Liver cancer, particularly hepatocellular carcinoma (HCC), arises mainly in the setting of chronic liver disease and cirrhosis. The strongest established risk factors are chronic infections with hepatitis B virus (HBV) and hepatitis C virus (HCV), heavy alcohol consumption, non alcoholic fatty liver disease linked to obesity and diabetes, and exposure to aflatoxins in contaminated food. Genetic susceptibility and inherited metabolic disorders can also contribute.

Research shows that persistent inflammation and cycles of cell death and regeneration drive mutations and malignant transformation of hepatocytes. Key molecular pathways frequently altered include Wnt β catenin, PI3K AKT mTOR, MAPK, and p53. This has led to intense efforts to classify liver tumors by genetic and molecular profiles, which can predict prognosis and guide therapy.

Prevention is a major focus. Widespread HBV vaccination has already reduced HBV related liver cancer in some regions. Antiviral treatments for HBV and HCV lower but do not completely eliminate the risk of cancer in patients with advanced fibrosis, so long term surveillance with ultrasound and alpha fetoprotein testing remains important.

For early stage disease, surgical resection, liver transplantation, and local ablation offer the best chance of cure. Advanced liver cancer is treated with systemic therapies. Targeted drugs such as multikinase inhibitors and VEGF inhibitors, as well as immune checkpoint inhibitors, have improved survival but responses are variable and resistance is common. Current research priorities include combination regimens, biomarkers to select patients for specific treatments, earlier detection tools, and strategies to prevent progression from chronic liver disease to cancer.