of the physician.[8]

Treatment of Liver Cancer

The ability of each treatment method to produce desired results is dependent on  choosing the appropriate treatment method for patients based on their stage of HCC. 

Medical treatments may include, [8]

• Chemotherapy
• Radiation therapy
• Chemoembolization
• Immunotherapy
• Radioembolization
•  Systemic antitumor therapy

Surgical treatment options :

• Hepatectomy (liver resection)
• Ablation
• Liver transplantation

Prevention

Preventing liver cancer as an individual may not be entirely possible, but the following steps may ensure that you have a reduced risk of developing the disease:

• Hepatitis B screening and vaccination. All babies should be immunized against  hepatitis B 
• Prevent hepatitis C by avoiding contact with infected blood and don’t share needles or syringes.
• Withdraw from cigarette smoking
• Watch for excessive alcohol consumption

• Food preservation and improved source of water. Maize, peanuts, and their products are major staple foods prone to aflatoxin contamination. To lower this risk, a liver cancer prevention program was introduced in China’s rural areas, highlighting two key actions: replacing ditch and pond water with good water supply and improving food storage methods, such as sun-drying crops on mats, removing visibly moldy grains or nuts before storage, and using natural fiber bags for storage.[9]

• Regular blood tests and liver ultrasounds may be very necessary if you are at high risk of having liver disease, diabetes or obesity.

Conclusion

Liver cancer is a silent but deadly disease that places a huge burden on the world, with Africa, especially Nigeria, among the hardest hit. Yet it is also one of the most preventable cancers. By tracking key risk factors like hepatitis B and aflatoxin exposure, improving access to clean water and safe food storage, and investing in early screening and treatment, we can save countless lives. With stronger awareness, better healthcare systems, and community action, the fight against liver cancer can shift from crisis to hope.

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Frequently Asked Questions

What causes liver cancer 

Liver cancer occurs when liver cells develop DNA changes that cause them to grow uncontrollably and form a tumor.

Can liver cancer affect young people?

Yes. Liver cancer can affect young children, but it is most common in adults. There is a high incidence in people aged 50-70 years.

Is a person at risk of having liver cancer if a first-degree relative has it? 

Yes, genetic factors play a role. A positive family history puts a person at risk 

Are there other ways of preventing liver cancer aside from stopping alcohol intake? 

Yes, there are. Hepatitis B screening and vaccination, good food and water storage, avoiding sharing sharps or contaminated blood products, and weight loss.

Is a liver transplant the only way out? 

No, other potentially curative options include surgically removing the tumor or part of the liver affected and ablative therapies like radiofrequency ablation or percutaneous ethanol injection, as well as treatments like external beam radiation, chemotherapy, and systemic therapies, depending on the cancer’s stage and spread.

Can liver cancer be sexually transmitted?

No, liver cancer itself is not a sexually transmitted infection (STI) and cannot be “caught” through sex or other direct contact with a person who has liver cancer. However, some sexually transmitted viruses, like Hepatitis B (HBV), can lead to chronic infection, increasing the risk of developing liver cancer over time.

Further Reading

Have you ever heard people smoking shisha say there are no risks to it and wondered if they are right, well this article exposes the truth about shisha smoking. Read 5-Sneaky Health Dangers Behind Shisha’s Seductive Scent.

References

1.  David Anwanwan, Santosh Kumar Singh , Shriti Singh, Varma Saikam, Rajesh Singh. Challenges in liver cancer and possible treatment approaches.Volume 1873, Issue 1, 2020, 188314, ISSN 0304-419X. Available from: https://doi.org/10.1016/j.bbcan.2019.188314.
2. Patricia C. Valery,  Mathieu Laversanne, Paul J. Clark, Jessica L. Katherine A,  Freddie Bray. Projections of Primary Liver Cancer to 2030 in 30 Countries Worldwide. First published: 31 August 2017. HEPATOLOGY, VOL. 67, NO. 2, 2018. Available from: https://doi.org/10.1002/hep.29498
3. M. Mohamadian, N. Mhadaviar, A. Mohammadian-HAFSHEJAN13, H. Salehiniya. Liver Cancer in the world. Epidemiology, incidence, mortality and risk factors World Cancer Res J 5.2 (2018): e1082. https://www.wcrj.net/wp-content/uploads/sites/5/2018/06/e1082-Liver-cancer-in-the-world-Epidemiology-incidence-mortality-and-risk-factors. 
4. Mokdad AA, Singal AG, Yopp AC. Liver Cancer. JAMA. 2015;314(24):2701. Available from: http://doi:10.1001/jama.2015.15425
5.  François Spitz, Gene regulation at a distance: From remote enhancers to 3D regulatory ensembles, Seminars in Cell & Developmental Biology. Volume 57, 2016. Pages 57-67, ISSN 1084-9521. Available from;https://doi.org/10.1016/j.semcdb.2016.06.017.
6. Badr Alzahrani, Tristan J. Iseli, Lionel W. Hebbard, Non-viral causes of liver cancer: Does obesity led inflammation play a role? Cancer Letters. Volume 345, Issue 2, 2014, Pages 223-229, ISSN 0304-3835. https://doi.org/10.1016/j.canlet.2013.08.036.
7.  Cleveland Clinic. Liver Cancer: Symptoms, Causes and Prevention. Published September 2021. Available from: https://my.clevelandclinic.org/health/diseases/9418-liver-cancer
8.  Minshan Chen, Jianqiang Cia, Weilin Wang, Xiujun Cia, Feng Shen, Shuikui Qin. Liver Cancer (2023) 12 (5): 405–444.PubMed: 37901768 Available from: https://doi.org/10.1159/000530495
9.  Li Q, Cao M, Lei L, Yang F, Li H, Yan X, He S, Zhang S, Teng Y, Xia C, Chen W. Burden of liver cancer: From epidemiology to prevention. Chin J Cancer Res. 2022 Dec 30;34(6):554-566. Available from: http://doi: 10.21147/j.issn.1000-9604.2022.06.02.