Stage 4 Liver Cancer: Symptoms, How Long to Live

Medically Reviewed by Dr. Aman Priya Khanna
Written by Sangeeta Sharma, last updated on 12 December 2023
Stage 4 Liver Cancer: Symptoms, How Long to Live

In every 1,00,000 people in India, there are around 3-5 cases of liver cancer, resulting in 30,000 to 50,000 cases of liver cancer every year. But when compared to other types of cancer, liver cancer is relatively rare. 

Liver cancer is sometimes also known as Hepatoma or Hepatocellular Carcinoma (HCC). The progress of liver cancer can be mapped by identifying its different stages. According to the TNM staging system, there are four stages of liver cancer. As the cancer stage progresses toward a higher number, it means that the tumour has grown in size and may have spread to the other body parts as well. For example, Stage 4 liver cancer means that the disease has progressed to the most advanced stage. In this stage, cancer is not limited to the liver, but it may have spread to the nearby lymph nodes or even to distant body organs. So, accurate cancer information can be gathered using the process of staging.

Importance of Staging in Cancer

The staging process helps determine the tumour’s size and how far it has spread. 

Knowing the stage of liver cancer allows the doctor to identify the disease progression and evaluate treatment options. The TNM staging system is the most commonly used method to determine the cancer stages.

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What is the TNM Staging System?

It is the most used method to determine how far cancer has progressed in the patient. The TNM system uses three factors to identify the stage of cancer:- 

  1. Tumour (T): Checks the size of the tumour
  2. Node (N): If cancer has spread to the nearby lymph nodes
  3. Metastasis (M): If cancer has spread to the distant parts of the body, such as the lungs and bones

Identifying the cancer stage helps the doctor to know if it is treatable. If yes, what can be the right treatment for the patient? If cancer has advanced, the doctors may apply a different treatment approach than the tumours caught in an early stage. 

The treatment plan can also be based on the patient’s symptoms to improve his or her quality of life. 

This article focuses on stage 4 liver cancer, its symptoms, and what is the life expectancy of the patient at this stage. 

Stage 4 Liver Cancer

In this stage, the tumour may have grown any size and spread to the blood vessels and nearby organs of the liver. There are chances that more than one tumour may have developed at this stage. 

Stage 4 liver cancer can be of two types: stage 4A and 4B. 

  1. Stage 4A: One or more tumours may be detected at this stage. Cancer may have grown in the nearby lymph nodes, but it doesn’t reach the distant organs at this stage. 
  2. Stage 4B: More than one tumour may be present in the body. It may not have reached the nearby lymph nodes at this stage, but it spreads to distant organs, such as lungs and bones. 

Liver cancer can be life-threatening for the patient as it makes the liver not perform its function fully. The liver helps in digestion, detoxification of the blood, and fighting infections by building immune factors. If the liver fails to perform these functions, it can lead to serious health risks. 

Other Liver Cancer Stages

The stages of liver cancer are identified during the diagnosis. There are mainly four types of tumour (T) stages: T1-T4.

Liver Cancer Stages Stage Grouping Stage Description
Stage I (A)




T1a: A single tumour in the liver of size 2 cm (4-5 inches) or less that has not grown into the blood vessels 

N0: Cancer hasn’t spread to the nearby lymph nodes

M0: No distant organs affected

Stage I (B)




T1B:Tumour larger than 2 cm but hasn’t grown into the blood vessels 

N0: Cancer hasn’t spread to the nearby lymph nodes

M0: No distant organs affected

Stage II




T2: It can mean a single tumour larger than 2 cm that has grown into the blood vessels or more than one tumour of size but none larger than 5 cm (around 2 inches)
Stage III (A)




T3: More than one tumour, with at least one tumour larger than 5 cm

N0: Not spread to the nearby lymph nodes

M0: Distant organs not affected

Stage III (B)




T4: The tumour can be of any size and has grown into one of the major veins of the liver (the hepatic or portal veins)

It hasn’t reached the nearby lymph nodes or organs

Stage IV (A)

Any T



Any T: The tumour(s) may have grown to any size. 

N1: Spread to the nearby lymph nodes, but the distant organs are unaffected (M0)

Stage IV (B)

Any T

Any N


Single or multiple tumours of any size that may or may not have spread to the lymph nodes (any N)

M1: Cancer has spread to distant organs, such as bones or lungs

Symptoms of Stage 4 Liver Cancer

The patient may not observe any signs or symptoms during the initial stages of liver cancer. However, as the disease progresses, the patients may notice certain symptoms that may or may not be related to the cancer stage. The symptoms may vary depending on how the disease affects every person individually. 

