Liver Tumours

A liver tumour is a general term for tissue or a mass in the liver that looks different from normal. The word “tumour” or “mass” does not always mean cancer. Because ultrasound, computed tomography (CT) and MRI scans are used so often today, benign liver lesions that cause no complaints are also frequently noticed [1].

Liver masses are generally divided into three groups:

Benign liver tumours

These are lesions that are not cancer and are usually found by chance during imaging carried out for another reason. The most common are:

• Haemangioma: A benign mass that develops from the blood vessel structures in the liver and usually needs no treatment.
• Focal nodular hyperplasia (FNH): A benign growth usually seen in a healthy liver, with no risk of becoming cancerous.
• Hepatocellular adenoma: A less common mass. Because some types carry a risk of growth, bleeding or, rarely, malignant change, closer follow-up or treatment may be needed.
• Simple liver cysts: Fluid-filled structures that are usually harmless [1,2].

Cancers that develop from the liver’s own tissue

These are called “primary liver cancer”. The main types are:

• Hepatocellular carcinoma (HCC): This develops from liver cells and is the most common primary liver cancer in adults.
• Intrahepatic cholangiocarcinoma: A cancer that develops from the bile ducts inside the liver [3–6].

The risk factors, biological characteristics and treatments of these two diseases are different.

Liver metastases

The spread to the liver of a cancer that started in another organ is called a liver metastasis. Cancers of the colon and rectum in particular, as well as cancers of the pancreas, stomach, breast, lung and some others, can spread to the liver.

A metastasis is not a cancer of the liver itself. For example, the spread of colon cancer to the liver is regarded not as “liver cancer” but as “colon cancer that has metastasised to the liver”. Treatment is planned according to the organ in which the cancer started and how widespread the disease is [7].

What symptoms can liver tumours cause?

Small liver masses often cause no symptoms at all. When a mass grows or affects how the liver works, the following complaints may occur:

• Pain, pressure or fullness in the upper right part of the abdomen
• Loss of appetite and feeling full early
• Unexplained weight loss
• Weakness and tiredness
• Nausea
• Swelling of the abdomen or build-up of fluid in it
• Yellowing of the eyes and skin
• Dark urine and pale stools
• Itchy skin
• Easy bruising or bleeding

These symptoms can have many different causes and on their own do not mean cancer. However, complaints that persist or keep getting worse need to be assessed by a doctor.

What are the risk factors for hepatocellular carcinoma?

HCC usually develops in people with long-standing liver disease. The main risk factors are:

• Cirrhosis of the liver
• Chronic hepatitis B infection
• Chronic hepatitis C infection
• Liver disease due to alcohol use
• Metabolic dysfunction-associated fatty liver disease
• Obesity and type 2 diabetes
• Certain inherited liver diseases
• Long-term exposure to a toxin called aflatoxin

For people with cirrhosis and those in certain high-risk groups, surveillance with a liver ultrasound scan every six months, and an AFP blood test when needed, is generally recommended in order to detect HCC early. The exact follow-up programme is decided according to the person’s liver disease [3,4].

Why do benign tumours develop?

In most haemangiomas and FNH, no clear cause can be found. Hepatocellular adenoma, on the other hand, may in some people be associated with:

• Oestrogen-containing contraceptive pills
• Anabolic steroid use
• Excess weight and metabolic diseases
• Certain rare inherited conditions. Medicines should not be stopped without assessment by a doctor [1,2].

When a mass is found in the liver, answers are first sought to the following questions:

• Is the mass benign or malignant?
• Has it developed from the liver itself, or spread from another organ?
• Is there one mass or more than one?
• What is its relationship with the blood vessels or bile ducts?
• Is the rest of the liver healthy enough?

