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Liver Cancer Causes and Risk Factors

Liver cancer usually happens when long-term liver damage causes inflammation, scarring and harm to liver cells. Over time, these damaged cells are more likely to develop genetic changes that lead to cancer.

Liver cancer is on the rise in the United States, due in part to increases in body weight and alcohol use, which can cause cirrhosis and liver scarring. While anyone can get liver cancer, it’s most common in people who are older, men and those of Asian American or Pacific Island descent.

If you have risk factors for liver cancer, it’s important to take action. At Banner MD Anderson Cancer Center, our team of liver cancer specialists can help you understand your risk and review your symptoms.

Cirrhosis and liver cancer risk

Cirrhosis is the most important risk factor for liver cancer. It happens when healthy liver tissue is injured over years and is replaced with scar tissue.

Cirrhosis changes your normal liver structure and blood flow. As liver cells repeatedly try to repair damage, the risk of abnormal cell growth increases. Most cases of hepatocellular carcinoma, the most common type of liver cancer, happen in people who already have cirrhosis.

Common causes of cirrhosis include:

  • Chronic viral hepatitis
  • Fatty liver disease
  • Long-term alcohol use
  • Genetic and metabolic disorders

Cirrhosis raises your cancer risk, even if your symptoms are mild. So if you have advanced liver scarring, your health care provider may recommend regular screening for liver cancer.

Hepatitis B and hepatitis C

Long-term infection with hepatitis B or hepatitis C increases your risk of liver cancer.

Hepatitis B

Worldwide, chronic hepatitis B infection is one of the most common causes of liver cancer, especially in areas where the virus is widespread.

Hepatitis B can cause liver cancer, even without cirrhosis. That’s because the virus can change the DNA of liver cells, which increases your cancer risk over time. If you have chronic hepatitis B, lifelong monitoring for liver cancer may be important, even if liver damage seems limited.

All adults should be vaccinated against hepatitis B to help lower the risk of hepatitis B, thus, reducing your risk of liver cancer.

Hepatitis C

Hepatitis C increases your liver cancer risk, mainly because it causes inflammation and cirrhosis. Antiviral treatments can cure hepatitis C but your cancer risk does not disappear entirely if you already have cirrhosis.

Avoiding needle sharing and getting screened for hepatitis C can lower your chance of developing liver cancer from hepatitis C.

Both hepatitis B and C infections can be silent for years. Having both hepatitis B and C, or either one combined with heavy alcohol use, can further increase your risk of liver cancer. Early testing, treatment and long-term monitoring can help reduce complications and improve outcomes.

It is recommended that all adults be screened for hepatitis C at least once during their lifetime. 

Fatty liver disease (MASLD and MASH)

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are becoming more common causes of liver cancer.

These conditions are linked to:

  • High body weight (high BMI)
  • Type 2 diabetes
  • High cholesterol
  • Insulin resistance

With MASLD, fat builds up in liver cells. MASLD can develop into MASH, where fat buildup causes inflammation and liver injury. Over time, this can progress to fibrosis, cirrhosis and liver cancer.

Liver cancer related to MASLD and MASH can happen even in people who do not drink alcohol, so awareness and screening are important.

Alcohol-related liver disease

Long-term heavy alcohol use damages your liver cells and causes inflammation. Over time, this damage can lead to cirrhosis and raise your risk of liver cancer.

Alcohol-related liver disease often overlaps with other risk factors, such as:

  • Viral hepatitis
  • Fatty liver disease
  • Poor nutrition

The combination of alcohol use and another liver condition further increase cancer risk. Reducing or stopping alcohol use can slow liver damage but cancer risk stays higher if cirrhosis has developed.

In addition, heavy alcohol use can sometimes be linked to liver cancer, even in people who do not have cirrhosis, although this is less common. 

Genetic and metabolic liver conditions

Several inherited conditions may increase your liver cancer risk because they change how your body processes iron, protein or other substances.

  • Hemochromatosis: With hemochromatosis, your body absorbs too much iron. This excess iron builds up in the liver, damages liver cells and raises liver cancer risk. Risk is even higher if you also have cirrhosis.
  • Alpha-1 antitrypsin deficiency: This condition affects a protein that helps protect your lungs and liver. In the liver, this protein buildup can cause injury, cirrhosis and cancer.
  • Other rare metabolic disorders: Certain inherited metabolic diseases can damage your liver over time and increase cancer risk, especially if they cause scarring.

Additional factors that influence risk

Other factors may contribute to liver cancer risk, including:

  • Long-standing liver inflammation
  • Poorly controlled diabetes
  • Cigarette smoking
  • Exposure to toxins or chemicals that affect the liver
  • Other chronic liver diseases that can cause cirrhosis, like autoimmune hepatitis and primary biliary cholangitis
  • Some inherited conditions

While these factors alone may not cause cancer, they can worsen existing liver disease and accelerate progression toward cirrhosis.

Why these are liver-specific risk factors 

Liver cancer develops when there’s direct injury to liver tissue. The risk factors discussed above reflect conditions that directly injure the liver and increase the risk for primary liver cancer, especially hepatocellular carcinoma.

Related cancers, like bile duct or gallbladder cancers, develop from different cell types and progress differently. It’s important to understand the difference so you get accurate screening, diagnosis and treatment planning.

Monitoring and prevention for high-risk patients

If you have risk factors for liver cancer, you may benefit from regular monitoring and screening, even if you feel well.

Monitoring may include:

  • Imaging tests at regular intervals
  • Blood tests
  • Ongoing care to keep liver disease from getting worse

Managing liver disease, treating viral hepatitis and addressing metabolic risk factors can help keep your liver healthier, lower the risk of complications and support liver health.

Liver cancer care at Banner MD Anderson

At Banner MD Anderson, we provide comprehensive care for people at risk for liver cancer. Turn to us for advanced screening, early diagnosis and specialized treatment planning for complex liver disease.

What comes next

Knowing your risk factors helps guide early detection and care. The next step is understanding the signs and symptoms of liver cancer.

Learn more about the signs, symptoms and types of liver cancer.  

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