End-stage liver cancer symptoms usually include:

  1. Abdominal pain 
  2. Swelling in the abdomen 
  3. Loss of appetite 
  4. A feeling of fulness even after eating a small portion of food 
  5. Itching on the skin 
  6. Fluid building up in the abdomen 
  7. Jaundice 
  8. Liver enlargement 
  9. Spleen enlargement 
  10. Nausea or vomiting 
  11. Unintended weight loss 

Sometimes, liver cancer may cause the liver to produce hormones affecting other body organs. In such cases, the patient may notice the following symptoms:

  1. Male breast enlargement or testicle shrinkage (Gynaecomastia)
  2. High levels of red blood cells (Erythrocytosis)
  3. High cholesterol 
  4. Reduced blood sugar levels that may cause fatigue or unconsciousness 
  5. Increased calcium in the body that may cause constipation, a feeling of confusion, nausea, or weakness

Causes and Risk factors of Liver Cancer

In most cases, chronic hepatitis infections lead to liver cancer, but it can also sometimes occur in patients with no underlying disease. Therefore, it may not be possible to pinpoint the exact cause of liver cancer. 

However, cancer occurs when the DNA of the liver cells develops a mutation. Cells are the basic units of the body in all living organisms. Most chemical reactions take place inside a cell and are controlled by the DNA. And when the DNA is altered, a cell may grow uncontrollably and become a tumour. 

Several risk factors, including medical conditions and behaviours, can lead to liver cancer. These factors include:

  1. Cirrhosis: It causes scarring in the liver tissue causing permanent damage. Cirrhosis can also cause liver cancer as it progresses. 
  2. Hepatitis B: Prolonged exposure to the Hepatitis B virus can lead to liver cancer. Studies show that hepatitis B increases the risk of liver cancer 12 times even if the patient doesn’t have cirrhosis. 
  3. Hepatitis C: If a patient has been suffering from Hepatitis C infection for a long time, he or she is also at an increased risk of developing liver cancer. 
  4. Diabetes: Patients with diabetes are at higher risk of having liver cancer than the ones who don’t have diabetes. 
  5. Non-Alcoholic Fatty Liver Disease: When excess fat builds up in the liver, it may cause liver cancer over time. 
  6. Excessive Alcohol Consumption: Drinking excess amounts of alcohol for a long time can cause permanent damage to the liver and also increases the risk of liver cancer. 
  7. Exposure to Aflatoxins: Aflatoxins are the toxins produced by moulds or fungi that grow on crops such as maize, peanuts, and tree nuts. Exposure to these toxins can also increase the risk of developing liver cancer.

How is Liver Cancer Diagnosed?

To diagnose liver cancer, the doctor first performs a physical exam of the suspected patient. During the physical exam, the doctor checks whether there is any abnormal fluid buildup in the abdomen or signs of jaundice (yellowing of the skin and the whites of the eyes). If the patient has any signs of Hepatocellular Carcinoma (HCC), the doctor may also feel the abdomen to check if it is swollen or if any lumps are present. 

Several other imaging procedures follow the physical examination to determine the cancer stage. The imaging procedures may include:

  1. An ultrasound 
  2. Computerised tomography 
  3. Magnetic resonance imaging, 
  4. Blood tests, including liver function tests 
  5. Other than the blood tests and imaging procedures, the doctor may order some additional tests to diagnose liver cancer. These tests may include:
    1. Angiogram: This test is performed to test the blood vessels of the liver. During the test, a dye is injected into an artery which carries it to the liver blood vessels. The dye helps to check the blood-vessel activity and to rule out the possibility of a blockage. 
    2. Biopsy: A biopsy is a conventional test performed to identify the signs of cancer. In this test, a small tissue is removed from the liver to determine if the patient has liver cancer or not. 

Treatment for Stage 4 Liver Cancer

  1. Stage 4 liver cancer is not reversible, but its symptoms can be managed with treatment. The treatment options for stage 4 mainly depend upon the patient’s health. 
  2. As stage 4 is an advanced form of cancer, treatment options are often limited. Liver transplant and surgery are not really effective for stage 4 liver cancer. However, a combination of drugs is often prescribed by doctors. 
  3. Radiation therapy (using high-energy particles) is also considered a potential treatment approach to stage 4 liver cancer.  

Stage 4 Liver Cancer Life Expectancy

The survival rate after diagnosis of liver cancer is five years, but it may vary depending on the person. Life expectancy after cancer diagnosis depends on several factors, such as:

  1. Stage of cancer
  2. Patient’s health
  3. Treatment plan  

The life expectancy specific to stage 4 liver cancer is four to eleven months if cancer has grown in the nearby lymph nodes or distant organs. But this survival rate also depends on the severity of liver damage and the treatment plan given to the patient. So, every patient must consult the doctor to understand his or her case.


A diagnosis of stage 4 liver cancer can be extremely overwhelming for the patient and his or her family and friends. Initially, taking every step further after the diagnosis, such as finding a doctor and picking the right treatment option, may seem difficult and confusing. So, increasing awareness about the disease becomes really important to take well-informed decisions. 

If you are diagnosed with liver cancer, contact HexaHealth experts to find the best doctors and get personalised treatment advice. Our expert medical health professionals are here to inform you more about your condition and address your emotional needs. Remember, getting educated about your condition can help you cope with it. So, get in touch with us today!

Frequently Asked Questions

What are the myths versus facts about Liver Cancer?

