Having a high mortality, primary liver cancer accounts for roughly 2% of all cancers in North America and for 10% to 50% of cancers in Africa and parts of Asia. It’s most prevalent in males, particularly those older than age 60, and the incidence increases with age.

Most primary liver tumors (90%) originate in the parenchymal cells and are hepatomas (also called hepatocellular carcinomas or primary liver cell carcinomas). Some primary tumors originate in the intrahepatic bile ducts and are known as cholangiomas (also known as cholangiocarcinomas or cholangiocellular carcinomas). Rarer tumors include a mixed-cell type, Kupffer cell sarcoma, and hepatoblastoma, which occurs almost exclusively in children. Roughly 30% to 70% of patients with hepatomas also have cirrhosis, and a person with cirrhosis is about 40 times more likely to develop hepatomas than someone with a normal liver.

The liver is one of the most common sites of metastasis from other primary cancers, particularly melanoma and cancers of the colon, rectum, stomach, pancreas, esophagus, lung, or breast. In North America, metastatic liver cancer is about 20 times more common than primary liver cancer and, after cirrhosis, is the leading cause of fatal hepatic disease. Liver metastasis may occur as a solitary lesion, the first sign of recurrence after a remission.

No particular staging system exists for liver cancer. Although most hepatoblastomas are resectable, the prognosis is almost always poor. The disease is rapidly fatal—usually within 6 months—from GI hemorrhage, progressive cachexia, liver failure, or metastatic spread. When cirrhosis is present, the prognosis is especially grim, with death from liver failure usually occurring within 2 months of diagnosis.