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What are the risk factors?

Primary liver cancer most often develops in people with underlying liver disease, usually cirrhosis. In cirrhosis, healthy liver cells are replaced by scar tissue, and benign nodules (non-cancerous lumps) form throughout the liver. As this gets worse (advanced cirrhosis), the liver stops working properly.

Cirrhosis may be caused by: long-term (chronic) infection with hepatitis B or C virus; drinking too much alcohol; metabolic-associated fatty liver disease (MAFLD) as a result of obesity and/or type 2 diabetes; or having too much iron in the bloodstream (haemochromatosis).

A small but increasing number of people are developing liver cancer without cirrhosis. This may occur in people with long-term hepatitis B infection, or with liver disease related to obesity or type 2 diabetes.

Other risk factors for liver cancer are smoking tobacco or having a family history of HCC. Aboriginal and Torres Strait Islander peoples and migrants from  countries with higher rates of hepatitis B infection (including Asia, the Pacific Islands and Africa) are also at greater risk of developing primary liver cancer.

The more risk factors a person has, the greater the chance of developing liver cancer.

The link between hepatitis and liver cancer

Worldwide, up to 8 in 10 cases of liver cancer (HCC) can be linked to infection with the hepatitis B or C virus (viral hepatitis). This is changing as vaccinations and effective treatments for viral hepatitis are helping to reduce the rates of hepatitis-related liver cancer.

How hepatitis spreads

Hepatitis B and C spread through contact with infected blood, semen or other body fluids.

The most common way hepatitis B spreads is from an infected mother to a baby during birth. Hepatitis B can also be transmitted during unprotected sex with an infected partner, or by sharing personal items, such as razors or needles, with an infected person.

Hepatitis C is usually transmitted through the sharing of needles during illicit drug use, tattooing, sharing personal items, or contaminated medical equipment.

Viral hepatitis infects the liver cells (hepatocytes). When the body’s immune system attacks the virus, the liver becomes inflamed. Infection that lasts for more than six months may lead to liver damage (cirrhosis), which increases the risk of primary liver cancer.

Preventing hepatitis

All babies in Australia are offered the hepatitis B vaccine at birth. To further prevent the spread of hepatitis B, at-risk people should also be vaccinated. This includes: Aboriginal and Torres Strait Islander peoples; people from South-East Asia, Africa and the Pacific Islands; people living in a household with someone with hepatitis; and health care workers.

If you already have hepatitis B, vaccination won’t be helpful, but you will usually have regular tests to ensure you don’t develop cancer or other liver problems. If you also have signs of liver damage, you may be offered antiviral medicines to help prevent further damage.

There is no vaccine for hepatitis C infection, but effective medicines are available and the virus can often be cured. While this treatment can lower the risk of primary liver cancer, it does not eliminate it. Importantly, people with cirrhosis should have long-term monitoring for liver cancer. 

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This information is reviewed by

This information was last reviewed June 2022 by the following expert content reviewers: A/Prof Simone Strasser, Hepatologist, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital and The University of Sydney, NSW; A/Prof Siddhartha Baxi, Radiation Oncologist and Medical Director, GenesisCare, Gold Coast, QLD; Prof Katherine Clark, Clinical Director of Palliative Care, NSLHD Supportive and Palliative Care Network, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Anne Dowling, Hepatoma Clinical Nurse Consultant and Liver Transplant Coordinator, Austin Health, VIC; A/Prof Koroush Haghighi, Liver, Pancreas and Upper Gastrointestinal Surgeon, Prince of Wales and St Vincent’s Hospitals, NSW; Karen Hall, 131120 Consultant, Cancer Council SA; Dr Brett Knowles, Hepato-Pancreato-Biliary and General Surgeon, Royal Melbourne Hospital, Peter MacCallum Cancer Centre and St Vincent’s Hospital, VIC; Lina Sharma, Consumer; David Thomas, Consumer; Clinical A/Prof Michael Wallace, Department of Hepatology and Western Australian Liver Transplant Service, Sir Charles Gairdner Hospital Medical School, The University of Western Australia, WA; Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT.