The liver is the largest internal organ in your body, and it has a range of functions. It helps your body digest food, store energy, and remove toxins. It also creates proteins involved in blood clotting and transports hormones and other substances in the blood.
Liver cancer disrupts these processes, causing the liver to become dysfunctional. This can hugely impact your health, and you may become quite unwell depending on the stage and type of liver cancer you have. Stage IV liver cancer can be pretty serious.
Let’s look at the symptoms, implications, and treatments associated with stage IV liver cancer, so you know what to expect and how to manage it.
We make it easy for you to participate in a clinical trial for Liver disease, and get access to the latest treatments not yet widely available - and be a part of finding a cure.
Liver cancer refers to any cancer affecting the liver. Several different types of liver cancer exist, and doctors can perform tests to determine which is present.
Before we discuss liver cancer in further detail, let’s note how cancer affects the liver:
Primary liver cancer
Secondary liver cancer (or liver metastasis)
Primary liver cancer originates in the liver. Secondary liver cancer is when cancer starts in another area before metastasizing. Metastasis means cancer has spread to another area.
Knowing whether you have primary or liver metastasis is important as this determines your treatment. Cancer cells behave differently and respond to different types of treatment depending on their type. If you have liver metastasis, you may also need treatment for cancer in another area of your body.
For example, if you have stomach cancer that has spread to the liver, this is known asmetastatic stomach cancer, not liver cancer. Your doctors will select the appropriate treatment for the initial cancer and liver metastasis.
The most common variant of liver cancer is hepatocellular carcinoma.¹ Hepatocellular refers to the cells of the liver. Carcinoma refers to cancer that starts either in the skin or lining of internal organs.
Hepatocellular carcinoma is the most common type of liver cancer, appearing in around 90% of cases.²
Sometimes, doctors even use hepatocellular carcinoma and liver cancer interchangeably. However, other rare types of cancer are associated with the liver, including:
Angiosarcoma: Endothelial (blood vessel lining) cancer that can spread to the liver³
Cholangiocarcinoma: Cancer that starts in the bile ducts connected to the liver and can spread to the liver⁴
Epithelioid hemangioendothelioma: A rare cancer that can begin within the blood vessels of the liver or other organs⁵
Embryonal sarcoma: A type of liver cancer that typically occurs in children aged 5–10⁶
Hepatoblastoma: The most common type of liver cancer in early childhood, usually occurring in children under 4⁷
The risk factors and causes of primary and secondary liver cancer vary as they start in different locations.
Common causes and risk factors of primary liver cancer are:
Heavy alcohol use
History of cirrhosis (scarring of the liver)
Hemochromatosis (an iron storage disease)
Hepatitis B, C, and D
Environmental exposure to aflatoxin
Metastatic liver cancer originates from another type of cancer that is already present in the body. It's caused by metastasis of an existing cancer.⁸
That is when cancer cells from a tumor break off, enter the bloodstream, and end up in another organ, such as the liver. These cells will then form another tumor at the new site.
When cancer starts to metastasize or spread, doctors often regard it as stage IV (4). However, it's important to note that metastatic liver cancer and stage 4 liver cancer do not mean the same thing.
As mentioned earlier, metastatic liver cancer starts somewhere else in the body and then spreads to the liver. In contrast, stage 4 liver cancer originates inside the liver and metastasizes (spreads) to other areas of the body away from the liver.
As with all types of cancer, we can use a staging system to understand how the cancer is progressing. The most common system uses stages 0-IV.
Here is an overview of the different stages:
Stage 0 (precancerous stage): Cells have the potential to develop into cancer.
Stage I (early stage): Cancer cells are present but haven’t spread beyond where they first developed.
Stages II and III: The cancer has spread into nearby tissues and may have spread to lymph nodes in the area.
Stage IV (late/advanced stage): The cancer has spread to distant sites in the body via the bloodstream. This is also known as metastasis.
The general symptoms of liver cancer are:
A hard lump on the right upper side of your abdomen, below the rib cage where your liver is
Discomfort in your upper abdomen on the right side
A swollen abdomen
Jaundice (yellow skin and whites of the eyes)
Being more prone to bruising or bleeding
Increased fatigue and weakness
Nausea and vomiting
Loss of appetite
The sensation of feeling full after eating only a small amount of food
Weight loss for no apparent reason
Pale or chalky-colored stool
With stage IV liver cancer, preexisting symptoms associated with your liver cancer will worsen. You are also likely to experience more symptoms than during the earlier cancer stages.
Depending on where your cancer has spread, you may notice other symptoms in that area.
Another thing to remember is that many cancer treatments can cause significant side effects, which will vary depending on the specific treatment. These side effects may overlap with some of the symptoms of liver cancer. For example, radiation therapy can also increase fatigue.
As with all types of stage IV cancer, you can expect your symptoms to worsen. That's because stage IV is the most advanced stage of cancer.
As liver cancer enters stage IV, the following symptoms will tend to become more intense:
Abdominal pain, swelling, and bloating
Loss of appetite
You may wish to consider treatments to manage these symptoms. For example, your doctor could prescribe medications for pain relief or to help with nausea.
Another thing to consider is palliative care, which focuses on your quality of life and support for your loved ones. While there might be no cure, a range of support options can ensure you are as comfortable as possible.
