Liver Cancer: Signs, Symptoms, and Complications

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The first signs of liver cancer, in some cases, arise with a complication: a bile duct obstruction, anemia, or bleeding, as examples. Since there’s no screening test for liver cancer, an awareness of the potential signs and symptoms is the only way to find the disease early. 

Signs and symptoms are most often the result of liver damage. They may include yellowing of the skin (jaundice), right-sided abdominal or shoulder blade pain, or a lump in the right upper abdomen. However, many of the warning signs (such as weight loss and fatigue) are found in other conditions.

This article discusses the symptoms of liver cancer, which can be similar for both hepatocellular carcinoma (liver cancer) and cholangiocarcinoma (bile duct cancer). It will help you to identify changes in your body that may be signs of liver cancer and know when to see a healthcare provider about your concerns.

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Common Symptoms of Liver Cancer

Liver cancer usually has few symptoms or signs in the early stages, before the disease progresses. Due to this delayed onset of symptoms, liver cancer is often diagnosed in an advanced stage (unless the tumor originates near a bile duct and causes an obstruction early).

Primary liver cancer—that which originates in the liver—is different from liver metastases, which are lesions from the spread of cancer (breast or lung, for example) to the liver. Liver cancer is usually a single large tumor, while metastases (spread) are usually small and multiple.

Primary liver cancer that originates in the liver usually causes earlier symptoms than liver metastases (which are much more common). These may occupy a significant part of the liver before they are detected.

Symptoms that may occur include:

An Abdominal Mass or Lump 

You may feel a very hard lump or swelling in the region just below your rib cage on your right side. Often, this mass is painless, and if you have pain, you may feel more discomfort in the areas surrounding the mass. 

Sometimes liver cancer causes enlargement of the spleen as well, which can result in pain or a mass felt in the left upper abdomen.

Right-Sided Abdominal Pain 

Pain, discomfort, or aching on the right side of the abdomen just under the ribs may occur due to the pressure of a liver tumor on other structures or nerves in this region. Take in a deep breath and press lightly upward under your rib cage on the right side—this is roughly where your liver lies. If you have an enlarged liver (there are many causes), the edge of your liver may be felt lower in your abdomen.

Right Shoulder-Blade Pain 

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

This is the case with liver cancer. The tumor (or spread from the tumor) can irritate nerves that tell your brain the pain is coming from your shoulder blade when it’s actually coming from the liver. This pain is typically felt in the right shoulder, though it may occur on either side. The pain may also extend into your back. 

If you experience this, especially if you haven’t engaged in any recent physical activity that might explain it, see your healthcare provider. 

Jaundice 

Jaundice refers to a condition in which the skin, as well as the white part of the eyes, appears yellow. It is caused by the build-up of bile salts in the skin.

It is more easily detected in natural light, such as being outside, than in indoor light. In addition to yellowing of the skin, some people notice that their bowel movements appear pale and whitish instead of brown. At the same time, urine may appear darker than normal, even without dehydration.

Itching

The build-up of bile salts in the skin, which results in jaundice, can also cause itching. We don’t often think of itching as a serious symptom, but the itching associated with liver dysfunction can be very intense.

Bloat and Shortness of Breath

Fluid build-up in the abdomen referred to as ascites can indicate liver cancer. It may feel like bloating at first; some people note that their clothes don’t fit properly in the waistline or their belt size changes even though they haven’t gained weight. In time, fluid build-up in the abdomen can push upward on the lungs causing shortness of breath.

Unintentional Weight Loss or Gain

A first sign of liver cancer may be unintentional weight loss that’s not related to a change in diet or exercise. It always deserves a visit to a healthcare provider. Unexplained weight loss is defined as the loss of 5% of body weight or more over a period of six months to 12 months, without trying. An example would be a 200-pound man losing 10 pounds over a period of six months without a change in habits.

Unintentional weight loss was found to be related to an underlying cancer, including liver cancer, in a third of people observed in a 2017 review of studies. Other serious causes exist as well, so it’s important to see a healthcare provider as soon you recognize such a change.

