Causes and Risk Factors of Liver Cancer

We don't know the precise causes of liver cancer, but risk factors include excessive alcohol use, smoking, liver infections such as hepatitis B and hepatitis C, certain other medical and genetic conditions, and other concerns. 

Liver cancer can affect both children and adults but occurs most often in adults. There are several types of liver cancer, but the risk factors below refer to adult primary liver cancer, called hepatocellular carcinoma and bile duct cancer (cholangiocarcinoma). Studies have found that liver cancer and bile duct cancer are increasing worldwide, and are the leading cause of cancer deaths in some regions.

There is no screening test for liver cancer, but being aware of your risk factors and knowing the signs and symptoms can help detect it when it's still in early, and more treatable, stages.

liver cancer risk factors

Common Risk Factors

Cancer begins when a series of gene mutations lead a cell to grow out of control. How this happens in liver cancer isn't confirmed, but several mechanisms have been postulated. What is known is that several factors increase one's risk of developing the disease. Some of them do so substantially, whereas others may raise the risk only a small amount. There are other risk factors that are considered, though experts aren't sure if they are indeed related.

Having a risk factor for liver cancer does not mean that you will develop the disease. It's also possible to get liver cancer even if you don't have any known risk factors.

It is usually a combination of factors working together that results in the development of a tumor. Combinations of risk factors can be additive, but can also be multiplicative, such as with the combinations of alcohol and smoking or hepatitis B and smoking.

Race and Sex

Asians and Pacific Islanders develop liver cancer more often than people of other races, largely due to the hepatitis epidemic among these regions. Caucasians develop liver cancer less frequently, but the disease appears to be increasing.

Liver cancer is more common in men than women, although the reasons aren't entirely clear.

Hepatitis B Infection

Chronic hepatitis B infection is a major risk factor for the development of liver cancer and is the leading cause of liver cancer in Africa and most of Asia. People with chronic hepatitis B are at risk for the development of liver cancer, though some people with chronic hepatitis B are at more risk than others.

Treatments are available, but many people are not aware they carry the virus or live in an area in which medical care is less than optimal. Overall, hepatitis B carriers are 100 times more likely to develop liver cancer, and 2.5 percent of people with cirrhosis due to hepatitis B (and 0.5 to 1 percent of people without cirrhosis) will develop the disease each year.

While 95% of people with hepatitis B clear the virus after infection roughly 5% will become chronic carriers.

Hepatitis C Infection

Hepatitis C is also a major risk factor for the development of liver cancer and is currently the leading cause of liver cancer in the United States, Europe, and Japan. Unlike hepatitis B, many people do not clear the virus, and it becomes a progressive disease. Roughly 20 to 30 percent of people who are infected go on to develop cirrhosis.

When hepatitis C is found and treated with antiviral medications, the risk of cirrhosis, and likely liver cancer can be greatly reduced.

Most people with hepatitis C are unaware they are infected. Therefore, it's recommended that all American adults born between 1945 and 1965 get tested.

Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease is a condition similar to alcoholic liver disease, but it results in an accumulation of fat in the liver (fatty liver) by a different mechanism. It's thought to be an autoimmune disease (in which the body makes antibodies against itself) and may have a genetic component.

With NAFLD, the risk of liver cancer is increased. Closely related, metabolic syndrome may also be a risk factor for liver cancer.


Immunosuppression increases the risk of liver cancer, as well as other cancers. Organ transplant recipients are twice as likely to develop liver cancer as the general population, and the risk is even higher for those who have received a liver transplant.

Having HIV/AIDS is associated with a five-fold greater risk of developing liver cancer.

Lupus (Systemic Lupus Erythematosus)

The reason is uncertain, but people who have lupus are more than twice as likely to develop liver cancer.


People who have diabetes have a risk of liver cancer two to three times higher than the general population. Of interest, it appears that the diabetic medication Glucophage (metformin) may reduce this risk.

Chemical Exposures (and Occupational Risk)

A number of chemical exposures have been linked to the development of liver cancer and are probable carcinogens.

One exposure that the general public may encounter is arsenic in well water. 

Occupational exposures are also of concern, including exposure to vinyl chloride (found in plastics), acrylamide, PFOA or perfluorooctanoic acid (found in dry cleaning methods), polychlorinated biphenyls (PCBs), perfluorinated chemicals (PFCs), benzo(a)pyrene (BaP), and trichloroethylene.