You can try several liver cancer treatments even when you have stage IV liver cancer. You will need to discuss these options with your specialist to determine whether these treatments are right for you.
Unfortunately, a liver transplant is not an option if you have stage IV liver cancer. Once cancer has spread to other parts of the body, a transplant cannot cure it.
A range of targeted therapies can treat liver cancer. These therapies are medications that home in on features that occur in cancer cells. These medications tend to be less toxic than standard chemotherapy because they have less effect on healthy cells.
Examples of targeted therapies are:
Another type of treatment is immunotherapy, which uses your immune system to fight cancer.
Several types of immunotherapies exist. Doctors typically use immune checkpoint inhibitors for liver cancer.⁹ These medications block certain proteins in cancer cells, which improves the immune response against them.
To boost the effectiveness of these medications, your doctor may combine more than one. Examples of immunotherapies for liver cancer are:
Atezolizumab (along with the targeted therapy bevacizumab)
Nivolumab with ipilimumab
Radiation therapy uses radiation (such as high-energy x-rays) to kill or slow the growth of cancer cells.
There are a few different specific types of radiation therapy:
Three-dimensional conformal radiation therapy
Intensity-modulated radiation therapy
Stereotactic body radiation therapy
Volume-modulated arc therapy
In all of these types, radiation beams target the tumor from outside the body.
In some cases, your doctor may opt for internal radiation therapy. This involves implanting a source of radiation into the area of the tumor, where it will continuously deliver radiation to the cancer cells over time.
People with stage IV liver cancer may have the option of participating in clinical trials, which test new treatments or approaches. These studies enable people to try a new treatment that might work for them. Even if the new treatment is ineffective for you, your participation could provide valuable information for researchers, which could help others with liver cancer.
Every new medical treatment must undergo clinical trials to prove it is safe and effective. All cancer treatments available today went through clinical trials.
Talk with your doctor if you want to partake in a clinical trial. Participating involves risks and benefits, and it’s important to think through the decision carefully.
With stage IV liver cancer, many factors influence your life expectancy. These include:
The specific type of cancer you have
What treatments you undergo
Whether the cancer responds to these treatments
Your overall health
We need more research on liver cancer and life expectancy to better represent the general population with liver cancer. However, according to one small study conducted by Cancer Research UK, patients with stage IV metastatic hepatocellular carcinoma may have 4–11 months to live.¹⁰ This applies to cases of liver cancer that spread to the lymph nodes or distant organs.
Your life expectancy will depend on the type of treatment you receive, the characteristics of your particular cancer, and your general health. Your doctor can give you an estimate based on these elements.
Instead of focusing on life expectancy, it may help to focus on your quality of life. Liver cancer treatments can manage the cancer and ease your symptoms to improve your quality of life.
While the survival rates of stage IV liver cancer are low, there have also been cases where patients have lived for years after their diagnosis.¹¹ Therefore, it's important to consider your treatment options.
Statistics from the National Cancer Institute indicate that the five-year relative survival rate for people with stage IV liver cancer is about 3%.¹² This means that about 3 in 100 patients with stage IV liver cancer will survive for at least five years after their diagnosis.
It's also important to realize that these statistics may change over time as we discover new and improved treatments for liver cancer. Since these statistics are based on people diagnosed at least five years ago, they may not accurately represent those with liver cancer today.
Therefore, it's best to discuss your chances of survival with a specialist who understands your case well. That way, you will have a better idea of what to expect.
If you have any concerns about your survival rate or life expectancy, it's best to discuss this with your specialist. While we can sometimes use the statistics as a guide, they may not necessarily apply to your case. In the meantime, focus on your quality of life and consider any potential treatments if you haven't already.
If you have stage IV liver cancer, your symptoms will likely worsen. For example, you may experience increasing jaundice, pain, fatigue, and difficulty eating. Treatments may manage these symptoms and maintain a better quality of life.
Unfortunately, there is no exact guide to how long someone may live with stage IV liver cancer with treatment. That's because other factors, such as your overall health and age, can influence the outcome. Additionally, where your liver cancer has spread may affect the outcome. However, the median survival for people with stage IV liver cancer is about nine months.
Past studies found that combining surgery and chemotherapy provides the best overall survival.¹³ However, many newer treatment options are now available, including immunotherapy and targeted therapies. Talk with your doctor about which treatment is best for you.
Studies have found that about 3% of patients with stage 4 liver cancer survive for five years.
Liver cancer (2022)
Hepatocellular carcinoma (2021)
Cholangiocarcinoma | NIH: National Cancer Institute
Epithelioid hemangioendothelioma (EHE) | NIH: National Cancer Institute
Childhood undifferentiated embryonal sarcoma of the liver | NIH: National Cancer Institute
Hepatoblastoma | NIH: National Cancer Institute
Metastatic cancer: When cancer spreads | NIH: National Cancer Institute
Survival | Cancer Research UK
Cancer stat facts: Liver and intrahepatic bile duct cancer | NIH: National Cancer Institute
Cancer staging | NIH: National Cancer Institute
Radiation therapy side effects | NIH: National Cancer Institute
What is liver cancer? | NIH: National Cancer Institute