Risks and causes of liver cancer
Your risk of developing liver cancer depends on many factors. These include your age,
, liver health and environmental factors.
Anything that can increase your risk of cancer is called a risk factor.
Different cancers have different risk factors. Having one or more of these risk factors doesn't mean you will definitely get that cancer.
Primary liver cancer is different to cancer that spreads to your liver from somewhere else in your body. This is called secondary liver cancer or liver metastases.
Getting older
Although liver cancer can happen at any age, it is most common in older people. Most people diagnosed are over the age of 60. The highest rates are in 85 to 89 year olds.
Liver cirrhosis
Cirrhosis is scarring of the liver due to previous damage. This scarring can cause problems with the way the liver works.
Having cirrhosis increases your risk of getting a type of liver cancer called hepatocellular carcinoma (HCC). The risk varies depending on the cause of the cirrhosis. Causes of cirrhosis include:
- long term infection with hepatitis B, C or D
- long term alcohol drinking above the recommended amount
- inherited diseases such as iron overload disorder (
haemochromatosis ) and
alpha 1 antitrypsin deficiency - having too much fat in the liver - this is called non alcoholic fatty liver disease or metabolic dysfunction associated steatoic liver disease
- primary biliary cirrhosis (PBC)
Non alcoholic fatty liver disease
Non alcoholic fatty liver disease (NAFLD) is also called metabolic dysfunction associated steatoic liver disease (MASLD). Having it increases your risk of liver cancer.
In NAFLD fat builds up in the liver. The fat causes inflammation and damage, which might lead to cirrhosis.
Non alcoholic fatty liver disease is common in people who have a group of symptoms called metabolic syndrome. These include:
- having extra weight around the waist
- using insulin less effectively than normal
- high blood pressure
- high levels of fat in the blood
Smoking
Smoking increases your risk of many different cancers, including liver cancer. In the UK, 20 out of 100 (20%) cases of liver cancer are caused by smoking.
The risk of liver cancer is also higher in people who smoke and have hepatitis B, C or D infection.
Being overweight or obese
Overweight or obesity increases the risk of liver cancer. Type 2 Diabetes and non alcoholic fatty liver disease are more common in people who are overweight. So this may partly explain the link.
More than 20 out of 100 cases of liver cancer (20%) in the UK are caused by overweight and obesity.
Alcohol
Drinking more than 6 units of alcohol each day increases your risk of liver cancer. Doctors call this heavy drinking. 7 out of 100 cases of liver cancer (7%) in the UK are caused by drinking alcohol.
Drinking alcohol long term can cause cirrhosis of the liver. Cirrhosis in turn increases the risk of liver cancer. Alcohol might also directly damage the DNA inside liver cells.
The risk of liver cancer is higher in heavy drinkers who have hepatitis B, C or D virus infections compared to those who drink moderate amounts of alcohol or don't drink at all.
Diabetes
People with diabetes have a higher risk of liver cancer than people who do not have diabetes. This risk may be due to the higher levels of insulin in people with diabetes or due to liver damage caused by the diabetes. The risk may be increased more in people who have other risk factors such as liver cirrhosis or hepatitis infection.
Some treatments for diabetes such as metformin may reduce the risk of liver cancer.
Aflatoxin
Aflatoxin is a substance that is produced when some foods are contaminated by fungus. It can be found in foods such as:
- mouldy peanuts
- wheat
- soya beans
- groundnuts
- corn
- rice
People from certain parts of Africa and Asia who have eaten these over a long period of time have an increased risk of developing liver cancer. The risk is increased further in people who also have chronic hepatitis B infection.
Hepatitis
Long term infection with the hepatitis B, C or D virus increases the risk of developing primary liver cancer. This is mainly because these viruses cause damage to the liver (cirrhosis).
Smoking, and drinking alcohol when you have hepatitis B, C or D can further increase your risk of liver cancer.
Human immunodeficiency virus (HIV)
Studies have shown that there are more cases of liver cancer in people living with . This might be because they have low immunity, which means the body is less able to fight infection. So they are less likely to clear a hepatitis infection, which can cause cirrhosis.
Chemicals
There is evidence that exposure to the chemical vinyl chloride increases liver cancer risk. There is also limited evidence that exposure to other chemicals such as arsenic, plutonium and trichloroethylene may increase risk. People may come into contact with these chemicals through their work.
Gallstones or gallbladder removal
People may have an increased risk of liver cancer if they:
- have had gallstones before, or
- had their gallbladder removed (cholecystectomy)
The increased risk may be due to raised pressure in the bile duct. This causes long term inflammation in the liver tissue.
Family history
People with a family history of liver cancer may have an increased risk of developing it themselves. This might be due to genetic or shared environmental factors.
Liver flukes (parasitic worms)
Liver flukes are infections caused by parasites. These infections can increase your risk of liver cancer. They are usually caused by eating contaminated food or drinking contaminated water. They are not common in the UK.
Testing for liver cirrhosis
There are projects taking place across the United Kingdom to diagnose people with liver cirrhosis. Doctors think that if they can pick up cirrhosis early, they might be able to treat it and prevent some liver cancers.
What happens?
A specialist team offer a type of liver scan called a fibroscan to people who have a higher risk of liver disease. This includes people who:
- have been drinking more than the recommended levels of alcohol for a long time
- are diabetic
- have high blood pressure
- might have hepatitis
- are obese
If the fibroscan finds that you might have liver disease, the specialist team will tell you if you need to see specialist or have another scan.
For detailed information on risk factors for liver cancer
We have more detailed information for health professionals about liver cancer risks and causes.
Are there other causes?
Stories about possible cancer causes are often in the media and it can be hard to know what’s true and what’s not. You may have heard of something that isn’t included here. This is because we only include a risk factor in this information if it is supported by good quality evidence.
Reducing your risk
There are ways you can reduce your risk of cancer.