SymptomCancer
Liver Cancer Symptoms
Liver cancer symptoms usually appear only once a tumor is fairly large, which is why people at high risk are screened. The commonest signs are pain or a lump under the right ribs, losing weight without trying, poor appetite, feeling full quickly, yellow skin and eyes (jaundice), and a swollen belly. In someone with cirrhosis or chronic hepatitis B, a sudden worsening of liver function can be the first clue. These symptoms have many other causes, but any of them needs a doctor's assessment.
Also called: Signs of liver cancer, hepatocellular carcinoma symptoms, HCC symptoms, liver tumor signs
At a glance
- Early stage
- Usually no symptoms, which is why high-risk people are screened every 6 months.
- Common symptoms
- Pain or a lump under the right ribs, weight loss, poor appetite, early fullness, fatigue.
- Later signs
- Jaundice, a swollen belly (ascites), itching, pale stools, dark urine, easy bruising.
- Who is at high risk
- People with cirrhosis from any cause, and people with chronic hepatitis B.
- Next step
- Liver ultrasound and blood tests including AFP, then CT or MRI.
When to get help
Call 911 or go to the ER
- Sudden severe pain in the upper right belly with dizziness, fainting or a rapidly swelling belly (possible bleeding tumor)
- Vomiting blood or passing black, tarry stools
- New confusion or extreme drowsiness in someone with liver disease
See a doctor within a day or two
- Yellowing of the skin or whites of the eyes
- A rapidly swelling belly, or new leg swelling, in someone with cirrhosis
- Fever with pain under the right ribs
Book a routine appointment
- Unexplained weight loss of more than 5 percent of body weight over 6 to 12 months
- Persistent pain, fullness or a lump under the right ribs
- Loss of appetite or feeling full after small meals for more than 2 to 3 weeks
- Cirrhosis or chronic hepatitis B without an ultrasound in the last 6 months
Why liver cancer symptoms appear late
The liver is large, has a big reserve and has few pain nerves inside it. A tumor can grow to several centimeters without causing symptoms. Pain usually starts only when the tumor stretches the liver's outer capsule, presses on nearby organs or blocks bile ducts. In people with cirrhosis, symptoms of cancer are easily confused with the cirrhosis itself.
Early signs of liver cancer
When early symptoms occur, they are vague:
- a dull ache or discomfort under the right ribs, sometimes spreading to the right shoulder blade
- tiredness and weakness
- loss of appetite
- feeling full after a small meal
- mild nausea
- unexplained weight loss
Common symptoms as the cancer grows
| Symptom | Why it happens |
|---|---|
| Pain in the upper right belly | Tumor stretching the liver capsule |
| A lump or fullness under the right ribs | Enlarged liver (hepatomegaly) |
| Enlarged spleen on the left | Raised pressure in liver blood vessels |
| Jaundice, itching, dark urine, pale stools | Bile ducts blocked or liver function failing |
| Swollen belly | Fluid build-up (ascites) |
| Fever without infection | Substances released by the tumor |
| Easy bruising or bleeding | Reduced production of clotting proteins |
| Swollen veins on the belly | Raised pressure in the portal vein |
Liver cancer pain location
Pain is felt in the upper right abdomen just below the ribs and may spread to the back or right shoulder. A sudden severe pain can mean the tumor has bled, which is an emergency.
Less common signs
Some liver cancers produce hormone-like substances, causing low blood sugar (shakiness, sweating, confusion), high blood calcium (thirst, constipation, confusion), high red blood cell counts, high cholesterol, or breast enlargement and shrinking testicles in men.
Liver cancer symptoms in people with cirrhosis
Most liver cancers develop in people with cirrhosis. In them, the first sign of cancer may be a sudden decline:
- new or worsening ascites
- new jaundice
- confusion from hepatic encephalopathy
- bleeding from swollen veins in the esophagus
- weight loss despite fluid build-up
Anyone with cirrhosis whose condition worsens unexpectedly should be checked for liver cancer.
Symptoms in women
Liver cancer symptoms are the same in women and men. Women are affected less often than men, because the main risk factors (heavy drinking, hepatitis B and C) have historically been more common in men, but the rise in fatty liver disease is increasing cases in both. Women with pain under the right ribs and weight loss should not assume the cause is gallbladder or gynecological without proper checks.
What else can cause these symptoms
The symptoms above are much more often caused by something other than liver cancer:
- gallstones and gallbladder inflammation (pain after fatty meals)
- hepatitis and fatty liver disease
- stomach ulcers and gastritis
- cancer that has spread to the liver from the bowel, pancreas, breast or lung (liver metastases), which is more common in the US than cancer that starts in the liver
- non-cancerous liver lumps such as hemangiomas and cysts
Who should be screened
Because early liver cancer is silent and can be cured when small, guidelines recommend an ultrasound every 6 months, often with an AFP blood test, for:
- everyone with cirrhosis, from any cause
- people with chronic hepatitis B who are at higher risk, for example Asian men over 40, Asian women over 50, people of African descent, and those with a family history of liver cancer
- some people with advanced liver scarring from hepatitis C or fatty liver disease
How doctors check for liver cancer
- Blood tests: liver function, clotting, and alpha-fetoprotein (AFP), a tumor marker that is raised in many but not all liver cancers
- Ultrasound of the liver
- Multiphase CT or MRI: liver cancer often has a distinctive pattern on these scans that allows diagnosis without a biopsy in people with cirrhosis
- Biopsy when the scans are not typical
See our page on liver cancer for types, stages and treatment.
Frequently asked questions
What are the early signs of liver cancer?
Early liver cancer usually causes no symptoms. When early signs occur, they are vague: discomfort under the right ribs, tiredness, poor appetite, feeling full quickly and unexplained weight loss. This is why people with cirrhosis or chronic hepatitis B are offered regular ultrasound screening.
Where is liver cancer pain felt?
In the upper right part of the belly, just below the ribs. It can spread to the back or the right shoulder blade. It is often a dull, persistent ache. Sudden severe pain may mean the tumor is bleeding and needs emergency care.
Can you have liver cancer with normal blood tests?
Yes. Liver function tests and AFP can be normal, especially with small tumors. That is why imaging with ultrasound, CT or MRI is used for screening and diagnosis rather than blood tests alone.
How quickly do liver cancer symptoms develop?
Symptoms often develop over weeks to months once a tumor is large enough to stretch the liver or affect its function. Tumor growth rates vary widely. In people with cirrhosis, a sudden decline in health can be the first sign.
Is jaundice always a sign of liver cancer?
No. Jaundice is more often caused by hepatitis, gallstones blocking the bile duct, medicines, or harmless conditions such as Gilbert syndrome. Any new jaundice in an adult still needs prompt medical assessment and blood tests.
Sources
This guide was written from current patient and clinical guidance, including:
- American Cancer Society: Signs and Symptoms of Liver Cancer
- National Cancer Institute: Liver Cancer Treatment (PDQ) Patient Version
- American Association for the Study of Liver Diseases (AASLD): Practice Guidance on Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma
- NHS: Liver cancer symptoms
- CDC: Liver Cancer