Liver cancer has been called a “silent disease” because very often, symptoms do not occur until the illness is in its later stages.

“Usually the disease is picked up on screening, before symptoms appear,” says Eugene R. Schiff, MD, a professor of medicine and executive director of the Schiff Center for Liver Diseases at the University of Miami Health System in Florida. As with many forms of cancer, it’s easier to treat liver cancer when it’s diagnosed early, so he recommends that people at high risk be screened every six months.

High-risk individuals include people with hepatitis B, hepatitis C, or cirrhosis from any cause. Liver cancer screening usually involves a physical exam, blood tests to look for a protein made by liver cancer and other abnormalities, and possibly imaging tests such as an ultrasound or CT scan of the abdomen.

Liver Cancer: The Liver’s Role

Roughly the size of a football, the liver is the body’s largest internal organ. It has four lobes and fills the right side of the abdomen, inside the rib cage.

Liver Cancer: Early Symptoms

Most liver cancer symptoms are caused by physical changes in the liver — such as swelling — and changes in organ function that the cancer produces. Abdomen pain is probably the most common symptom of liver cancer, Dr. Schiff says. Other symptoms include:

• A hard lump just below the rib cage on the right
• Unintentional weight loss
• Nausea or loss of appetite
• Fatigue

Liver Cancer: Later Symptoms

As the disease progresses, later symptoms may include:

• Ascites, or accumulation of fluid in the abdomen, which may lead to abdominal swelling
• Jaundice, or yellowing of the skin and the whites of the eyes

Jaundice results when a substance called bilirubin accumulates in the blood. Bilirubin is a waste product formed by the breakdown of red blood cells. Normally, the liver removes bilirubin from the blood and processes it for excretion in the stool, but when a disease like cancer impairs the liver’s ability to perform this function, bilirubin can build up in the blood and impart its yellowish-orange tinge to the skin or eyes.

Finally, if liver cancer diagnosis is delayed long enough, bleeding into the digestive tract could occur, warns Schiff.

Keep in mind that these symptoms occur in many other diseases of the liver and other organs, so none of them is a sure sign of cancer. They are, however, signals to see your doctor as soon as possible so they can perform the necessary tests and make an accurate diagnosis.

As Schiff says, “early detection is best, because it increases the chance of [a] cure.”