Liver Cancer Is Often Silent: Why Regular Monitoring Matters for Those at Higher Risk

Why Can Liver Cancer Be Difficult to Detect Early?

Liver cancer may not cause noticeable symptoms during its early stages. When symptoms do develop, they can include abdominal discomfort or swelling, unexplained weight loss, loss of appetite, fatigue, nausea or yellowing of the skin and eyes, known as jaundice.

Because symptoms can appear later in the disease, waiting until something feels wrong may not be the best approach for people who already have a higher risk of developing liver cancer. The American Cancer Society notes that there are no widely recommended liver cancer screening tests for people at average risk, but regular testing may be recommended for certain people at higher risk.

This distinction is important: surveillance is not recommended for everyone. It is intended for people whose individual risk is high enough that regular monitoring may provide a benefit.

Who Is at Higher Risk for Liver Cancer?

Hepatocellular carcinoma, or HCC, is the most common type of primary liver cancer is adults and often develops in people who have chronic liver disease. Cirrhosis and chronic viral hepatitis are among the most significant risk factors.

People who may have an increased risk include those with:

• Cirrhosis: Long-term liver damage can cause healthy liver tissue to be replaced with scar tissue. Cirrhosis can result from several conditions and significantly increases the risk of liver cancer.
• Chronic hepatitis B: Long-term infection with hepatitis B virus can increase liver cancer risk, including in some people who have not developed cirrhosis.
• Chronic hepatitis C: Hepatitis C can cause ongoing liver inflammation and damage that may eventually lead to cirrhosis and increase liver cancer risk.
• Metabolic dysfunction-associated steatotic liver disease (MASLD): Previously known as nonalcoholic fatty liver disease, MASLD can progress in some people to metabolic dysfunction-associated steatohepatitis (MASH), formerly called NASH, fibrosis and cirrhosis. Advanced liver disease related to MASLD/MASH can increase liver cancer risk.
• Certain inherited or chronic liver conditions: Conditions such as hereditary hemochromatosis and some autoimmune or metabolic liver diseases can lead to cirrhosis and increase liver cancer risk.

Having one of those conditions does not mean someone will develop liver cancer, and surveillance recommendations are not identical for everyone with a risk factor.

What Does Liver Cancer Surveillance Involve?

For people who meet criteria for liver cancer surveillance, regular testing allows healthcare providers to look for changes in the liver before symptoms develop.

Current American Association for the Study of Liver Diseases guidance recommends liver cancer surveillance approximately every six months using abdominal ultrasound and an alpha-fetoprotein (AFP) blood test for people with cirrhosis and certain populations with chronic hepatitis B.

An ultrasound uses sound waves to create images of the liver and can help identify suspicious areas or changes.

An AFP blood test measures alpha-fetoprotein, a substance that can be elevated in some people with liver cancer. AFP is not a perfect test and can be elevated for reasons other than cancer. Some people with liver cancer may also have normal AFP levels, which is why it is not used alone to diagnose the disease.

If surveillance identifies something unusual, additional imaging or testing may be recommended. 

Why Does Early Detection Matter?

Finding liver cancer at an entire stage can create more opportunities for potentially curative treatment.

Depending on the cancer and the health of the liver, early-stage treatment options can include surgery to remove part of the liver, liver transplantation or local treatments such as ablation. Treatment decisions depend on many factors, including the size and location of the cancer, how well the liver is functioning and the patient's overall health.

This is why surveillance can be especially valuable for people known to be at higher risk. The goal is to identify concerning changes when the cancer may still be small and more treatment options may be available.

Should You Be Screened for Liver Cancer?

There is no routine liver cancer screening recommendation for everyone. Whether surveillance is appropriate depends on a person's underlying liver disease, medical history and individual level of risk.

If you have cirrhosis, chronic hepatitis B or C, advanced liver disease related to MASL/MASH, an inherited liver condition or another history of chronic liver disease, talk with your healthcare provider about your individual risk.

Questions you may want to ask include:

• Am I at increased risk for liver cancer?
• Should I undergo regular liver cancer surveillance?
• How often should I be monitored?
• What tests are appropriate for me?
• Are there steps I can take to protect my liver health?

Your healthcare provider can consider your complete medical history and help determine whether regular surveillance is appropriate.

Staying Ahead of a Disease That May Not Cause Early Symptoms

Liver Cancer Awareness Month is a reminder that awareness is not limited to recognizing symptoms. For people at increased risk, knowing whether regular surveillance is appropriate can be equally important.

Liver cancer may develop without obvious early warning signs, but identifying it earlier can provide more treatment options. If you have a history of chronic liver disease or other liver cancer risk factors, talk with your healthcare provider about your risk and whether ongoing monitoring should be part of your care.