Liver cancer.
A plain-language guide to primary liver cancer: what hepatocellular carcinoma is, who is at risk, why surveillance matters, and how it is diagnosed and treated in Australia.
What liver cancer is.
The liver is the body's chemical factory: it processes nutrients, clears toxins and makes proteins and bile. Primary liver cancer starts in the liver itself. The most common type, hepatocellular carcinoma (HCC), begins in hepatocytes, the main liver cells, and accounts for about nine in ten primary liver cancers.
This is different from secondary liver cancer, which is cancer that started somewhere else, such as the bowel, and spread to the liver. Secondary liver cancer is much more common in Australia than primary liver cancer, and it is treated according to where it started.
Other primary liver cancers include cholangiocarcinoma, which starts in the bile ducts inside the liver, and angiosarcoma, a rare cancer of blood vessels.
In 2025 an estimated 3,175 people were diagnosed with liver cancer in Australia, and the rate has risen sharply since the early 1980s. Across all stages, 24.6 out of 100 people diagnosed between 2017 and 2021 were alive five years later. That figure reflects both late diagnosis and the underlying liver disease that so often accompanies it.
Who is at risk, and why surveillance matters.
About eight to nine in ten HCCs develop in a liver that is already cirrhotic. Cirrhosis is scarring from years of inflammation, and it is the main reason people are offered surveillance.
The biggest known risk factor in Australia is chronic hepatitis B or C. Others include alcohol-related liver disease, metabolic dysfunction-associated steatotic liver disease (the condition formerly called fatty liver disease), and aflatoxin exposure from mouldy stored foods, which matters mainly in parts of Africa and Asia.
Surveillance means a liver ultrasound every six months, with or without a blood test for alpha-fetoprotein (AFP). It is offered to people with cirrhosis who are well enough to be treated if a cancer is found, and to some people with chronic hepatitis B even without cirrhosis. It is not a national screening program: it is targeted at people whose risk is high enough to justify it.
Surveillance finds cancers earlier, when curative treatment is possible. Treated hepatitis B, and cured hepatitis C, lower the risk but do not remove it, so surveillance usually continues.
If you have cirrhosis or chronic hepatitis B, ask whether you should be on six-monthly surveillance. It is the single most effective way to find liver cancer early.
Symptoms worth taking to a GP.
Early liver cancer often causes no symptoms, which is why surveillance exists. When symptoms appear, they often reflect the liver disease underneath as much as the cancer.
Pain or fullness on the right side
Discomfort under the right ribs, or a hard lump felt below the rib cage.
Swelling or fluid
A swollen abdomen from ascites, fluid that builds up when the liver is not working normally.
Pain around the right shoulder blade
Referred pain from the diaphragm or liver capsule, sometimes felt in the upper back.
Jaundice
Yellowing of the skin and the whites of the eyes, which needs urgent assessment.
Weight loss, loss of appetite, nausea
Often gradual and easy to attribute to other causes.
Unusual tiredness
Fatigue is common in liver disease and can worsen as cancer develops.
Easy bruising or bleeding
A sign of impaired liver function, and a reason to be assessed promptly.
Cirrhosis changes what is normal for you. New pain, new swelling, or a sudden change in energy should be checked rather than attributed to your usual liver disease.
How it is diagnosed.
In people at high risk, liver cancer can often be diagnosed from imaging alone. The sequence is designed to confirm the diagnosis and stage it without unnecessary procedures.
From abnormal scan to a treatment plan
BCLC stages run from 0 (very early) to D (end stage). Stage 0 is a single tumour under 2 cm in a well-functioning liver; stage D is advanced liver failure, where treatment focuses on comfort.
What treatment looks like.
Resection
Surgery removes the part of the liver containing the tumour. It is used when the cancer is confined to one area, the remaining liver is healthy enough, and there is no significant portal hypertension. The liver regenerates, but only if the underlying liver is in reasonable condition.
Ablation
For small tumours, heat or chemical ablation can destroy the cancer without removing liver tissue. It is often used for tumours under 3 cm, or when surgery is not suitable.
