Causes and risk factors of liver cancer

Certain risk factors can increase a person’s chance of developing primary liver cancer.

What are risk factors?

We do not know the exact cause of liver cancer (HCC). But certain things called risk factors can increase a person’s chance of developing it. Having one or more risk factors does not mean you will get cancer. And not having any risk factors does not guarantee that you will not.

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Risk factors for HCC include the following:


HCC is more common as people get older. Most people diagnosed are over 65.


HCC is more common in men than in women.


People who smoke tobacco have a much higher risk of HCC than non-smokers.

Hepatitis infection

Long-term infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) can cause HCC.


People who have cirrhosis have a higher risk of getting HCC. Cirrhosis is scarring all over the liver. It damages the liver and stops it working properly.

The risk factors for cirrhosis include:

  • Alcohol

    Drinking a lot of alcohol over a long period of time can cause cirrhosis.

  • Non-alcoholic fatty liver disease

    This is when fat builds up in the liver and causes damage.

  • Haemochromatosis

    This is an inherited condition that causes iron levels to build up in the body. If diagnosed and treated early, it does not usually cause problems.

  • Primary biliary cirrhosis (also called primary biliary cholangiopathy)

    This is when the body’s immune system, which normally fights infection, slowly destroys the small bile ducts in the liver. Bile ducts are the tubes that connect the liver and gall bladder to the small bowel.


People with type 2 diabetes have a higher risk of developing HCC.

Metabolic syndrome

People with metabolic syndrome have a higher risk of developing HCC.

Metabolic syndrome is a group of conditions that occur together.

They include:

  • high blood pressure
  • high blood sugar
  • high levels of unhealthy fats (triglycerides) in the blood
  • extra fat around the tummy area (abdomen).

Family history

Having a close family member (father, mother, sister or brother) with primary liver cancer increases a person’s risk. Doctors are not sure why this is.

Other risk factors

Taking anabolic steroids over a long period of time slightly increase the risk of developing HCC. These are mainly used by bodybuilders.

A poison called aflatoxin, found in mouldy peanuts and grains, is a major risk factor for HCC in parts of Africa and Asia.

About our information

  • References

    Below is a sample of the sources used in our primary liver cancer information. If you would like more information about the sources we use, please contact us at

    Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016; 40: 2425–2440. Available from: [accessed Feb 2020] 

    NICE. Lenvatinib for untreated advanced hepatocellular carcinoma: Technology appraisal guidance (TA 551) [Internet]. 2018. Available from: [accessed Feb 2020] 

    NICE. Liver disease. Quality standard (QS 152) [Internet]. 2017. Available from: [accessed Feb 2020] 

    NICE. Liver cancers overview [Internet]. 2019. Available from: [accessed Feb 2020]

    NICE. Regorafenib for previously treated advanced hepatocellular carcinoma. Technology appraisal guidance (TA555) [Internet]. 2019. Available from: [accessed Feb 2020]

    Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2018; 29 (S4): iv238–iv255. Available from [accessed Feb 2020]    

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Paul Ross, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Date reviewed

Reviewed: 30 June 2020
Next review: 30 June 2023

This content is currently being reviewed. New information will be coming soon.

Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

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