Liver cancer may cause no symptoms for a long time [5]. As it grows, it can cause pain or a hard lump under the ribs on the right side, pain near the right shoulder blade or in the back, a swollen abdomen, jaundice (yellowing of the skin and eyes), unexplained loss of appetite and weight, feeling full quickly, nausea, tiredness, easy bruising or fever [1]. Because symptoms appear late, people with cirrhosis and some people with chronic hepatitis B should have a liver ultrasound every 6 months, often with an AFP blood test [3, 4].
Key points
- Most liver cancers start in a liver that has been damaged for years: cirrhosis, chronic hepatitis B or C, heavy drinking and inflammatory fatty liver disease [2].
- Worldwide, liver cancer is the sixth most common cancer and the third leading cause of cancer death [2].
- For people at high risk, a liver ultrasound every 6 months (often with an AFP blood test) is recommended [3, 4]; in a large study of people with hepatitis B, this cut deaths from liver cancer by more than a third [5].
- Things that lower the risk: hepatitis B vaccination, treatment of hepatitis B and C, avoiding alcohol and smoking, and keeping a healthy weight [2, 3].
Symptoms of liver cancer
| Symptom | Explanation | What to do |
|---|---|---|
| Pain or discomfort in the upper right abdomen | Under the right ribs, where the liver lies [1] | Tell your doctor about pain that persists or gets worse |
| A hard lump under the right ribs | Sometimes felt by the person or by the doctor [1] | See a doctor as soon as possible; the doctor will usually arrange an urgent ultrasound [7] |
| Pain near the right shoulder blade or in the back | A listed symptom [1] | If it comes with other symptoms in this table, see a doctor |
| Swollen abdomen | The abdomen becomes larger than usual [1] | New swelling of the abdomen, especially in someone with cirrhosis, should be checked soon |
| Yellowing of the skin and the whites of the eyes | Sometimes with dark urine and pale, chalky stools [1] | See a doctor as soon as possible |
| Loss of appetite, feeling full quickly and unexplained weight loss | Listed symptoms [1] | If you are losing weight without trying, see a doctor |
| Unusual tiredness or weakness, nausea and vomiting | General symptoms [1] | If they persist, have them checked |
| Easy bruising or bleeding | A listed symptom [1] | Tell your doctor |
| Unexplained fever | A listed symptom [1] | Have a persistent fever with no clear cause checked |
This table does not replace an examination by a doctor; in most people these symptoms have another cause.
When should I call my doctor?
Abdominal pain and tiredness usually have a simple cause. But if you have cirrhosis, hepatitis B or C, or fatty liver disease and one of the symptoms above has started recently, do not wait for your next scheduled ultrasound; see a doctor sooner. A lump under the right ribs, jaundice, unexplained weight loss or new swelling of the abdomen needs checking in anyone [1, 7].
Vomiting blood or black stools, confusion or unusual drowsiness, rapid swelling of the abdomen with fever, or sudden severe abdominal pain needs urgent care at an emergency department.
Who is at risk, and who should be checked every 6 months?
The main risk factors for liver cancer [2]:
- cirrhosis (healthy liver tissue replaced by scar tissue) of any cause
- chronic hepatitis B; it can lead to cancer even without cirrhosis [3]
- chronic hepatitis C
- heavy drinking
- fatty liver disease, especially its inflammatory form, which can lead to cirrhosis
- smoking; the more and the longer, the higher the risk
- aflatoxin: a poison from a mould that grows on corn and nuts stored in hot, humid places
- rare inherited conditions such as haemochromatosis (iron overload) and Wilson disease (copper overload)
Who should have an ultrasound every 6 months?
The American and European liver associations recommend a liver ultrasound every 6 months (often with an AFP blood test) for these people [3, 4]:
- everyone with cirrhosis, whatever the cause; unless their liver disease or other illnesses are so severe that cancer treatment would not be possible [3, 4]
- some people with chronic hepatitis B without cirrhosis; the doctor decides based on age, sex, a family history of liver cancer and the state of the liver [3]
For people who have fatty liver disease or hepatitis C but no cirrhosis, regular ultrasound for cancer is usually not recommended [3, 4]. If you do not know whether your liver has cirrhosis, ask your doctor. If you have never been tested for hepatitis B and C, ask your doctor for the test. See: Which screening tests do I need?
If the doctor suspects liver cancer, which tests are needed?
- 1
Ultrasound and blood tests
A liver ultrasound, an AFP test and liver function tests are usually the first steps. A high AFP can be a sign of liver cancer, but it also rises in hepatitis and cirrhosis, and it is sometimes normal even when cancer is present [8].
- 2
CT scan or MRI with contrast
If the ultrasound shows a lump of 1 cm or larger, or the AFP is high, a multiphase CT scan or MRI with contrast is needed [3].
- 3
A biopsy only when needed
In someone with cirrhosis or hepatitis B, the typical appearance of the tumour on these scans is often enough for the diagnosis, and a biopsy is not needed [3, 8]. If the scans are not conclusive, a needle biopsy is done [3]. Read: Does a biopsy make cancer spread?
