Primary liver cancer in adults

Liver tumours include both non-cancerous (benign) and malignant (cancerous) types; the latter are further classified into those that originate in the liver itself (primary liver cancer) or have spread from other sites of the body (metastatic liver cancers). There are around 6600 new cases of primary liver cancer each year in the UK, with the highest rates reported among those aged 85–89 years (Cancer Research UK, 2020). The disease can occur in younger people and in the past two decades, alcohol, a known cancer-causing substance (hepatocarcinogen), has increasingly contributed to the risk of primary liver cancer development in young adults, with an estimated 6500 deaths occurring in this age group in 2021 worldwide (Danpanichkul et al, 2025). In recent years, the incidence of liver cancer has increased by 167% in the UK alone (Cancer Research UK, 2020), while in the United States incidence rates have more than tripled since the

HCC at the beginning is asymptomatic, and when the patient becomes symptomatic, in most cases the disease is advanced and has spread to other parts of the body. Most commonly, patients are diagnosed following investigations requested for another cause. 
Early signs and symptoms include (Tidy, 2023): 

• Feeling generally unwell
• Nausea
• Loss of appetite
• Tiredness
• Weight loss.

As the cancer progresses, jaundice may develop (caused by a build-up of bilirubin, occurring because of a blocked bile duct), in addition to itching and ascites). Patients with advanced hepatocellular cancer (HCC) may complain of abdominal pain and weight loss, and on abdominal examination there will be a mass in the right upper quadrant. In a few patients, the first manifestation of HCC is bloody ascites, shock, or peritonitis, caused by haemorrhage of the tumour (Tholey, 2025). 

There are several types of liver cancer. Hepatocellular carcinoma (HCC) is the most common type, accounting for 80% of the global liver cancer burden (Vogel et al, 2018). Other types are shown in Table 1.

Approximately 90% of patients with HCC have a history of liver cirrhosis (Watson, 2025). Cirrhosis causes toxic damage to hepatocytes and the release of inflammatory cytokines, prolonged oxidative stress (an imbalance between free radicals and antioxidants), which then leads to DNA damage, cell mutations and the development of cancer (Watson, 2024). Non cirrhotic liver cancer can also occur. The Hepatitis B virus (Hep B) and the Hepatitis C virus (Hep C) are also regarded as leading causes of HCC. Hep B and Hep C can increase risks up to 60 times and are responsible for 85% of cases worldwide (Watson, 2024). In patients with Hep B, HCC can develop in 10–20% of patients with no

Initial assessment should include a thorough history, with past medical history, any symptoms the patient has, and lifestyle factors such as alcohol and smoking history. These are important as family history increases the risk by 1.5 times, smoking by 1.6, alcohol excess by 5, and obesity by 1.5. Medical conditions such as diabetes, organ transplants and immunosuppression due to HIV are also linked to a greater risk (Watson, 2024).

Tests

On presentation, routine bloods including FBC, U&E’s, and liver function tests are requested initially in the primary care setting (Cicalese, 2024). Liver function tests including bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and albumin may be elevated on the initial evaluation and may indicate the severity of the disease (Asafo-Agyei et al, 2023). Other abnormal laboratory findings noted in patients with decreased liver function include an elevated international normalised ratio (INR), prothrombin time (PT), thrombocytopenia, anaemia, hyponatraemia,

Any treatment offered will depend on several factors, such as the size of the tumour or tumours, the degree of spread and how well the liver is functioning. Unfortunately, despite advances in treatments in recent years, options may be limited because of cirrhosis and the patient’s overall health status (Renne et al, 2021).

Options include (Macmillan Cancer Support, 2025; Cicalese, 2024):

• Surgery: surgery is the mainstay of treatment and can be a potentially curative treatment for HCC. Surgical resection and liver transplantation achieve the best results in appropriately selected candidates (5 year survival 60% and higher). 
• Embolisation : trans arterial chemoembolization (TACE) or trans arterial embolisation (TAE). TAE cuts off the blood supply to the liver. TACE delivers chemotherapy directly to the area of the liver at the site of the cancer before the blood supply is blocked. 
• Thermal ablation (heat treatment): heat is used to destroy cancer cells and

British Liver Trust. Liver cancer UK unites wit almost 60 other UK cancer charities to call for reform to improve waiting times. 2025. Available: https://britishlivertrust.co.uk-uk-unite-with-almost-60-other-cancer-charities-to-call-for-reform-to-improve-waiting-times/

Cancer Research UK. Liver cancer statistics. 2020. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/staistics-by-cancer-type/liver-cancer#heading-Zero

Cancer Research UK. Types of liver cancer. 2025. Available at: https://www.cancerresearchuk.org/about-cancer/liver-cancer/types

Cicalese L. Hepatocellular carcinoma (HCC). 2024. Available at: https://emedicine.medscape.com/article/197319-overview#a1

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Asafo-Agyei KO, Samant H. Hepatocellular Carcinoma. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559177/

Macmillan Cancer Support. Stages of liver cancer. 2025. Available at: https://www.macmillan,org,uk/cancer-information-and-support/liver-cancer/stages-of-liver-cancer

Ren Z, Ma X, Duan Z, Chen X. Diagnosis, therapy, and prognosis for hepatocellular carcinoma. Anal Cell Pathol (Amst). 2020;3:8157406. doi: