Knowing if you’re at risk

Some people with liver disease are at risk for developing liver cancer

Damaged liver cells are more likely to become cancerous

Cancer often develops as the result of cells that have become damaged over time. Cell damage can occur due to a variety of causes. The most common form of cancer that starts in the liver is called hepatocellular carcinoma, or HCC.1,2


In the United States, HCC has been linked to a condition known as cirrhosis. In cirrhosis, liver tissue that has become damaged over time is slowly replaced by scar tissue.3 This growing scar tissue makes it harder for the liver to do its job and raises the risk of cancer developing. Cirrhosis may be caused by a variety of things, including chronic viral infections, heavy alcohol use, fatty liver, and some rare genetic conditions.4

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Nine out of 10 people who develop the most common type of liver cancer have cirrhosis.9

Common risk factors for liver cancer and cirrhosis4

Chronic Infection with Hepatitis B (HBV) or Hepatitis C (HCV)
Hepatitis causes inflammation (swelling) of the liver and cirrhosis. Long-lasting damage from HBV and HCV can increase the risk of liver cancer.4

Heavy Alcohol Use
Alcoholic liver disease can cause cirrhosis and can also increase the risk of liver cancer. Heavy alcohol users who have cirrhosis have 10 times more risk of developing liver cancer compared with heavy alcohol users who do not have cirrhosis.4

Fatty Liver
Nonalcoholic steatohepatitis (NASH) is another condition that can cause cirrhosis and increase the risk of liver cancer.4 NASH is a form of nonalcoholic fatty liver disease (NAFLD)—inflammation due to a buildup of fat in the liver. NASH is more common in people who are obese and those with type 2 diabetes. It is possible for people with NASH/NAFLD who do not have cirrhosis to develop liver cancer.6

Other Factors
There are other risk factors for liver cancer, including cigarette smoking, inherited conditions that cause excessive iron or copper storage in the liver, and other rare genetic conditions.4

Medical organizations recommend liver cancer surveillance for all people with cirrhosis and for other at-risk individuals.5 Speak with your doctor about your risk factor(s) for developing liver cancer and what monitoring may be appropriate for you.3,7 


The term liver cancer is used to represent the most common form of liver cancer, hepatocellular carcinoma (HCC).

References: 1. Tholey D. Hepatocellular carcinoma. Merck Manual consumer version website. Updated April 2020. Accessed April 18, 2024. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/tumors-of-the-liver/hepatocellular-carcinoma. 2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. 3. Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67(1):358-380. 4. National Cancer Institute website. Liver (hepatocellular) cancer prevention (PDQ®)–patient version. Updated April 21, 2020. Accessed April 18, 2024. https://www.cancer.gov/types/liver/patient/liver-prevention-pdq. 5. Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723-750. 6. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts of NAFLD & NASH. Accessed April 18, 2024. 7. Benson AB III, D'Angelica MI, Abbott DE, et al. NCCN Guidelines Insights: Heoatobiliary Cancers, Version 1.2017. J Natl Compr Canc Netw. 2020;15(5):563-573.