Merck Manual

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Primary Liver Cancers


Danielle Tholey

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Reviewed/Revised May 2023
Topic Resources

Primary liver cancers are cancers that originate in the liver. The most common is hepatocellular carcinoma Hepatocellular Carcinoma Hepatocellular carcinoma is a cancer that begins in the liver cells and is the most common of the primary liver cancers. Having hepatitis B or hepatitis C or fatty liver disease, or drinking... read more (hepatoma). At first, liver cancer usually causes only vague symptoms (such as weight loss, loss of appetite, and fatigue). As a result, the diagnosis is often made late, and the prognosis is usually poor.

The Liver

Other Primary Liver Cancers

Other primary liver cancers are uncommon or rare. For diagnosis, a biopsy Biopsy of the Liver Doctors can obtain a sample of liver tissue during exploratory surgery, but more often they obtain a sample by inserting a hollow needle through the person's skin and into the liver. This type... read more is usually needed. Most people with these cancers have a poor prognosis. If the cancer has not spread, it can sometimes be removed. When it can be removed, people may live several years or longer.


This relatively slow-growing cancer originates in the lining of the bile ducts in or outside the liver. In China, infestation with liver flukes (a parasite) contributes to the development of this cancer. People with primary sclerosing cholangitis Primary Sclerosing Cholangitis Primary sclerosing cholangitis is inflammation with progressive scarring and narrowing of the bile ducts in and outside the liver. Eventually, the ducts become blocked and then obliterated.... read more are at risk of developing cholangiocarcinoma.

Symptoms of the cancer are often vague but may include sudden deterioration of the person’s general health, a mass in the upper right part of the abdomen, jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more Jaundice in Adults (a yellowish discoloration of the skin and the whites of the eyes), weight loss, and abdominal discomfort.

Fibrolamellar carcinoma

This type of hepatocellular carcinoma is rare. It usually affects relatively young adults. It is not caused by preexisting cirrhosis or hepatitis B or C and has no other known risk factors.

People with fibrolamellar carcinoma usually fare better than those with other types of hepatocellular carcinoma. Many live several years after this cancer is removed.


This cancer is rare but is one of the most common primary liver cancers in infants. Occasionally, it occurs in older children and may produce hormones (called gonadotropins) that result in early (precocious) puberty Early Puberty Early (precocious) puberty is sexual maturation that begins before the average age. The cause of early puberty is often unknown, but it may be caused by structural abnormalities or tumors in... read more . No cause has been identified.

Health may generally deteriorate, and a mass may be felt in the upper right part of the abdomen.


This rare cancer originates in the blood vessels of the liver. An angiosarcoma may be caused by exposure to vinyl chloride in the workplace, as occurs in the manufacture of polyvinyl chloride (PVC), or by exposure to arsenic. However, in most people, no cause is identified.

Diagnosis of Other Primary Liver Cancers

  • Physical examination

  • Blood and imaging tests

  • Sometimes liver biopsy

A hepatoblastoma is usually suspected when doctors feel a large mass in the upper right part of an infant's abdomen and the infant’s health is deteriorating. Results of blood tests to measure levels of alpha-fetoprotein (AFP) and imaging tests Imaging Tests of the Liver and Gallbladder Imaging tests of the liver, gallbladder, and biliary tract include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography... read more may help doctors make the diagnosis. Levels of AFP—a protein normally produced by immature liver cells in fetuses—usually increase when liver cancer is present.

Cholangiocarcinoma in the liver, fibrolamellar carcinoma, hepatoblastoma, and angiosarcoma are diagnosed by liver biopsy Biopsy of the Liver Doctors can obtain a sample of liver tissue during exploratory surgery, but more often they obtain a sample by inserting a hollow needle through the person's skin and into the liver. This type... read more (removal of a sample of liver tissue with a needle for examination under a microscope).

Treatment of Other Primary Liver Cancers

  • Surgical removal of cancer

Usually, treatment of these cancers has little effect, and most people die within a few months of when the cancer was detected. However, if the cancer is detected relatively early, it may be surgically removed, offering the hope of long-term survival.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • American Cancer Society: Provides comprehensive information about liver cancer, including its symptoms, diagnosis, staging, and survival rates.

  • American Liver Foundation: Hosts community education programs that give an overview of all aspects of liver disease and wellness. Also provides access to support groups, information on finding a physician, and opportunities to participate in clinical trials.

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