Liver Cancer

What is Liver Cancer?

Liver cancer, also known as hepatic cancer, activates in the cells of your liver, which is a football-shaped organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach. Malignant cells that develop in the normal cells of the liver (hepatocytes) are called hepatocellular carcinoma.

Liver cancer is the eighth most common cancer among Malaysian population and sixth most common cancer among males. The incidence of liver cancer increased with age and higher in males compared to females. Chinese were found to have higher incidence rate compared to Malay and Indian. The lifetime risk was 1 in 144 for males and 1 in 418 for females.

Types of Liver Cancer

Hepatocellular Carcinoma (HCC)

HCC begins in the cells of the liver, called hepatocellular cells. Also called hepatoma, it is the most common type of liver cancer, accounting to approximately 75 percent of all liver cancers.


A type of bile duct cancer that occurs in the small, tube-like bile ducts within the liver that transfers bile to the gallbladder. Cholangiocarcinoma cases account for 10 – 20 percent of all liver cancers. There are two subtypes of cholangiocarcinoma; intrahepatic bile duct cancer which begins in ducts within the liver, and extrahepatic bile duct cancer that develops in ducts outside the liver.


Angiosarcoma, also called hemangiocarcinoma, begins in the blood vessels of the liver and develops quickly. The speedy growth is often the reason why they are typically diagnosed at an advanced stage. Angiosarcoma cases account for about one percent of all liver cancers.

Fibrolamellar HCC

Fibrolamellar HCC is a rare type of HCC that is often more responsive to treatment compared to other types of liver cancer.

Secondary liver cancer

Secondary liver cancer is when a primary cancer from another part of the body starts spreading to the liver. This occurrence is also known as metastasis and for liver cancer, it usually begins with colorectal cancer. More than half of colorectal cancer patients will eventually develop secondary liver cancer.


There are 4 stages for Liver Cancer:

Stage 1 Stage 2
  • There is a single tumour and has not spread to the blood vessels, lymph nodes or any other part of the body
  • A single primary tumour, or several small tumours, all less than 5cm in diameter have grown into the blood vessels
  • The cancer has not spread to nearby lymph nodes or any other part of the body
Stage 3 Stage 4
  • Stage III liver cancer is divided to three subcategories:
    • Stage III A: There are several tumours and at least one is larger than 5cm. The cancer has not spread to nearby lymph nodes or any other part of the body.
    • Stage III B: The cancer has grown into one of the main blood vessels of the liver, but cancer cells have not spread into the lymph nodes or to any other part of the body.
    • Stage III C: The cancer has spread into organs close to the liver, or the tumour has grown into the outer covering of the liver. The cancer has not spread to nearby lymph nodes or to any other part of the body.
  • The cancer has been spread to nearby lymph nodes and may have grown into nearby blood vessels or organs
  • Advanced liver cancer does not often spread to distant organs, but when it does, it is most likely to spread to the lungs and bones

Warning signs

  • Hepatomegaly – enlarged liver, the abdomen might appear swollen
  • Jaundice – yellowing of the skin and eyes
  • Abdominal pain – often on the right side, and may reach as high up as the shoulder
  • Weight loss not associated with diet
  • Fatigue
  • Nausea and emesis (vomiting)
  • Back pain
  • Itchy skin
  • Fever

Am I at risk?

Yes, even more so with these factors:

  • Heavy use of alcohol
  • Smoking tobacco use may increase the risk of developing liver cancer
  • Exposure to arsenic and chemicals
  • Long term (chronic) infection with Hepatitis B (HBV) or Hepatitis C virus (HCV)
  • Obesity

Unavoidable risk factors:

  • Age
  • Gender and ethnicity
  • Family history
  • Inherited metabolic disease
  • Diabetes

What can I do?

Beat the cancer. Cut your risk by taking these steps:

  • Limit alcohol intake
  • Do not use intravenous (IV) drug, unless under the supervision of a healthcare professional
  • Maintain a balanced body weight
  • Quit smoking
  • Get HBV vaccination

Liver Cancer Myths vs. Facts

Myth Fact
Liver disease is a result of alcoholism Alcohol is only one of the causes of over 100 forms of liver disease.
Only adults will get liver disease Children are also affected. Major causes of liver disease in children include genetics, viruses (Hepatitis A, B, C) and a blocked flow of bile from the liver. In addition, obese children are at high risk of developing a fatty liver.