Imaging methods

The investigations most often used in diagnosis are:

• Ultrasound: A method that does not involve radiation and is often used for the first assessment of the liver.
• Contrast-enhanced multiphase CT: Shows at which phase the mass takes up the contrast agent, its relationship with the blood vessels and the other structures in the abdomen.
• Contrast-enhanced liver MRI: Very valuable for assessing the structure of masses in detail and for telling benign lesions apart from one another.
• PET-CT: Not needed for every liver mass; it may be used in some cancers to determine how widespread the disease is.

Not every mass seen on ultrasound is a tumour. Conditions such as areas spared from fatty change or patchy fatty change can also look like a mass. For this reason, contrast-enhanced CT or MRI is often needed for a definite assessment [1,3].

Blood tests

Your doctor may request the following tests:

• Liver function tests
• Blood count and clotting tests
• Hepatitis B and hepatitis C tests
• Kidney function tests
• AFP
• Selected tumour markers such as CEA and CA 19-9

Tumour markers can help with the diagnosis, but on their own they do not establish a diagnosis of cancer. A normal result does not completely rule out cancer, and a raised result does not always mean cancer.

Is a biopsy done on every liver mass?

No. Some lesions, such as a haemangioma, FNH or a typical HCC in a patient with cirrhosis, can be reliably recognised on appropriate imaging read by an experienced radiologist. In these cases a biopsy may not be needed.

If the imaging findings are not conclusive, if the patient has another known cancer, or if the result would change the treatment, a needle biopsy may be carried out. The decision on biopsy should be made by a multidisciplinary team, taking into account the risk of bleeding and the features of the mass [1,3,4].

Treatment varies according to the type, number, size and location of the mass. The working capacity of the liver, the presence of cirrhosis, whether the disease has spread to other organs and the patient’s general state of health also affect the decision.

For this reason, it is important that liver tumours are assessed by a multidisciplinary team made up of a hepatobiliary surgeon, a gastroenterology or hepatology specialist, a medical oncologist, an interventional radiologist, a radiation oncologist, a radiologist and a pathologist [3–7].

How are benign liver tumours treated?

Haemangioma

Haemangiomas that have typical features on imaging and cause no complaints usually need no treatment. Being large is not always a reason for surgery on its own. If there is marked growth, doubt about the diagnosis, pressure on neighbouring organs or rare complications, treatment may be considered [1,2].

Focal nodular hyperplasia

Typical FNH does not become cancerous and usually needs neither treatment nor continual imaging. If the diagnosis is not certain, or if the complaints are thought to be genuinely caused by this mass, further assessment may be carried out [1].

Hepatocellular adenoma

For adenomas, treatment is decided according to the size of the mass, its subtype, the person’s sex and whether it is growing.

Stopping oestrogen-containing medicines under medical supervision, ending anabolic steroid use and reducing excess weight may be recommended. Some adenomas can shrink with these measures.

Surgery comes into consideration more often for adenomas found in men, for certain molecular subtypes, and for lesions that keep growing or remain about 5 centimetres or larger. The reason for this is the risk of bleeding and malignant change [1,2].

How is hepatocellular carcinoma treated?

In the treatment of HCC, not only the stage of the tumour but also the working capacity of the liver is important. The main options are:

• Liver resection: Surgical removal of the part of the liver containing the tumour. The remaining liver tissue must be sufficient and healthy.
• Liver transplantation: In selected patients, this can treat both the tumour and the underlying cirrhosis. Eligibility is determined by the number and size of the tumours, involvement of the blood vessels and other medical characteristics.
• Ablation: Destroying small tumours by burning them with radiofrequency or microwave energy.
• Transarterial treatments: Methods such as reaching the blood vessel that feeds the tumour and delivering medicine and a blocking agent (TACE) or radioactive particles (TARE/radioembolisation).
• Radiotherapy: In selected patients, precise methods such as stereotactic body radiotherapy can be used.
• Systemic treatment: In advanced stages, medicines that target the immune system, targeted therapies or combinations of these can be used.

Current guidelines list combination treatments targeting the immune system among the main options for advanced HCC in suitable patients. However, the choice of treatment is personalised according to liver function, bleeding risk, accompanying illnesses and previous treatments [3–5].

