Liver cancer causes and risk factors

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on March 23, 2023.

Cancer that originates in the liver is called liver cancer. The liver contains different types of cells that are used to describe different types of liver cancer. The most common type of primary liver cancer in adults is hepatocellular carcinoma, which forms in the organ’s main cells. Another type of primary liver cancer, intrahepatic bile duct cancer, starts in the bile ducts within the liver. Other forms of primary liver cancer, such as angiosarcoma, which begins in the cells lining the blood vessels of the liver, are more rare.

According to the American Cancer Society, about 41,630 new cases of primary liver cancer and intrahepatic bile duct cancer will be diagnosed in the United States in 2024, and roughly 29,840 people will die. Liver cancer is the seventh-most common cause of cancer death in women, and the fifth-most common cause of cancer death in men, according to the American Society of Clinical Oncology. Between 1980 and 2015, liver cancer incident rates more than tripled in the United States, but have since declined and stabilized.

What causes liver cancer?

While the exact cause of liver cancer may not be known, several factors may increase the risk of developing the disease. Because no widely recommended routine screening tests have been developed for liver cancer, people with a family history of the disease or other risk factors should talk with their doctor about steps they can take to monitor or reduce their risk. The National Comprehensive Cancer Center recommends alpha-fetoprotein blood tests and ultrasounds every six to 12 months for people with a high risk of developing liver cancer. Just as with many other cancers, catching it early can make treating liver cancer more successful and prevent it from metastasizing.

Risk factors for liver cancer

General liver cancer risk factors

Age: In the United States, the average age at onset of liver cancer is 63 years.

Gender: Men are more likely to develop liver cancer than women, by a ratio of 2 to 1.

Race and ethnicity: In the United States, liver cancer rates are highest in Asian Americans and Pacific Islanders. White Americans have the lowest risk for liver cancer. Chronic infection with hepatitis B virus or hepatitis C virus is the most common liver cancer risk factor. These infections lead to cirrhosis of the liver. Both hepatitis B and C viruses may spread from person to person through sharing of contaminated needles (such as in drug use), unprotected sex or childbirth. The viruses may also be passed on through blood transfusion, though this risk has been greatly reduced in the United States since the start of blood testing for these viruses.

Obesity: Being obese may increase the chances of developing liver cancer, probably through development of non-alcoholic steatohepatitis (NASH) and eventually, cirrhosis.

Lifestyle liver cancer risk factors

Heavy use of alcohol: Drinking alcohol doesn't directly cause liver cancer, but heavy drinking or long-term alcohol use may increase the risk of developing the disease. Alcohol abuse is a common cause of cirrhosis of the liver, which increases a person’s liver cancer risks.

Smoking: Tobacco use may increase the risk of developing liver cancer.

Anabolic steroids: Used by athletes to increase strength and muscle mass, the long-term use of anabolic steroids (male hormones) may slightly increase the risk of developing liver cancer. Cortisone-like steroids such as hydrocortisone, dexamethasone and prednisone do not carry the same risk.

Arsenic: Chronic exposure to naturally occurring arsenic through drinking water (contaminations in some wells) increases the risk of developing some forms of liver cancer.

Aflatoxins: These are cancer-causing substances made by a fungus that contaminates wheat, corn, soybeans, rice and some types of nuts. Contamination usually occurs due to storage of the food stuff in a moist, warm environment, more common in warmer and tropical countries. Long-term exposure to aflatoxins is a major liver cancer risk factor, especially in people with hepatitis B or C infections. Regular testing by the federal government regulates the content of aflatoxins in foods in the United States.

Exposure to certain chemicals: Exposure to vinyl chloride (a chemical used in the making of some plastics) and thorium dioxide (a chemical previously used for X-ray testing) may increase the risk of angiosarcoma of the liver. In recent years, strict regulation on exposure to these chemicals has been imposed in the United States.

Other conditions that may increase risk

Cirrhosis of the liver: Cirrhosis occurs when liver cells become damaged and are replaced by scar tissue. People with cirrhosis have an increased risk of liver cancer. In most cases (up to 90 percent of the cases in the United States), people who develop HCC have underlying cirrhosis. Cirrhosis is caused by several factors. Besides alcohol abuse and chronic hepatitis B or C infections, NASH (a fatty liver disease often seen in obese people who consume little or no alcohol), certain types of inherited metabolic diseases and autoimmune diseases may cause cirrhosis.

Metabolic diseases: Certain types of inherited metabolic diseases may cause cirrhosis and increase the chances of developing liver cancer. Genetic hemochromatosis (an iron-overload disorder that builds up iron stores throughout the body including the liver), tyrosinemia (elevated levels of the amino acid tyrosine), alpha-1-antitrypsin deficiency, porphyria cutanea tarda (deficiency in heme synthesis), glycogen storage disease, and Wilson disease (elevated levels of copper in the liver) are rare diseases that may damage the liver and increase a person’s liver cancer risks.

Diabetes: Having diabetes may also increase the risk of developing liver cancer.

Is it possible to prevent liver cancer?

Although there's no way to guarantee that someone will never develop liver cancer, there are ways to reduce the risk of developing the disease:

  • Avoid drinking excessive amounts of alcohol.
  • Maintain a healthy weight.
  • Get vaccinated against hepatitis B.
  • Quit smoking, or don't pick up the habit.
  • Test for hepatitis C, and get treated if the results are positive.
  • Limit exposure to chemicals such as vinyl chloride and thorium dioxide.
  • Avoid using anabolic steroids.
  • Seek treatment for diabetes or metabolic diseases.

Learn more about diagnostic procedures for liver cancer

Next topic: What are the symptoms of liver cancer?

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Show references
  • American Cancer Society (2023, Jan. 12). Key Statistics About Liver Cancer.
  • American Society of Clinical Oncology (2023, March). Liver Cancer: Statistics.
  • American Cancer Society (2022, Jan. 12). Risk of Dying From Cancer Continues to Drop at an Accelerated Pace.