Rapid and unexpected weight gain is also a possible sign of liver cancer. This usually occurs due to the rapid build-up of fluid in the abdomen (ascites).

Loss of Appetite 

A loss of appetite may occur with many disorders, but can be quite profound with liver problems. This may be accompanied by a sense of becoming full very rapidly, even when eating only small meals. As these symptoms could be warning signs of not only liver cancer but other cancers, a visit to a healthcare provider is warranted.

Nausea and Vomiting

There are several reasons why liver cancer can lead to nausea and vomiting, and this is a common symptom at all stages of the disease. There are a vast number of causes for nausea and vomiting, but when it occurs frequently, or if it is worsening, talk to your healthcare provider.

Fatigue and/or Weakness

Cancer fatigue is different from ordinary tiredness, and it is not the kind of fatigue that improves with a good night of sleep. Sometimes this symptom is easier to see if you look back at a period of six to 12 months and gauge your energy today against what it was at that time. 

Fever

A low-grade, but persistent fever, something healthcare providers refer to as a “fever of unknown origin” or FUO, is a fairly common symptom of liver cancer. An FUO is defined as a temperature greater than 101 degrees that lasts for three or more weeks and that cannot be tied to an obvious cause after three or more healthcare provider’s visits (or three days in the hospital).

There are several other potential causes of a persistent fever, but having one is a good reason to see your healthcare provider.

General Feeling of Being Unwell

It’s hard to describe intuition as a symptom, but people often sense when something is “off” in their body. If you have a general sense that you are not well, see your healthcare provider.

Symptoms Caused by Liver Tumor Hormones

Some liver cancers secrete hormones (or interact with drugs or other body systems) that can cause additional symptoms.

High Cholesterol (Hypercholesterolemia)

The cholesterol levels in your diet may contribute to the risk of liver cancer. Some studies, including research in animal models, suggest that’s the case with liver cancers linked to non-alcoholic fatty liver disease (NAFLD).

Liver cancer also may cause changes in how lipids (like cholesterol) are produced and used in the body. Researchers are looking at how cholesterol may play a role in treating liver cancers.

Low Blood Sugar (Hypoglycemia)

Liver cancer may lead to low blood sugar (hypoglycemia), with symptoms that include:

  • Irregular heartbeat
  • Facial numbness (lips, for example)
  • Lightheadedness and fainting
  • Fatigue

The liver plays a key role in keeping blood sugar levels stable in the body, and dysfunction can occur due to cancers or conditions linked to liver cancer. These include glycogen storage diseases, caused by rare genetic conditions with common complications that include hepatocellular carcinomas.

Pancreatic cancer, affecting blood sugar levels, also may be implicated because it often spreads to the nearby liver. Diabetes may contribute to the risk of pancreatic cancer, and vice versa.

Diabetes can independently increase the risk of liver cancer and pancreatic cancer, as well as colon, bladder, and breast cancer. So can chronic hepatitis B or C viruses. Cirrhosis and hemochromatosis, an inherited metabolic disorder, also put you at greater risk, as do lifestyle factors like smoking or obesity.

Male Enlarged Breasts (Gynecomastia)

Breast enlargement (gynecomastia) is a common finding in people assigned male at birth who have liver disease, including cirrhosis.

Tumors in the liver can themselves secrete an enzyme (aromatase) that contributes to gynecomastia, too.

High Red Blood Cells (Erythrocytosis)

There are several possible causes for high red blood cell counts that occur with liver cancer and other types. Some studies have shown hypoxia (a lack of oxygen in the blood) may contribute; others find a paraneoplastic syndrome could cause a secondary erythrocytosis. Much of the evidence, however, points to cancer treatments as the cause.

High Blood Calcium (Hypercalcemia)

For people diagnosed with cancer, a high blood level of calcium is a common finding, occurring in 20% to 30% of cases. There are several different causes that may contribute to hypercalcemia, some of the depending on the type of cancer.

Most often, in about 80% of cases in cancer patients, the high blood calcium is related to a peptide called parathyroid hormone-related peptide (PTHrP) that’s secreted by the tumor. This paraneoplastic syndrome is often related to advanced disease and is rarely a first sign of liver cancer.

