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How the liver works and why it matters so much | CION Cancer Clinics
The liver cleans your blood, makes the proteins that stop bleeding and hold fluid in, stores energy and makes bile. With cancer in the liver, how well the rest of the liver works matters as much as the tumour. Cancer that started in the liver usually grows in a damaged liver; cancer that spread there often does not. This page explains why that difference matters. At CION Cancer Clinics in Hyderabad, our oncologists explain liver cancer in plain words and plan care around you and your family.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What does the liver actually do?
- What are the liver's most important jobs?
- Why does the liver have two blood supplies?
- Which liver tests show how well the liver is working?
- What do families often believe about the liver that is not true?
- What can this page not tell you?
- Common questions about how the liver works
The short answer
What does the liver actually do?
The liver cleans the blood, makes the proteins that keep fluid in your blood vessels and help blood clot, stores energy, and makes bile to digest fat. You cannot live without it, and no machine can do its work for long. That is why every liver cancer decision is also a decision about how much working liver you have left.
Why this matters if you have been told about a liver tumour
With most cancers, doctors mainly ask about the tumour. With cancer in the liver, they ask two questions: how big and how spread out is the tumour, and how well is the rest of the liver coping? A small tumour in a badly scarred liver can be harder to treat than a larger one in a healthy liver.
First, which kind of cancer is it?
Cancer that starts in the liver (primary) usually grows in a liver already damaged by hepatitis, fat or alcohol. Cancer that spread to the liver from the bowel, breast or elsewhere (secondary) often sits in a liver that otherwise works well. If you are not sure which you have, read primary versus secondary liver cancer first.
Its main jobs
What are the liver's most important jobs?
The liver does hundreds of things. These are the ones your doctors watch most closely, because when they fail, you notice.
Cleaning the blood
All the blood from your stomach and bowel passes through the liver before it reaches the rest of the body. The liver breaks down toxins, old blood cells, alcohol and most medicines.
When it struggles
- Yellow eyes and skin (jaundice)
- Confusion or sleepiness from toxins reaching the brain
- Medicines lasting longer or acting more strongly
Making proteins
The liver makes albumin, which holds fluid inside the blood vessels, and the clotting factors that stop bleeding.
When it struggles
- Fluid building up in the belly (ascites) or the legs
- Easy bruising, or bleeding that takes long to stop
Storing energy and making bile
It stores sugar and releases it between meals, and makes bile, which flows into the gut to help digest fat. A struggling liver can leave you tired, losing muscle and losing weight.
Fighting infection
The liver holds immune cells that catch germs coming in from the gut. People with advanced liver disease pick up infections more easily, including infection of fluid in the belly.
Not sure whether this applies to you?
Ask an oncologistHow blood moves through it
Why does the liver have two blood supplies?
The portal vein brings blood from the gut
Most of the liver's blood arrives through the portal vein, carrying food and toxins absorbed from the stomach and bowel. This is also why cancers of the bowel, stomach and pancreas so often spread to the liver.
The hepatic artery brings oxygen
A smaller share arrives through the hepatic artery, straight from the heart. Normal liver relies mostly on the portal vein. HCC relies mostly on the artery, which is what treatments like TACE use to reach the tumour.
Liver cells filter and process it
The blood passes slowly between rows of liver cells, which take out what they need and break down what the body must get rid of.
Clean blood leaves through the hepatic veins
It drains into the large vein that returns blood to the heart. In cirrhosis, scar tissue slows this flow and pressure builds up behind it. That raised pressure is called portal hypertension, and it causes swollen veins (varices) and fluid in the belly.
On your blood report
Which liver tests show how well the liver is working?
- Bilirubin
- A yellow pigment the liver clears from the blood. When it rises, the eyes and skin turn yellow.
- Albumin
- A protein the liver makes. A low level suggests the liver is making less than the body needs.
- INR
- A measure of how quickly blood clots. It rises when the liver makes too few clotting proteins.
- SGPT and SGOT (ALT and AST)
- Enzymes that leak out when liver cells are irritated or damaged. They show injury, not how well the liver is working overall.
- Platelets
- Cells that help blood clot. They fall in cirrhosis because the spleen swells and holds on to them.
