Symptoms of liver cancer

Signs and symptoms of liver cancer are often the result of liver damage and may include jaundice (jaundice), pain in the right abdomen or shoulder, or a mass in the upper right abdomen. However, many warning signs are not specific, such as weight loss and fatigue. Sometimes complications of liver cancer, such as biliary obstruction, anemia, or bleeding are the first symptoms.

Since there is no screening test for liver cancer, being aware of potential signs and symptoms is the only way to find the disease early.

It is important to briefly distinguish primary liver cancer – which originates in the liver – from liver metastasis, which is the spread of cancer (breast or lung, for example) from another area of ​​the body. may reach the liver. Liver cancer is usually a large tumor, while metastases (spread) are often small and numerous.

Primary liver cancer usually causes symptoms relatively early, while liver metastases (much more common) can occupy a significant portion of the liver before they are detected.

Symptoms are similar to hepatocellular carcinoma (liver cancer) and cholangiocarcinoma (bile duct cancer), but bile duct cancer tends to cause early obstructive symptoms (such as jaundice) than liver cancer.

Common symptoms:

Like many cancers, liver cancer often has few symptoms or signs in its early stages.

As the disease progresses, its symptoms begin to appear, prompting people to seek medical attention. Because of this slow onset of symptoms, liver cancer is usually diagnosed at an advanced stage (unless the tumor is near a bile duct and causes early obstruction).

Possible symptoms include:

An abdominal mass or lump

You may feel a very hard lump or swelling in the area just below your right rib cage. Usually, this mass is painless, and if you do have pain, you may feel more discomfort in the area around the mass.

Sometimes liver cancer also causes the spleen to enlarge, which can lead to pain or a lump in the left upper abdomen.


Right side stomach pain

Pain, discomfort, or tenderness in the right side of the abdomen just below the ribs can occur from pressure of the liver tumor on other structures or nerves in this area. Take a deep breath and press gently under the right rib cage – this is where your liver is located. If you have an enlarged liver (there are many causes), your liver may be lower in the abdomen.

Right shoulder pain

Shoulder blade pain can be a sneaky symptom, as the condition it warns you may not be anywhere near the shoulder blade (due to the way nerves travel in our bodies).

This is a case of liver cancer. The tumor (or spreading from the tumor) can stimulate nerves that tell your brain that pain is coming from your shoulder blade when it’s actually coming from your liver.

This pain is usually felt in the right shoulder, although it can be bilateral. The pain may also extend into your back.

If you experience this, especially if you haven’t participated in any recent physical activity that can be explained, see your doctor.


Jaundice refers to a condition in which the skin, as well as the white part of the eye, appears yellow. It is due to the accumulation of bile salts in the skin.

It is more easily detected in natural light, such as outside, than in indoor light. In addition to jaundice, some people notice that their intestinal tract is pale and white instead of brown.

At the same time, urine may appear darker than usual, even without dehydration.


The accumulation of bile salts in the skin, which leads to jaundice, can also cause itching. We don’t usually think of itching as a serious symptom, but the itching associated with liver dysfunction can be very intense.

Bloat and Shortness of Breath

Fluid buildup in the abdomen called ascites can indicate liver cancer. It may feel like bloating at first; Some people note that their clothes don’t fit around their waists or their belt sizes change even though they don’t gain weight. Over time, fluid that accumulates in the abdomen can push up on the lungs, making it difficult to breathe.

Unintentional weight loss or gain

Unintentional weight loss may be welcome by some, but when it doesn’t involve a change in diet or exercise, it’s always worth seeing a doctor. Unexplained weight loss is defined as the loss of 5 percent or more of body weight over a period of six to 12 months without exertion. An example would be a 200-pound man who lost 10 pounds in a six-month period without a change in habits.

Unintentional weight loss was found to be associated with underlying cancer in one-third of people observed in a 2017 review of research, including liver cancer. There are other serious causes as well, so it’s important to see your doctor as soon as you notice a change.

Rapid and unexpected weight gain is also a sign of liver cancer. This usually happens due to a rapid accumulation of fluid in the abdomen (ascites).

Loss of appetite

An appetite can occur with many disorders, but can be quite profound with liver problems. This can be accompanied by feeling full very quickly, even when eating only small meals. Since these symptoms can be warning signs of not only liver cancer but also other cancers, it’s important to see a doctor.

Nausea and vomiting

There are many reasons why liver cancer can lead to nausea and vomiting, and these are common symptoms at all stages of the disease. There are a large number of causes of nausea and vomiting, but when it happens frequently, or if it worsens, talk to your doctor.

Fatigue and/or Weakness

It seems that everyone is tired these days, but cancer-related fatigue often takes things to the next level. Cancer fatigue is different from normal fatigue, and it’s not the kind of fatigue that improves with a good night’s sleep. Sometimes, this symptom is easier to see if you look back over a period of 6 to 12 months and assess your energy today compared to then.