Complications

Liver cancer can result in a number of complications. They may result from the pressure of a tumor on the bile duct or other organs, hormones produced by the cancer cells, liver dysfunction that results in the build-up of toxins in the body, or other mechanisms.

Some potential complications include:

Anemia

Anemia, a low red blood cell count, is a very common complication of liver cancer. It may occur due to a few mechanisms, including a lack of clotting factors in the blood leading to bleeding.

Symptoms include fatigue, shortness of breath, a rapid heart rate, pale skin, and lightheadedness. Since liver cancer can sometimes result in erythrocytosis (increased red blood cell production) as well, these effects sometimes cancel each other out.

Bile Duct Obstruction

Bile is made in the liver. Several ducts ensure that it gets transported to the small intestine, either via the gallbladder or directly. Liver tumors or bile duct tumors can grow within a duct or exert pressure near one, resulting in bile duct obstruction.

When a duct is obstructed for either reason, it usually results in the rapid onset of severe and constant pain in the right upper abdomen, nausea, vomiting, jaundice, and itching.

Bleeding

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 sufficient numbers. The result is that bleeding may occur (even with a normal number of platelets) and anemia may ensue.

The first sign of liver disease may occur with frequent bleeding when you brush your teeth or frequent nosebleeds. More serious bleeding, such as internal hemorrhage, may occur when the cancer is advanced.

Portal Hypertension

Liver cancer (and other liver diseases) can lead to bleeding from the digestive tract in another way as well. A tumor within 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 vein (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, much like you see on people’s legs, or on the abdomen at times with liver disease. When these varicosities rupture, it can result in massive bleeding into the esophagus (esophageal variceal bleeding), which can be life-threatening if not treated rapidly. Bleeding may occur in the stomach and intestines as well due to the same mechanism.

Hepatorenal Syndrome

Hepatorenal syndrome is a condition in which liver disease 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 it’s estimated that 40% of people who have cirrhosis will develop the syndrome within five years. Unfortunately, it is usually irreversible in these individuals unless liver transplantation is performed.

Hepatic Encephalopathy

Hepatic encephalopathy can be a frightening complication of liver cancer but is actually a reversible cause of symptoms that can look like Alzheimer’s disease: memory loss, disorientation, personality changes, and severe confusion caused by toxins.

Symptoms may begin mildly with difficulty doing math-centered tasks, like balancing a checkbook. Other symptoms may include breath that has a sweet odor and flapping of the arms when they are held out straight in front of a person. There are ways to treat the encephalopathy, but the prognosis usually depends on the extent of the tumor.

When to See a Healthcare Provider

If you note any of the signs and symptoms above or any you can’t explain, see your healthcare provider. If liver cancer is present, the prognosis is generally better the earlier the disease is diagnosed. 

People who have no risk factors for liver cancer can and do develop the disease at times—something worth keeping in mind if you’re unsure about speaking with your healthcare provider.

Healthcare providers may suspect chronic liver disease if they find:

  • Right upper quadrant pain
  • Enlargement of the liver (cirrhosis usually causes it to shrink)
  • Fatigue or change in mood
  • Worsening of portal hypertension
  • Hemorrhoids
  • Bleeding

If you notice any of these symptoms, contact your healthcare provider right away instead of waiting for your next scheduled appointment.

Liver Cancer Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Summary

Liver cancer is not uncommon and represents the fourth-leading cause of cancer death worldwide. It’s common for liver cancers to be fairly advanced at diagnosis because the symptoms aren’t always obvious and screening tests are still being developed.

You may experience nausea, fatigue, and other symptoms that occur with many health conditions. Specific findings, like abdominal pain or jaundice, may help to refine the diagnosis.

Speak to your healthcare provider about any liver cancer symptoms or concerns. If you do have risk factors for liver cancer, such as cirrhosis, you may already be experiencing similar symptoms as a result of an existing health issue. In this case, the key point is to watch for a change in your symptoms.

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