Most patients usually have no symptoms other than those related to their chronic liver disease. It is often detected by chance as a result of an ultrasound test or CT scan for other problems. Occasionally, there may be vague symptoms of heaviness or discomfort in the right side of the abdomen. Pain and poor appetite or weight loss or fatigue are usually late symptoms.
Suspicion for liver cancer should be raised in patients with previously compensated liver cirrhosis who develop decompensation such as water in the belly (ascites), mental change changes (encephalopathy), yellowing of skin and eye (jaundice), or vomiting of blood or black stools (from variceal bleeding).
Other uncommon presentations include sudden pain in the abdomen as a result of rupture of the tumour, related to bleeding of the tumour. Jaundice can caused by invasion or compression of the bile ducts or early liver failure. Rarely patients can have bone pain or breathlessness due to the cancer spreading (metastasis) to the other parts of the body e.g. bone and lungs.
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