How is intrahepatic cholangiocarcinoma treated?

If the disease is confined to the liver and can be safely removed, the main treatment is to remove the tumour together with an adequate margin of healthy tissue around it and the regional lymph nodes.

In disease that cannot be operated on or has spread to other areas, chemotherapy, immunotherapy and, in selected patients, local treatments can be used. In advanced disease, molecular testing of the tumour tissue is important. The presence of features such as FGFR2, IDH1, BRAF, HER2, NTRK and MSI/dMMR may provide the option of targeted medicines or immunotherapy for some patients [6].

How are liver metastases treated?

The treatment of metastases is planned according to the organ in which the cancer started. Treatment options may include:

• Systemic chemotherapy
• Targeted medicines or immunotherapy
• Liver resection
• Ablation
• TACE or radioembolisation
• Stereotactic radiotherapy
• Using these methods together in different sequences.

Particularly for metastases that come from colon and rectal cancer and are confined to the liver, surgical removal can offer some patients long-term disease control and a chance of cure. Some metastases that cannot be operated on at first may become suitable for surgery after shrinking with drug treatment. For this reason, even if surgery does not seem possible at the first assessment, it can be useful to obtain the opinion of a hepatobiliary surgeon [7].

What is recovery like after liver surgery?

When part of the liver is removed, the remaining healthy part can increase in volume over time. This is called the liver’s capacity to regenerate. However, for surgery to be safe, a sufficient amount of functioning liver tissue must be left behind.

Whether the operation is done by keyhole or open surgery, the amount of liver removed, the presence of cirrhosis and the person’s general condition all affect the recovery time.

After the operation:

• Pain is controlled.
• You start walking and doing breathing exercises early.
• Eating and drinking are reintroduced gradually.
• Liver tests and blood values are monitored.
• Measures to prevent blood clots are taken.

The hospital stay may be a few days for smaller procedures; for extensive liver operations it may be longer. In most patients, the return to daily life happens gradually over a period of weeks.

Why is regular follow-up important?

The aims of follow-up are:

• To detect early if the treated tumour comes back
• To assess whether a new lesion has developed in the liver
• To keep underlying conditions such as cirrhosis or hepatitis under control
• To monitor the effect of treatment on liver function
• To support problems with nutrition, weight loss and quality of life.

Follow-up may include examination, blood tests, tumour markers and contrast-enhanced CT or MRI. The frequency of check-ups is set individually according to the type and stage of the tumour and the treatment given.

After the operation, if high fever, abdominal pain that keeps getting worse, jaundice, marked swelling of the abdomen, persistent vomiting, shortness of breath, a change in consciousness or discharge from the wound develops, you should contact your healthcare team without delay.

1. Frenette C, Mendiratta-Lala M, Salgia R, et al. ACG Clinical Guideline: Focal Liver Lesions. Am J Gastroenterol. 2024;119(7):1235–1271. doi:10.14309/ajg.0000000000002857.
2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the Management of Benign Liver Tumours. J Hepatol. 2016;65(2):386–398. doi:10.1016/j.jhep.2016.04.001.
3. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the Management of Hepatocellular Carcinoma. J Hepatol. 2025;82(2):315–374. doi:10.1016/j.jhep.2024.08.028.
4. Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma. Hepatology. 2023;78(6):1922–1965. doi:10.1097/HEP.0000000000000466.
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6. Vogel A, Ducreux M; ESMO Guidelines Committee. ESMO Clinical Practice Guideline Interim Update on the Management of Biliary Tract Cancer. ESMO Open. 2025;10:104057. doi:10.1016/j.esmoop.2024.104057.
7. Cervantes A, Adam R, Roselló S, et al. Metastatic Colorectal Cancer: ESMO Clinical Practice Guideline for Diagnosis, Treatment and Follow-up. Ann Oncol. 2023;34(1):10–32. doi:10.1016/j.annonc.2022.10.003.