A low-grade, but persistent fever, something doctors call “fever of unknown origin” or FUO, is a fairly common symptom of liver cancer. A FUO is defined as a temperature greater than 101 degrees that persists for three weeks or more and cannot be tied to an obvious cause after three doctor visits (or three days in the hospital). There are several other potential causes of a persistent fever, but a good one is to see your doctor.

General feeling of being unwell

It’s hard to describe intuition as a symptom, but studies tell us – often looking back – that people often sense when something is “off” in their body. If you have a general sense that you are unwell, see your doctor. At times, symptoms can be difficult to define using the terms listed above. Our bodies usually do a good job of “telling” us when something is wrong if we just take the time to listen.

Rare symptoms

Some liver cancers secrete hormones that can cause other symptoms. These may include low blood sugar ( hypoglycemia ) which can lead to dizziness and fainting, especially in people who have not eaten in a while; breast enlargement ( gynecomastia ); testicular atrophy; and a high red blood cell count.


Liver cancer can lead to a number of complications. They can be caused by pressure of a tumor on the bile duct or other organs, hormones produced by cancer cells, liver dysfunction leading to a build-up of toxins in the body or muscles. other regime.

Some potential complications include:


Anemia , a low red blood cell count, is a very common complication of liver cancer and can occur by several mechanisms, including a lack of clotting factors in the blood leading to bleeding. Anemia can be insidious at first, and it often causes symptoms like fatigue, shortness of breath, rapid heartbeat, pale skin, and lightheadedness. Since liver cancer can sometimes lead to erythrocytosis (increased production of red blood cells), these effects sometimes cancel each other out.

Bile duct obstruction

Bile is made in the liver. Several ducts ensure that it is transported to the small intestine, either through the gallbladder or directly. Liver tumors or bile duct tumors can grow in a duct or cause pressure near one, leading to a blockage of the bile duct.

When the duct is blocked for one of two reasons, it often leads to the rapid onset of severe and constant pain in the right upper abdomen, nausea, vomiting, jaundice, and itching.


The liver is responsible for making proteins (clotting factors) that help your blood clot. When a large percentage of your liver has been overtaken by cancer, these factors are no longer produced in adequate quantities. As a result, bleeding may occur (even with a normal platelet count) and anemia may occur. The first sign is usually bleeding when you brush your teeth or nosebleeds often. More serious bleeding, such as internal bleeding, can occur as the cancer progresses.

Portal hypertension

Liver cancer (and other liver diseases) can lead to bleeding from the digestive tract in a different way. A tumor in the liver can make it difficult for blood to flow through the small veins in the organ that lead to the large portal vein. The resulting pressure on the veins ( portal hypertension ) causes increased pressure in blood vessels upstream, such as those in the esophagus.

These veins are weaker than the larger portal vein and can develop into varicose veins, like you see on a person’s legs, or in the abdomen during liver disease. When these complications rupture, it can lead to massive bleeding into the esophagus ( hemorrhage , which can be life-threatening if not treated quickly.Bleeding can occur in the stomach and intestines.) intestine by a similar mechanism.

High blood calcium (Hypercalcemia)

Liver cancer can lead to high levels of calcium in the blood ( hypercalcemia of malignancy) through a few different mechanisms. This can cause nausea and vomiting, extreme muscle weakness, and confusion, which can progress to coma and even death if left untreated.

Hepatorenal syndrome

Hepatorenal syndrome is a liver condition that leads to kidney disease due to changes in blood vessels and reduced blood flow to the kidneys. Hepatorenal syndrome is very common with liver cancer and other forms of liver disease, and an estimated 40% of people with cirrhosis will develop the syndrome within 5 years.

Hepatic encephalopathy

Hepatic encephalopathy can be a dreaded complication of liver cancer but is actually a reversible cause of symptoms that can resemble Alzheimer’s disease.

When the liver is unable to remove toxins, they travel to the brain. This can lead to memory loss, disorientation, personality changes, and severe confusion. Symptoms may begin mildly with difficulty performing math-focused tasks, like balancing a checkbook. Other symptoms may include sweet-smelling breath and flapping arms when they are held right in front of a person. There are many ways to treat encephalopathy, but the prognosis often depends on the extent of the tumor.

When to see your doctor

If you note any of the above signs and symptoms, or any that you can’t explain, see your doctor. While many may indicate harmless conditions, if liver cancer is present, the prognosis is generally better than before the disease is diagnosed. People with no risk factors for liver cancer can and do develop the disease at times – something to keep in mind if you’re unsure about talking to your doctor.

If you have risk factors for liver cancer, such as cirrhosis, your situation is a little more difficult. It is possible that you have experienced similar symptoms due to an existing health problem. In this case, the key point is to monitor the change in your symptoms.

One study found that symptoms that alert doctors to the presence of liver cancer in people with chronic liver disease include right upper quadrant pain, liver enlargement (cirrhosis often causes it to occur). contraction), more fatigue, mood swings, worsening of portal hypertension, hemorrhoids, bleeding and diabetes become difficult to control. If you notice any of these symptoms, contact your doctor right away instead of waiting for your next appointment.

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