  1. Myth: People who don’t drink alcohol are not at risk of having liver cancer. 
    Fact: This is not true. Drinking an excessive amount of alcohol for a long time can lead to liver cancer, but it is not the only risk factor. People with non-alcoholic fatty liver disease (NAFLD) may also get liver cancer. NAFLD is associated with high cholestrol, obesity, and diabetes. So, people who don’t drink alcohol must also incorporate healthy food habits into their lifestyle to lower the risk of liver disease. 
  2. Myth: Medicines taken on a daily basis don’t affect liver health. 
    Fact: Most medications are toxic to liver health. However, the damage they do to the liver may vary. But taking medications that are harmful to liver health every day may cause severe damage and can even lead to liver cancer. So, it is best to confirm the effect of the prescribed medications on the liver before starting their consumption.  
  3. Myth: Liver cancer can be extremely painful. 
    Fact: No, this may not be the case always. Liver cancer is known to be a ‘silent killer’ as the patient who has liver cancer doesn’t feel any symptoms till it reaches an advanced stage. The liver tissue doesn’t have any nerves that cause pain. So, one can have liver cancer and not feel any pain.  
  4. Myth: Lifestyle changes don’t affect liver health. 
    Fact: The lifestyle of a person affects their overall well-being. Consuming high calories of food and avoiding physical activities can lead to diabetes and obesity, which can result in a fatty liver. Fatty liver is a major risk factor for liver cancer. Therefore, maintaining a healthy lifestyle can reduce the risk of liver cancer.
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How long will you live with Stage 4 liver cancer?

If cancer has spread to the lymph nodes and other distant organs, the patient's life expectancy can be from four to eleven months. However, the survival rate also depends on the severity of the damage and whether the patient has received treatment or not.

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Can chemo help stage 4 liver cancer?

Generally, chemotherapy is not considered an effective treatment for liver cancer. The doctors suggest a non-traditional approach called Hepatic Artery Infusion (HAI) to treat liver cancer. A combination of drugs is often prescribed by the doctor.

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Can you survive fourth-stage liver cancer?

Patients with stage 4 liver cancer have low survival rates, but there are cases when patients survive for many years in stage four liver cancer. The survival rate also depends on how early the patient has received treatment. Therefore, it is necessary to diagnose the problem at an early stage. 

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What happens in the last stage of liver cancer?

Stage 4 liver cancer is the final and most advanced stage of the disease. In this stage, cancer spreads beyond the liver, either to the nearby lymph nodes or to other distant body parts.

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How long a patient can survive at the final stage of liver cancer?

It is hard to predict a patient's survival at the final stage of liver cancer. But the following are some signs and symptoms to help you know that the patient is entering the final stage of liver cancer:

  1. Worsening weakness and exhaustion 
  2. Unintended weight loss and muscle thinning (muscle atrophy)
  3. Loss of appetite and difficulty in eating or swallowing fluids
  4. Inability to talk and concentrate
  5. Slow and noisy breathing 
  6. Cool skin, turning blue or dusky 
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What is the best treatment for stage 4 liver cancer?

Stage 4 liver cancer cannot be cured. However, the symptoms of the disease can be managed, and it can be prevented from spreading any further with the help of treatment options. The doctor evaluates treatment options depending on the patient’s health, where cancer has spread, and if the liver is functioning properly. 

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What are treatment options for stage 4 liver cancer?

Stage 4 liver cancer is not curable, but its symptoms can be managed through certain treatment options depending on the patient’s health. Liver transplant and surgery are not really effective for stage 4 liver cancer. However, a combination of drugs is often used to improve the patient’s immunity. 

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How effective is chemo for liver cancer?

Chemotherapy isn’t usually an effective treatment option for stage 4 liver cancer. The doctors usually suggest a combination of drugs and chemo to treat liver cancer. Sometimes, a different version of chemotherapy, known as Hepatic Artery Infusion (HAI), is also suggested as an effective treatment approach. 

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Can a stage 4 liver cancer get a transplant?

A liver transplant is only possible when the tumour has not spread to the nearby blood vessels and lymph nodes. 

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Is Stage 4 cancer terminal?

Stage 4 is an advanced cancer stage and requires an aggressive treatment approach. It may or may not be terminal, depending on the severity of the liver damage. 

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Does liver cancer spread quickly?

How fast the liver cancer spreads usually depends on the type of cancer. If it is hemangiosarcoma or angiosarcoma, cancer can spread quickly. In contrast, hepatocellular sarcoma spreads late in the disease. 

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How fast can a liver cancer progress?

Usually, Hepatocellular Carcinoma (HCC) grows from 1 cm to 2 cm in 212 days in a patient with HBV (Hepatitis B virus).

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Updated on : 12 December 2023


Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More


Sangeeta Sharma

Sangeeta Sharma

BSc. Biochemistry I MSc. Biochemistry (Oxford College Bangalore)

6 Years Experience

She has extensive experience in content and regulatory writing with reputed organisations like Sun Pharmaceuticals and Innodata. Skilled in SEO and passionate about creating informative and engaging medical conten...View More

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