Liver cancer is on the rise: 3 risk factors you can control to reduce your risk
November 12, 2025
By Yujin Hoshida, M.D., Ph.D.
Your liver is a metabolic powerhouse. This football-shaped organ filters your blood, produces bile for digestion, processes the nutrients you eat and drink, detoxes your body, and stores energy. The liver is built to handle that daily workload, but it’s not designed to handle chronic inflammation – one of the main drivers of liver cancer.
Though liver cancer doesn’t get as much public attention as other cancers, it is among the leading causes of cancer-related deaths. More than 800,000 people worldwide are diagnosed with liver cancer each year, and in 2025 an estimated 4,500 Texans are expected to be added to that total.
If the current disease rate holds steady, new annual diagnoses of hepatocellular carcinoma, the most common type of liver cancer, could nearly double to 1.5 million by 2050. Other types of liver cancer include cholangiocarcinoma (bile duct cancer) as well as angiosarcoma and hemangiosarcoma, both of which involve the liver’s blood vessels.
But there is good news.
A global commission of health experts has been formed to address the upward trend in liver cancer, and I am representing UTSW in that collective. Our manuscript, which was published in The Lancet, revealed that nearly two-thirds of liver cancers cases could be prevented by proactively managing three key risk factors that cause chronic liver inflammation:
- Hepatitis B and C infections
- Alcohol-associated liver disease
- Metabolic dysfunction-associated steatotic liver diseases (MASLD), which is often accompanied with obesity and diabetes
Accumulated inflammation damages the liver’s tissues and increases the risk that cancer cells will form. Liver cancer is “silent,” meaning it often causes no symptoms until the disease has progressed to an advanced stage. This makes prevention even more important.
The Lancet Commission on hepatocellular carcinoma has set a goal to reduce the global rates of liver cancer by at least 2% each year through educating the public about liver health and designing realistic prevention strategies. Reducing your risk of liver cancer starts with acknowledging your personal risk factors and committing to strategies to control them.
Risk factors and prevention strategies
Chronic liver inflammation is associated with the three main drivers of liver cancer: hepatitis B and C infection, excessive alcohol use, and MASLD, once known as nonalcoholic fatty liver disease. Long-term liver inflammation causes scarring of the liver (cirrhosis), which is when damaged tissue outnumbers healthy tissue, causing serious liver dysfunction and cell damage that can lead to cancer.
Preventing liver inflammation is key to reducing your liver cancer risk. The commission has outlined several strategies to help patients and providers. These can help manage the top three causes of liver cancer to prevent it or catch it early when it is easiest to treat.
Hepatitis B and C infection
The facts: Infection with hepatitis B or C has long been recognized as the main cause of liver cancer. These viruses cause long-term liver inflammation and damage, leading to cirrhosis and cancer. Improved screening, vaccination, and treatment for hepatitis B and C has helped stem hepatitis infections in the U.S., but new infections do not typically show symptoms until the disease has progressed. It’s possible to have chronic hepatitis B or C and not know it.
What you can do: All adults age 18 and older should get at least one hepatitis B and C virus screening, particularly if they are at high risk of infection due to unprotected sex or needle drug use. Patients with high levels of alanine transaminase, a liver enzyme that increases with liver damage, should consider starting an antiviral medication right away, upon confirmation of the viral infection.
The Centers for Disease Control and Prevention (CDC) recommends that all children and adults up to age 59 get a hepatitis B vaccine. There is no vaccine for hepatitis C. Getting hepatitis B or C treatment can slow liver damage and reduce your risk of developing liver cancer.
Related reading: Prenatal hepatitis C screening can spare women and babies from long-term liver damage
Alcohol-associated liver disease
The facts: Our research commission estimated that while hepatitis will likely remain the leading cause of liver cancer, alcohol use and metabolic dysfunction such as obesity will account for almost one-third of new liver cancer cases by 2050.
Drinking more than a moderate amount of alcohol daily over many years can lead to irreversible cirrhosis and liver failure as well as cancer. Excessive alcohol use is also associated with other cancers, including breast, esophagus, and colon.
Alcohol-associated liver disease (ALD) remains a serious public health concern. Studies published this year show that both significant liver damage and ALD death rates roughly doubled in the past two decades in the U.S. The increase has been especially noticeable among women and young adults ages 25-44.
What you can do: Avoid alcohol or limit yourself to one drink a day for women or two a day for men. A drink is defined as 12 fluid ounces of beer (5% alcohol by volume [ABV] or less), 8-10 fluid ounces of liquor, 5 fluid ounces of table wine (12% ABV or less), or 1.5 fluid ounces of spirits (about 40% ABV).
If you regularly drink more than this or if you tend to binge drink, talk with a doctor about ways to curb your alcohol intake.
Related reading: The health benefits of going 31 days without alcohol
Metabolic liver diseases
The facts: Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to excess fat stored in the liver. MASLD is among the leading reasons that women in the U.S. require liver transplants.
MASLD can cause severe inflammation, which is called metabolic dysfunction-associated steatohepatitis (MASH). When scar tissue overcomes the healthy liver tissue, it becomes cirrhosis of the liver, which can lead to liver cancer or failure of the organ.
Conditions associated with MASLD include high cholesterol, obesity, Type 2 diabetes, and insulin resistance, which is when the body doesn’t respond as expected to naturally produced insulin. Some genetic factors may also moderately increase the risk of developing MASLD.
What you can do: Achieving and maintaining a healthy weight is key to reducing your risk of MASLD. However, it is possible to have a normal weight and still store excess fat inside your liver and other organs.
