"Doctor, I just had some fatigue and didn't feel like eating—how can it be advanced liver cancer?" This is what I hear most in 30 years in the liver clinic. WHO reports about 900,000 new liver cancer cases globally each year; China accounts for about 47%, the highest worldwide. About 80% of patients are diagnosed at an advanced stage, with 5-year survival under 15%, while early liver cancer with proper treatment can reach over 70% 5-year survival.
Liver cancer is called the "silent killer"; early symptoms are often nonspecific or absent, and can be confused with stomach problems or fatigue. With close attention, some subtle signs can still be noticed; people with hepatitis B, cirrhosis, or other high-risk conditions should be especially alert.
• Persistent fatigue and drowsiness: One of the most common early symptoms; unlike ordinary tiredness, it does not improve with rest; about 60% of early patients have it. • Unexplained weight loss: Losing 5 kg or more in 1–3 months without dieting or extra exercise is an important early signal. • Low-grade fever: Unexplained fever 37.5–38.5°C lasting a long time, with little response to common fever reducers; related to tumor necrosis or lowered immunity.
• Poor appetite and indigestion: Sudden loss of appetite, bloating, belching, nausea, aversion to fatty food, feeling full after little food—often mistaken for "stomach trouble." • Dull or aching pain in the right upper abdomen: Early on there may be mild, intermittent discomfort; if pain increases and becomes persistent, see a doctor promptly.
Symptoms become more obvious and spread may have occurred; timely care can still prolong survival and improve quality of life.
Persistent severe pain in the right upper abdomen, which may radiate to the right shoulder, back, or flank. Sudden severe abdominal pain may mean tumor rupture and bleeding—an emergency; call for help immediately.
A key sign of mid to advanced disease (about 50–60%). Yellow skin and whites of the eyes, itching, dark urine (tea-colored), pale stools (clay-colored) due to bile duct obstruction and rising bilirubin. Jaundice usually indicates mid to advanced stage.
• Severe bloating and ascites: Low albumin and portal hypertension cause fluid in the abdomen; belly swelling and discomfort can affect breathing and eating. • Gastrointestinal bleeding: Serious complication (about 20–30%)—vomiting blood (coffee-ground or red), black tarry stools; severe cases can lead to shock. Often due to ruptured varices or poor clotting.
• Lung: Cough, sputum, blood in sputum, chest tightness, shortness of breath. • Bone: Pain at metastasis site, pathologic fracture. • Brain: Headache, dizziness, nausea, vomiting, limb weakness, confusion.
High-risk includes: HBV/HCV infection or carriers; cirrhosis (any cause); long-term heavy alcohol use (e.g. ≥40 g/day for 10+ years); long-term consumption of moldy food (aflatoxin); family history of liver cancer (first-degree). Incidence in high-risk people is 10–20 times that of the general population; regular screening matters more than waiting for symptoms.
Step 1: Stay calm; go to a proper hospital (tertiary if possible) gastroenterology or hepatology department; avoid unproven remedies. Step 2: Basic workup—liver function, AFP (alpha-fetoprotein), abdominal ultrasound. Step 3: If abnormal (e.g. mass on ultrasound, raised AFP), further tests: contrast-enhanced abdominal CT/MRI, and liver biopsy if needed (pathology is the gold standard). Step 4: Once diagnosed, work with your doctor on a personalized plan; early disease is often treated with surgery; advanced disease may use embolization, targeted therapy, immunotherapy, and other combined approaches.
Common questions about liver cancer symptoms and screening.
Yes, and it is common. About 70–80% of early liver cancer has no clear symptoms; by the time symptoms appear, many are already mid or advanced. High-risk people should have abdominal ultrasound + AFP every 6–12 months.
Stomach problems often include heartburn and central upper abdominal pain and may improve with stomach medicine. Liver cancer–related digestive symptoms tend not to improve much with stomach medicine and may be accompanied by right upper abdominal pain, fatigue, and weight loss. If you have long-standing "stomach" symptoms plus these signs, get your liver checked.
Not necessarily. Hepatitis B itself can cause fatigue and poor appetite. But HBV carriers are high-risk; if symptoms worsen or new ones appear (right upper pain, jaundice, rapid weight loss), get screened to rule out liver cancer.
Ordinary liver discomfort (e.g. from hepatitis or fatty liver) is often mild, intermittent, and may ease with rest. Liver cancer pain can start mild but often becomes persistent, spreads, and may radiate to the right shoulder or back and affect sleep and eating. If right upper pain lasts more than 1–2 weeks and is worsening, get checked.
Often jaundice indicates mid or advanced stage, but a few early tumors can cause mild jaundice by pressing on the bile duct. If you have jaundice, see a doctor to determine tumor size, location, and stage, then plan treatment. Even mid to advanced liver cancer can be managed with combined therapy to extend survival.
Early liver cancer symptoms are easy to miss; later stages are clearer but harder to treat. The key is early detection, screening, and treatment. Everyone should watch for fatigue, weight loss, and right upper abdominal discomfort; high-risk people (e.g. HBV, cirrhosis) should rely on regular screening to catch early disease. If you or a family member is high-risk or has possible symptoms, go to a gastroenterology or hepatology clinic for liver cancer screening. Early detection and screening are the key to fighting liver cancer.
More CancerCura and care knowledge