Transplant
A liver transplant replaces the diseased liver and the cancer with it. It is offered to a carefully selected group, classically using the Milan criteria: a single tumour under 5 cm, or up to three tumours each under 3 cm, without spread outside the liver or into blood vessels.
TACE and TARE
Transarterial chemoembolisation (TACE) delivers chemotherapy directly into the tumour's blood supply and blocks it. Transarterial radioembolisation (TARE, also called SIRT) delivers radioactive beads. Both are used for tumours that cannot be removed, often to control growth and keep a transplant option open.
Systemic therapy
For advanced cancer, combinations of immunotherapy and targeted therapy are standard. Atezolizumab with bevacizumab is commonly used, and requires screening for varices before starting because of bleeding risk. Other options depend on liver function and previous treatment.
Palliative care
When the cancer or the liver disease is advanced, the focus shifts to symptoms, nutrition and support for family. Palliative care can be given alongside active treatment at any stage. Advance care planning, which records what matters to you and who can speak for you, can start at any time.
Your liver function matters as much as your cancer stage. Ask your team to explain both, and why a particular option is or is not open to you.
The research we fund.
The HOPE Fund supports surgical and recovery research across upper GI and HPB care, including work relevant to liver surgery.
HIIT Cancer
A randomised trial of high-intensity interval training started immediately after major foregut surgery, testing whether early structured exercise improves recovery.
Better decisions in surgery
Work using AI to support surgical decisions and make care more consistent for HPB patients.
Patient information that is actually read
Informed patients make better decisions and cope better with treatment.
Questions people actually ask.
Is liver cancer the same as cancer that has spread to the liver?
No. Primary liver cancer starts in the liver, most often as hepatocellular carcinoma. Secondary liver cancer started somewhere else, commonly the bowel, and spread to the liver. They are treated differently.
Should I have surveillance if I have cirrhosis?
Guidelines recommend six-monthly liver ultrasound, with or without AFP, for people with cirrhosis who are well enough to be treated if cancer is found. Ask your hepatologist or GP whether you qualify.
Can liver cancer be cured?
It can be cured in some people, particularly when it is found early and can be removed, ablated or transplanted. Cure depends on the size and position of the tumour and on how well your liver works.
Why does liver function affect my options?
Surgery, ablation and transplant all depend on the remaining liver coping. If the liver is severely scarred, these treatments may not be safe, and the focus shifts to controlling the cancer and managing symptoms.
Is a biopsy always needed?
No. In people with cirrhosis or chronic hepatitis B, characteristic imaging can be enough to diagnose HCC. A biopsy is used when the imaging is not typical or the diagnosis is unclear.
Can treating hepatitis reduce my risk?
Yes. Antiviral treatment for hepatitis B lowers the risk of liver cancer, and curing hepatitis C lowers it too. The risk does not fall to zero, so surveillance usually continues.
This page is general information, not medical advice. It is written for people in Australia and does not replace a conversation with your own treating team, who know your history and your scans. If you are worried about a symptom, see your GP. In an emergency, call 000.
Sources: Cancer Australia, Liver cancer in Australia statistics (AIHW data to 2021, 2025 estimates), Cancer Australia, Liver cancer diagnosis, symptoms and treatment pages, Cancer Council Australia, Liver cancer, Cancer Council Australia, Hepatocellular carcinoma clinical guidelines (NHMRC approved 2023), EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma (2025), National Cancer Institute, Primary Liver Cancer Treatment (PDQ), Cancer Research UK, Liver cancer risks and causes.
Related guides.
Biliary tract cancer
Begins in the bile ducts (cholangiocarcinoma) or the gallbladder. These cancers can block the flow of bile, causing jaundice, a yellowing of the skin and eyes, which is often the first noticeable sign.
Read the biliary tract cancer guidePancreatic cancer
Begins in the pancreas, most commonly in the ducts that carry digestive enzymes. It tends to grow quietly and spread early, so research into earlier detection, such as our pancreatic cyst registry, is a priority.
Read the pancreatic cancer guideFund the work that finds it earlier.
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