- 4
Checking liver health and the stage
Treatment depends both on the size and number of tumours and on how well the liver is working and your general health [8]. Read about treatment on the liver cancer page.
Frequently asked questions
I have pain under my right ribs; could it be liver cancer?
Pain in this area has many causes, such as gallstones or muscle and stomach problems. Liver cancer can also cause pain or discomfort in the upper right abdomen [1]. If the pain continues, you can feel a lump, or you have cirrhosis or hepatitis, see a doctor; a simple ultrasound is the first step [7].
I have fatty liver disease; will I get liver cancer?
The risk of cancer in fatty liver disease that has not reached cirrhosis is low [3]; although liver cancer has occasionally been found without cirrhosis [2]. The main risk comes when fatty liver disease leads to inflammation and cirrhosis [2]. If you have fatty liver disease without cirrhosis, regular ultrasound for cancer is usually not needed [3, 4]; it matters more to protect your liver by losing weight, controlling blood sugar and avoiding alcohol and smoking [3].
I have hepatitis B; what should I do?
Talk to your doctor about antiviral treatment; controlling the virus lowers the risk of liver cancer [3]. Based on your age, sex, any family history of liver cancer and the state of your liver, your doctor will decide whether you should have a liver ultrasound every 6 months (often with AFP); if you have cirrhosis, you definitely should [3, 4]. Relatives who have not been vaccinated should talk to a doctor about testing and hepatitis B vaccination [3]. Read more: Is cancer contagious?
My AFP test is normal; does that mean I do not have liver cancer?
Not necessarily. AFP is sometimes normal even when liver cancer is present, and it also rises in hepatitis and cirrhosis [8]. This is why in people at high risk AFP is done together with an ultrasound, not on its own [3]. Read more: What is a tumour marker?
Does an ultrasound every 6 months really help?
Yes. In a large study in China of about 19,000 people with hepatitis B or chronic hepatitis, those who had an ultrasound and an AFP test every 6 months were more than a third less likely to die of liver cancer [5]. In a review of dozens of studies of people with cirrhosis, regular checks almost doubled the chance of finding the tumour at an early stage, and patients lived longer [6]. What matters is keeping the ultrasounds regular, without gaps.
Can liver cancer be prevented?
Is cancer that has spread to the liver from somewhere else the same as liver cancer?
No. Cancer that started in another organ, such as the bowel or the breast, and has spread to the liver is not counted as primary liver cancer and is different from it [1]. Read more: What is metastasis?
Surveillance and referral criteria (for doctors)
For physicians
Target population for surveillance (AASLD 2023, Table 1). Sufficient risk to warrant surveillance: Child-Pugh A or B cirrhosis of any aetiology (incidence 1% or more per year); Child-Pugh C cirrhosis only in transplant candidates; non-cirrhotic chronic hepatitis B (incidence 0.2% or more per year): men from endemic countries older than 40, women from endemic countries older than 50, people from Africa at an earlier age, a family history of HCC or a PAGE-B score above 10. Insufficient risk (less than 0.2% per year): hepatitis C with stage 3 fibrosis and non-cirrhotic NAFLD. Surveillance only for patients who would be candidates for HCC treatment [3].
Method and interval. AASLD: ultrasound and AFP every 6 months (Level 2, strong recommendation); contrast-enhanced CT or MRI only in selected patients in whom ultrasound is inadequate [3]. EASL 2025: liver ultrasound every 6 months is recommended; adding AFP increases sensitivity, lowers specificity and is a reasonable option; surveillance in advanced fibrosis without cirrhosis cannot currently be recommended because of insufficient evidence [4]. The sensitivity for early-stage HCC is 53% for ultrasound alone and 63% with AFP [3].
Recall. A new or enlarging solid lesion of 1 cm or larger on ultrasound (US-3) or a raised AFP (common threshold 20 ng/mL) requires multiphase CT or contrast-enhanced MRI; a lesion smaller than 1 cm is followed with ultrasound and AFP in 3 to 6 months. In an at-risk patient, arterial phase hyperenhancement with washout in a lesion of 1 cm or larger is diagnostic without biopsy [3].
Evidence. Shanghai randomised trial (18,816 people aged 35 to 59 with HBV or chronic hepatitis): ultrasound and AFP every 6 months reduced HCC mortality by 37% (mortality rate ratio 0.63; 95% CI 0.41 to 0.98), despite 58.2% adherence [5]. Meta-analysis of 59 cohort studies (145,396 patients with cirrhosis and HCC): surveillance was associated with early-stage detection (RR 1.86), receipt of curative treatment (RR 1.83) and better survival (HR 0.67, after adjustment for lead-time bias) [6].
Symptom-based referral (NICE NG12). Consider an urgent, direct-access ultrasound (within 2 weeks) in people with an upper abdominal mass consistent with an enlarged liver (recommendation 1.2.11) [7]. Assess liver reserve with the Child-Pugh and ALBI score.
Scientific evidence
Related cancer types
References
9 referencesShow all references, 3 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 9Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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