Sclerosing Cholangitis

Sclerosing cholangitis is a chronic liver disease associated with inflammatory bowel disease (such as Crohn's disease that involves the colon and ulcerative colitis).

Sclerosing cholangitis causes inflammation and scarring of the bile ducts such that bile backs up into the liver causing scarring there as well.

Approximately 10-15 % of people with sclerosing cholangitis develop cholangiocarcinoma (bile duct cancer).

Aflatoxin Exposure

Though an uncommon risk factor in the United States, this is a more significant one worldwide. Aflatoxin B1 is a toxin produced by fungi (of the genus Aspergillus) that grows on foods such as wheat, peanuts, other groundnuts, soybeans, and corn. The toxin causes damage to the p53 gene in liver cells—a tumor suppressor gene that helps repair damaged DNA and inhibit the growth of harmful cells.

Research is ongoing and studies are exploring whether aflatoxin causes liver cancer on its own or as a co-factor when combined with hepatitis B.

Strict food regulations and testing make exposure uncommon in the United States, through exposure and poisoning are common worldwide. The toxin is often found in foods that have not been stored properly, usually in warm and tropical climates. American travelers to such areas likely should not worry, though—it's thought that long-term exposure is required to cause liver cancer.


Liver cancer can run in families (even without a known genetic disease), and having a relative with the disease (on either side) increases your risk. The risk is greatest when it is a first degree relative such as a parent, sibling, or child.


Hereditary hemochromatosis (iron overload disease) is a condition marked by the body's increased absorption and storage of iron, often in the liver. In time, the condition usually leads to cirrhosis and liver failure (as well as other medical problems).

The risk of liver cancer in people who have hemochromatosis is 20 times higher than that of the general population.

Treatment (periodically withdrawing blood) can reduce the risk of problems, but many people are unaware they have the condition until they develop problems. It's thought that 1 million people in the United States are affected by one of the types of hemochromatosis.

Primary Biliary Cirrhosis

Primary biliary cirrhosis is a condition that appears to have a genetic component, as it runs in families. It is a progressive, autoimmune disease in which bile builds up in the liver, damaging bile ducts and leading to liver damage and cirrhosis.

Primary biliary cirrhosis is associated with a high risk of liver cancer, similar to that found in people with chronic hepatitis C. 

Wilson's Disease

Wilson's disease is a rare genetic disorder characterized by the accumulation of copper in the body and is thought to be a risk factor for liver cancer.

Other Hereditary Diseases

Other hereditary diseases that may increase the risk of liver cancer include alpha-1 antitrypsin deficiency, tyrosinemia, acute hepatic porphyrias, porphyria cutanea tarda, and glycogen storage disease.

Liver Cancer Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Lifestyle Risk Factors

Lifestyle factors are important in the development of liver cancer. While you cannot control many of the common risk factors mentioned above, you do have the ability to influence these.

Excessive, Long-Term Alcohol Use

Excessive, long-term use of alcohol can cause a number of liver diseases, including alcoholic hepatitis and alcoholic liver disease. Over time, cirrhosis develops with marked scarring of the liver, and often, liver failure.

Liver cancer is primarily associated with heavy drinking, or the intake of more than three drinks on a daily basis, though lesser amounts can still cause significant and irreversible liver disease.

Alcohol intoxication, though not associated with liver cancer over the short term, may increase the risk of behaviors associated with acquiring hepatitis B or C.


Smoking is a risk factor for many cancers, and liver cancer is no exception. Several studies suggest a link between smoking and liver cancer, and those who both smoke and drink heavily have a significantly greater risk of the disease.

Children who are born to parents who smoked either before or during pregnancy are at an increased risk of a rare type of liver cancer called hepatoblastoma.


The role of obesity in liver cancer is uncertain by itself, but obesity does increase the risk of developing non-alcoholic liver disease, a condition that quadruples the risk of liver cancer, as well as diabetes, which is associated with triple the risk.

Anabolic Steroid Use

Anabolic steroids, such as those used by weightlifters, are a risk factor for liver disease and liver cancer.

Chewing Betel Quid

Uncommon in the United States, chewing betel quid is a risk factor for liver cancer in regions where this is commonly practiced.

Other Risk Factors

There is some evidence that gallbladder removal (cholecystectomy) increases risk, though researchers are not certain of the connection. The jury's also out on whether there is an increased risk related to current use of birth control pills.

There may be some risk related to medical radiation (such as CT scans of the abdomen), but this risk is likely largely outweighed by the benefits of these tests.

