Primary liver cancer (hepatocellular carcinoma, HCC) often begins silently; early-stage tumors rarely cause pain or obvious changes. As the lesion enlarges or invades adjacent structures, the following complaints typically appear:
- Right-upper-quadrant discomfort
A dull, continuous ache or heaviness develops beneath the ribs and may radiate to the back or right shoulder. - Palpable mass or abdominal swelling
Patients or clinicians can feel a firm, nodular liver edge below the costal margin; progressive enlargement can produce visible asymmetry of the abdomen. - Unintended weight loss & anorexia
Rapid loss of >5 % body weight within weeks, early satiety and loss of interest in food are common systemic effects. - Fatigue and weakness
Persistent tiredness unrelated to exertion reflects both malignant cachexia and underlying chronic liver disease. - Jaundice
Yellow discoloration of sclerae and skin arises when tumour compression or portal vein invasion reduces bilirubin excretion. - Ascites & peripheral oedema
Fluid accumulates in the peritoneal cavity and ankles as portal hypertension and hypoalbuminaemia worsen. - Pyrexia & night sweats
Low-grade fever is present in ~30 % of cases, probably due to cytokine release or central tumour necrosis. - GI bleeding
Ruptured oesophageal or gastric varices may cause haematemesis or melaena when portal pressure rises. - Paraneoplastic signs
Hypercalcaemia, hypoglycaemia, erythrocytosis or cutaneous lesions (e.g., dermatomyositis) occasionally precede other manifestations.
Symptoms are often indistinguishable from decompensated cirrhosis; any new or worsening complaint in a cirrhotic patient warrants immediate imaging and tumour-marker assessment.
| Symptom / Sign | Typical Features |
|---|---|
| RUQ pain/heaviness | Dull ache, may radiate to shoulder |
| Palpable mass | Firm, nodular, expands downwards |
| Weight loss | >5 % in weeks, anorexia |
| Fatigue | Persistent, disproportionate |
| Jaundice | Yellow sclera, dark urine, pale stools |
| Ascites/oedema | Bulging flanks, ankle swelling |
| Fever | Low-grade, intermittent |
| GI bleeding | Haematemesis, melaena |
| Paraneoplastic | Hypoglycaemia, skin rash |