Expert Explains Liver Cancer Basics for Awareness Month

October is Liver Cancer Awareness Month, a time to highlight the basics of the disease. Liver cancer most often develops in people with chronic liver disease, explained Dr. Anjana Pillai in an interview with CURE. The liver filters toxins, processes nutrients and supports the immune system, but its strong reserve can mask early signs of disease.

Pillai is a professor of medicine and surgery and leader of multiple liver programs at UChicago Medicine

The two main types are hepatocellular carcinoma (HCC) and bile duct cancer (cholangiocarcinoma). HCC is the most common, linked to hepatitis B or C, alcohol use and metabolic dysfunction-associated steatotic liver disease (MASLD). Cholangiocarcinoma is less common but rising, especially among women.

Because early liver cancer rarely causes symptoms, regular imaging and blood tests are crucial for at-risk patients. Pillai also noted that maintaining a healthy weight, managing diabetes, limiting alcohol and staying active can help protect liver health.

CURE: What is liver cancer and how does it develop in the body?

Pillai: That’s a great question. Before discussing liver cancer, it’s important to understand how vital the liver is. It’s an organ most people don’t think about until it becomes sick, but it plays a key role in many bodily functions, filtering and detoxifying what we eat and drink, processing medications and other substances, producing bile to help digest fats, storing energy, making essential proteins for blood clotting, and supporting the immune system by helping clear infections.

When we talk about liver cancer, it’s often in the context of chronic liver disease. Most patients with liver cancer have one of two common types: hepatocellular carcinoma (HCC) or bile duct cancer (cholangiocarcinoma). HCC is the more common type, and the vast majority of cases occur in people with chronic liver disease or cirrhosis.

There are several risk factors for liver cancer. Viral hepatitis B or C, long-term alcohol use, and what was formerly called fatty liver disease (now referred to as metabolic dysfunction-associated steatotic liver disease [MASLD]) are among the most common. People with MASLD often have insulin resistance and other metabolic risk factors. Over time, these conditions can cause chronic liver damage, which increases the likelihood of developing primary liver cancer.

Cholangiocarcinoma is less common and more complex. Only about one-third of patients have traditional risk factors or underlying liver disease, such as primary sclerosing cholangitis (PSC). Many people are diagnosed incidentally during imaging for another reason or after developing symptoms. Unfortunately, cholangiocarcinoma, particularly the intrahepatic type, is on the rise — especially among women, according to recent National Cancer Institute data.

What are the main types of liver cancer patients should know about?

As mentioned, the two primary types are hepatocellular carcinoma (HCC) and cholangiocarcinoma (bile duct cancer). HCC accounts for about 85% of primary liver cancers, but cholangiocarcinoma (especially the intrahepatic form) has been steadily increasing in recent decades, particularly in women.

Who is at the highest risk for developing liver cancer?
Most people who develop liver cancer have chronic liver disease, advanced fibrosis, or cirrhosis. However, individuals with hepatitis B are at risk even without cirrhosis. Hepatitis B is a viral infection that can be prevented through vaccination, but people who were never vaccinated or didn’t know about the vaccine remain at risk.

Other major causes include alcohol-related liver disease and MASLD, both of which are rising in prevalence in the United States. Hepatitis C used to be a leading cause, but that’s now less common thanks to effective antiviral medications that can cure the infection.

What symptoms might someone notice early on?

That’s an important question because the liver has such remarkable reserve. Most people with liver disease have no symptoms unless they’re being monitored for another reason. This is why regular checkups with a primary care provider and liver enzyme testing are crucial. Mild elevations in liver enzymes can prompt further testing, such as an ultrasound, followed by CT or MRI scans if needed.

In early stages, most patients are asymptomatic. Some people with advanced liver disease or larger tumors may develop yellowing of the eyes and skin (jaundice), fluid buildup in the abdomen (ascites), or gastrointestinal bleeding. However, early-stage liver cancer — the most curable form — is usually found incidentally or through screening, not because of symptoms.

Why is liver cancer often diagnosed at a later stage?

Because most patients have no symptoms until the disease is advanced. Unless a tumor is large enough to affect liver function or block bile ducts, people often don’t realize anything is wrong. In some cases, jaundice appears earlier in biliary cancers if a tumor blocks the bile ducts, but that’s less common.

How can people at higher risk stay on top of their liver health?
The most important step is to stay connected to a healthcare provider, especially if you know you’re at risk for chronic liver disease. Ideally, patients should see a liver specialist, known as a hepatologist, for appropriate monitoring and screening.

For those with cirrhosis or hepatitis B, routine imaging and blood tests are recommended to detect cancer early, when it’s most treatable.

Risk reduction also matters. Limiting or avoiding alcohol is essential; there’s really no safe amount for someone with liver disease. Maintaining a healthy weight, managing diabetes or insulin resistance, and following a balanced, Mediterranean-style diet all support liver health. Regular exercise, aiming for about 150 minutes per week of moderate activity, can further reduce risk.

Even small lifestyle adjustments (like cutting back on alcohol, improving diet, and staying active) can make a meaningful difference in protecting liver health and lowering the risk of liver cancer.

Transcript has been edited for clarity and conciseness.

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