The parasite that causes schistosomiasis has been studied for its possible role in liver cancer. Instead of being a risk factor, it's thought that it is a co-factor in liver cancer related to hepatitis B and C infections.

Autoimmune hepatitis and gallstones are also risk factors for liver cancer.

Frequently Asked Questions

  • What are the early symptoms of liver cancer?

    Common signs of liver cancer include unexplained weight loss, loss of appetite, nausea, and a feeling of fullness under the ribs on either the right or left sides, which indicates an enlarged liver or spleen. Other signs include abdominal pain, pain in the right shoulder blade, abdominal swelling, itching, and jaundice.

  • What is the survival rate of liver cancer?

    According to the American Cancer Society, the five-year relative survival rate for liver cancer that has not spread is 34%. The survival rate for liver cancer that has spread to nearby lymph nodes or structures is 12%, whereas the rate for liver cancer that has spread to distant areas, such as the lungs or bones, is 3%.

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zhang W, Sun B. Impact of age on the survival of patients with liver cancer: an analysis of 27,255 patients in the SEER database. Oncotarget. 2015;6(2):633-41. doi:10.18632/oncotarget.2719

  2. Jiang K, Centeno BA. Primary Liver Cancers, Part 2: Progression Pathways and Carcinogenesis. Cancer Control. 2018;25(1):1073274817744658. doi:10.1177/1073274817744658

  3. Pham C, Fong TL, Zhang J, Liu L. Striking Racial/Ethnic Disparities in Liver Cancer Incidence Rates and Temporal Trends in California, 1988-2012. J Natl Cancer Inst. 2018;110(11):1259-1269. doi:10.1093/jnci/djy051

  4. Chronic Viral Hepatitis. Hepatitis B Foundation | Baruch S. Blumberg Institute.

  5. Rawla P, Sunkara T, Muralidharan P, Raj JP. Update in global trends and aetiology of hepatocellular carcinoma. Contemp Oncol (Pozn). 2018;22(3):141-150. doi:10.5114/wo.2018.78941

  6. Toshikuni N, Arisawa T, Tsutsumi M. Hepatitis C-related liver cirrhosis - strategies for the prevention of hepatic decompensation, hepatocarcinogenesis, and mortality. World J Gastroenterol. 2014;20(11):2876-87. doi:10.3748/wjg.v20.i11.2876

  7. Dhamija E, Paul SB, Kedia S. Non-alcoholic fatty liver disease associated with hepatocellular carcinoma: An increasing concern. Indian J Med Res. 2019;149(1):9-17. doi:10.4103/ijmr.IJMR_1456_17

  8. Engels EA, Pfeiffer RM, Fraumeni JF, et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA. 2011;306(17):1891-901. doi:10.1001/jama.2011.1592

  9. Mantovani A, Targher G. Type 2 diabetes mellitus and risk of hepatocellular carcinoma: spotlight on nonalcoholic fatty liver disease. Ann Transl Med. 2017;5(13):270. doi:10.21037/atm.2017.04.41

  10. Erkekoglu P, Oral D, Chao MW, Kocer-gumusel B. Hepatocellular Carcinoma and Possible Chemical and Biological Causes: A Review. J Environ Pathol Toxicol Oncol. 2017;36(2):171-190. doi:10.1615/JEnvironPatholToxicolOncol.2017020927

  11. Hamid AS, Tesfamariam IG, Zhang Y, Zhang ZG. Aflatoxin B1-induced hepatocellular carcinoma in developing countries: Geographical distribution, mechanism of action and prevention. Oncol Lett. 2013;5(4):1087-1092. doi:10.3892/ol.2013.1169

  12. Hereditary hemochromatosis - Genetics Home Reference - NIH. U.S. National Library of Medicine.

  13. Petrick JL, Campbell PT, Koshiol J, et al. Tobacco, alcohol use and risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: The Liver Cancer Pooling Project. Br J Cancer. 2018;118(7):1005-1012. doi:10.1038/s41416-018-0007-z

  14. An N. Oral Contraceptives Use and Liver Cancer Risk: A Dose-Response Meta-Analysis of Observational Studies. Medicine (Baltimore). 2015;94(43):e1619. doi:10.1097/MD.0000000000001619

  15. American Cancer Society. Signs and symptoms of liver cancer.

  16. American Cancer Society. Liver cancer survival rates.

Additional Reading

By Lisa Fayed
Lisa Fayed is a freelance medical writer, cancer educator and patient advocate.