Talk with a doctor about lifestyle modifications that could help reduce your risk. This may include diet and exercise changes as well as medication to improve your insulin response and lower your cholesterol. Bariatric surgery or medication to help manage your weight are also options. If you have obesity, you may benefit from working with a Weight Wellness expert to create a personalized weight management plan. In addition, new drugs have been developed to reduce scarring in the liver caused by MASLD.
Avoid unregulated supplements and anabolic steroids, which can harm the liver. Talk with your doctor about whether you should be screened for MASLD or MASH, especially if you have high cholesterol, Type 2 diabetes, or obesity.
Related reading: The art and science of tackling obesity
Other risk factors for liver cancer
The facts: Other habits and environmental factors that can increase your risk of liver cancer include:
- Exposure to certain toxins: These can include aflatoxins, which are produced by mold in improperly stored grains and nuts.
- Smoking: Tobacco use is associated with a higher liver cancer risk.
- Inherited liver diseases: These are genetic conditions that cause liver dysfunction or damage. These liver diseases include:
- Wilson’s disease, in which copper builds up in the liver, brain, and other vital organs
- Porphyria cutanea tarda, which causes substances called porphyrins to build up in the liver and creates painful blisters on the skin
- Hemochromatosis, a disorder in which the body absorbs and stores too much iron
- Primary sclerosing cholangitis (PSC), which causes inflammation and damage to bile ducts and is a strong risk factor for cholangiocarcinoma (bile duct cancer).
What you can do: Be aware of potential toxins in your environment, especially if you work in industries involving plastics or chemicals. If others in your family have had liver disease or liver cancer, talk with a doctor about whether you could benefit from genetic testing. If you smoke, consider joining a nicotine cessation program to get support to quit.
Who should be screened for liver cancer?
Ideally, people who have known risk factors for liver cancer will get regular screenings. This could help catch it in its earliest stages.
However, most liver cancers are not discovered until the disease has progressed and starts to cause symptoms such as:
- Loss of appetite
- Weight loss without trying
- Upper abdominal pain
- Abdominal swelling
- Nausea and vomiting
- Jaundice, or yellowing of the skin and eyes
- Dark urine
Screening for liver cancer is recommended by professional societies, including the American Association for the Study of Liver Diseases, with the most recent guidelines led by Amit G. Singal, M.D., Professor of Internal Medicine at UT Southwestern who is also UTSW’s Chief of Hepatology and Medical Director of the Liver Tumor Program.
If you have known health factors that increase your risk of liver cancer, talk with a doctor, ideally one who specializes in liver disease care, about getting screened. Regular abdominal ultrasounds and blood tests for the alpha-fetoprotein (AFP), which is a tumor marker for liver cancer, can help identify liver cancer early when it is easiest to treat.
There are also several emerging blood and imaging strategies to help find liver cancer earlier. UT Southwestern is leading a large clinical trial called TRACER with sites across the country that is comparing blood-based biomarkers versus ultrasound to determine the best approach for liver cancer screening. Other clinical trials related to liver cancer include:
Liver Cancer SPORE at UTSW
The Liver Tumor Program at UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center has been selected by the National Cancer Institute as a Specialized Program of Research Excellence (SPORE). Accompanied by a $12 million grant, the SPORE aims to speed the development of new ways to treat and prevent liver cancer.
What are my treatment options if I get liver cancer?
There have been many significant advances in liver cancer detection and treatment. UT Southwestern has been part of more than 40 clinical trials in the past 20 years, and we are actively running several federally funded research programs.
UT Southwestern’s Liver Tumor Program was selected by the National Cancer Institute as a Specialized Program of Research Excellence (SPORE), led by Drs. Singal and Hoshida as the principal investigators. The goal is to facilitate clinical translation of new prevention and treatment strategies to ultimately reduce deaths from liver cancer.
Surgical therapies, including resection and liver transplantation, can be the best option for some patients with early-stage liver cancer. The option to get a liver transplant depends on the size and stage of the cancer, status of underlying liver disease, and the availability of a donor organ. While waiting on the liver transplant list, treatment focuses on limiting the cancer’s spread and managing symptoms. UT Southwestern has done the most liver transplants of any North Texas hospital, performing more than 100 a year and having one of the region’s highest one-year survival rates.
Other therapies that directly target the tumor can include transarterial radioembolization, chemoembolization, or stereotactic body radiation therapy. These therapies offer high rates of local tumor control while minimizing systemic side effects.
Finally, immune checkpoint inhibitor combinations are well tolerated and have significantly improved survival for patients with advanced stage liver cancer. These therapies yield objective responses in nearly one-third of patients as well as overall survival exceeding 5 years in about 20% of patients. UT Southwestern is involved in several clinical trials to identify new therapies that can further improve these outcomes for patients with liver cancer.
The team at UT Southwestern has demonstrated that patients who see a multidisciplinary liver cancer care team typically have the best outcomes, including higher curative treatments and improved survival. UTSW has a Liver Cancer Clinic led by Dr. Singal and Adam Yopp, M.D., Professor of Surgery and Chief of the Division of Surgical Oncology. The clinic includes a team of specialists including hepatologists, oncologists, interventional radiologists, transplant experts, and surgeons who meet daily to create custom care plans specialized for each patient. This clinic allows patients with liver cancer to see multiple specialists in the same day to determine the best treatment plan for their individual case.
Liver cancer prevention is a public health challenge, especially in Texas where the rates of liver cancer are the highest of any state in the U.S. But each of us has the power to take charge of our liver health, and active research has been conducted to develop new prevention strategies. By understanding your risks and taking preventive action, you can protect your liver and improve your overall health.
If you’re concerned about your liver health or have risk factors for liver cancer, make an appointment by calling 214-645-4673 or request an appointment online.
