9 Signs and Symptoms of Liver Cancer

The liver is the largest gland in the body, situated in the upper abdomen spanning from the right side (mainly) to left side, protected by the ribcage. This organ is frequently affected by cancers, a dreaded disease. Cancer of the liver can be primary (cancer of its own tissues) or secondary (a spread of cancer from other organs of the body through blood, also known as a metastatic tumor). There are no specific signs of liver cancers which are surely diagnostic, but there are certain signs which are present due to cancer in the liver or due to diseases predisposing cancer in the liver. Read further for more information about this disease, and also see a list of signs and symptoms of liver cancer in its early to final stages.

Metastasis in the liver

Metastasis in the liver can be from almost any abdominal or extra-abdominal organ cancer. They are more common than primary cancers of the liver, which can arise from the liver cells or other structure in the liver like cells of the bile duct system or blood vessels. Liver cell cancers are more often seen than other cells in the liver.

Liver cirrhosis

Primary liver cancer cells are more often seen in conditions which leads to chronic inflammation in the liver resulting in an architecturally deranged and stiff liver called cirrhosis. This condition is due to excess alcohol intake, and viral infections like hepatitis B and C. Other causes include aflatoxin, non-alcoholic fatty liver disease and liver flukes.

The signs of liver cancer are due to the mere presence of a tumor in the liver causing pressure symptoms or due to symptoms of baseline cirrhosis. These signs often do not present until the advanced signs of disease, but sometimes they show up earlier.

Signs and symptoms of liver cancer

1. Nausea and vomiting: This is a feature often seen in liver cancers either primary or secondary. Sometimes they are present for some time before cancer is detected. This is due to either baseline cirrhosis or mass effect of cancer.
   
2. Loss of appetite and weight loss: This is also seen very often in liver and pancreas cancers. The affected person loses weight despite eating regularly.
   
3. Early satiety: The patient can feel full after a small meal due to the presence of enlarged liver mass near the stomach and congestion of the stomach due to associated liver cirrhosis.
   
4. Abdominal mass: A large mass is felt in the upper abdomen on the right side and in the centre (also called right upper quadrant and epigastrium). The mass is hard to feel and sometimes painful due to associated inflammation.
   
5. Pain in the upper abdomen or right shoulder: This may be due to inflammation of a tumor or liver, and also spread of this inflammation to the diaphragm (a muscular membrane separating the chest and abdomen).
   
6. Enlarged spleen: The spleen can be felt below the left ribcage. This splenic enlargement is due to congestion and enlargement of blood vessels (portal vein) of the liver due to the presence of baseline cirrhosis.
   
7. Abdominal swelling: Occurs due to the filling of fluid in the abdomen (also called ascites). This ascites can be due to either portal hypertension associated with cirrhosis of liver or due to spread of cancer to the abdominal cavity which results in blockage of lymphatics and accumulation of fluid.
   
8. Generalised itching: Sometimes this is a very prominent feature in liver cancers due to obstruction in the biliary system due to a tumor. It is also seen predominantly in some condition due to primary sclerosing cholangitis (PSC) which leads to liver cancer.
   
9. Jaundice or yellowness of skin, eyes and urine: This can be due to associated cirrhosis or mass effect of cancer-causing obstruction in the biliary system, or when a large part of the liver is replaced by cancer. Other signs which can be associated with liver cancer are fever and blood in vomiting and stools.

Other signs which can be associated with liver cancer are fever and blood in vomiting and stools.

The liver tumors also make or decrease degradation of certain chemicals known as hormones, which can lead to increase in blood calcium, muscle weakness, low blood sugar, breast enlargement and shrinkage of testicles in males.

So it is always wiser to consult your doctor at the earliest if you encounter a combination of these symptoms or signs so that this cancer can be detected as early as possible.

About the expert:

Written by Dr Pradeep Jain on 4 May 2018; updated on 30 October 2019

The author is Director, Laparoscopic GI, GI Onco, HPB, Bariatric & Minimal Access Surgery, Fortis Hospital, Shalimar Bagh.

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