The liver is nestled behind the right rib cage, making early diagnosis of liver cancer symptoms difficult.

For the most part, your liver is nestled securely behind your ribs. The right side of your ribcage serves as a skeletal shield to protect the liver and other organs from injury.

Trouble is, the ribcage may work too well if you have liver cancer, as it may shield your doctor from feeling any lumps or other early palpable warning signs of the disease. And since liver cancer symptoms usually do not occur in the early stages of the disease, it often goes undetected until it has progressed.

Experts have identified a number of factors that may increase your risk of liver cancer. Some of these factors, such as liver cirrhosis, may prompt your doctor to recommend screening for liver cancer. Be sure to understand your risk and whether you need to be on closer guard against liver cancer, and do what you can to reduce your risk before liver cancer symptoms develop.

Recognizing Liver Cancer Symptoms

In the United States, the majority of liver cancers are secondary tumors that have spread to the liver from other organs, such as the colon, lungs, pancreas, stomach, or breast.

Primary liver cancers—those that originate in the liver or the tiny ducts that carry bile from the liver to the gallbladder—are newly diagnosed in about 35,660 Americans annually, and about 24,550 Americans die from the disease each year, according to American Cancer Society statistics. The most common type is hepatocellular carcinoma, accounting for about 80 percent of primary liver cancers.

While liver cancer symptoms usually don’t appear until later stages of the disease, in some cases they show up sooner. These symptoms may include a lump or pain on the right side of the abdomen, just below the rib cage.

Pain also may develop in the upper abdomen, near the right shoulder blade. In some cases, the spleen may be enlarged and may be felt as a growth under the left ribcage.

Other common liver cancer symptoms include:

• Jaundice (a yellowing of the skin and eyes)
• Nausea and/or vomiting
• Loss of appetite, or feeling full after eating only a small meal
• Unintentional weight loss
• Itching

As is the case with any cancer, seeking a prompt evaluation for potential liver cancer symptoms is vital so that you can start treatment as soon as possible.

Liver Cancer Risk Factors and Early Detection

Several factors, such as smoking, increase the risk of liver cancer. If you smoke, review with your doctor interventions such as nicotine replacement products, counseling, and medications that can help you kick the habit.

Another well-established risk factor for liver cancer is chronic infection by hepatitis B or C—being infected by both viruses further increases the risk. (Hepatitis C infection is the more common cause of hepatitis-related liver cancer in the United States.) See your doctor if you experience any symptoms of hepatitis B or C, such as abdominal pain, nausea, vomiting, loss of appetite, dark-colored urine, jaundice, fever, and joint/muscle pain.

Also, some experts, such as The U.S. Preventive Services Task Force, recommend screening for people at high risk of hepatitis B or C. Ask your physician if you’re a candidate for this screening.

Hepatitis B and C can lead to cirrhosis of the liver, the most significant risk factor for primary liver cancer. Alcohol abuse is another leading cause of cirrhosis and is thus associated with greater liver cancer risk.

How Weight Affects Liver Cancer

Another indirect liver cancer risk factor is obesity. People who are very overweight are more likely to develop non-alcoholic fatty liver disease, or NAFLD.

A more advanced form of NAFLD—nonalcoholic steatohepatitis (NASH)—a progressive disease characterized by inflammation and scarring of liver tissue—may progress to cirrhosis of the liver, resulting in a greater likelihood of liver cancer.

Routine screening for people at average risk of liver cancer generally is not recommended. However, if you have cirrhosis or chronic hepatitis, your doctor may recommend periodic surveillance testing with ultrasound and blood tests for a protein, alpha-fetoprotein (AFP), which at high levels may indicate liver cancer.

Other imaging tests—computed tomography and magnetic resonance imaging—as well as a liver biopsy and blood tests to assess liver function, also may be necessary to diagnose liver cancer.

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Originally published in April 2016 and updated.