- Child-Pugh
- A score that combines several of these with fluid and confusion to grade liver function as A, B or C. It shapes which treatments are safe.
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Did you know
A healthy liver can regrow after part of it is removed. That is what makes liver surgery possible. A liver scarred by cirrhosis regrows far less well, which is why surgeons check liver function as carefully as the tumour itself.
Commonly believed
What do families often believe about the liver that is not true?
"Normal SGPT means the liver is fine."
Enzymes can be normal in advanced cirrhosis, because there are fewer active cells left to leak them. Albumin, bilirubin, INR, platelets and a scan say more about how the liver is really doing.
"A weak liver should be rested by cutting out protein."
Most people with liver disease need enough protein to keep their muscles. Cutting it can make weakness worse. Ask a doctor or dietitian before changing the diet.
"A liver tonic or detox will clean the liver."
The liver cleans itself. Some herbal tonics can injure the liver, and a scarred liver is most at risk. Tell your doctor about anything you take, without worrying about being judged.
"If I feel well, my liver must be healthy."
The liver has a lot of reserve and often gives no warning until damage is advanced. People with hepatitis B or cirrhosis need regular checks even when they feel completely well.
Being straight with you
What can this page not tell you?
It cannot tell you how well your own liver is working. That comes from your blood tests, your scans and an examination, read together. The same bilirubin number can mean different things in two different people.
It cannot grade your liver or choose a treatment
Scores like Child-Pugh and MELD are worked out by your doctors from several results at once. Your oncologist and a hepatologist, a liver specialist, use them to decide which treatments your liver can handle. CION coordinates hepatology care and scans through accredited partner hospitals, and the tumour board reviews the results.
Who this does not apply to
If your cancer started in another organ and spread to the liver, your liver may be working normally, and the original cancer drives the plan. Read what secondary liver cancer means. If you have cirrhosis, the page on what cirrhosis is goes further than this one.
If you have new yellow eyes with fever, new confusion or drowsiness, or are vomiting blood, go to hospital today.Questions we are asked
Common questions about how the liver works
Can you live with part of your liver removed?
Yes, if the part left behind is healthy enough and large enough. A healthy liver regrows over the following weeks and months. In a liver with cirrhosis, surgeons are far more careful, because the remaining liver may not cope. Your team will check liver function before suggesting an operation.
Does liver cancer stop the liver working?
Not usually at first. A tumour takes up only part of the liver, and the rest keeps working. Problems tend to come from the damage that was already there, such as cirrhosis, or when the tumour grows large, blocks bile flow or affects the main veins.
Why do doctors care so much about my liver blood tests?
Because many treatments, including surgery, TACE and some medicines, put extra strain on the liver. If the liver is already struggling, a treatment that suits the tumour could harm the patient. The blood tests show how much room there is to treat safely.
What is the difference between liver failure and liver cancer?
Liver cancer is a tumour growing in or spreading to the liver. Liver failure means the liver can no longer do its jobs. You can have one without the other, or both together. The page on cancer, failure and damage explains this further.
Does the liver feel pain?
The liver itself has few pain nerves, but its outer covering does. When the liver swells or a tumour stretches that covering, people feel an ache under the right ribs or in the right shoulder. Many early liver problems cause no pain at all, which is why regular checks matter for people at risk.
How is the liver linked to the gallbladder?
The liver makes bile and the gallbladder stores it. Bile travels through ducts from the liver to the gut. Cancers of the bile ducts and the gallbladder are different from liver cancer and are treated differently. See the gallbladder cancer pages if that is your situation.
Can a damaged liver recover?
Often, if the cause is treated early. Controlling hepatitis B with tablets, treating hepatitis C, stopping alcohol and losing weight with fatty liver can all let inflammation settle. Heavy scarring is harder to reverse, but further damage can still be slowed. A hepatologist will tell you what is possible for you.
Who should check my liver function?
If you have hepatitis B or C, cirrhosis or fatty liver, a physician or hepatologist should check it regularly. If you already have a liver tumour, your oncologist will review it before each treatment step. If you are not sure who to see, call the CION helpline and someone will guide you.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- Liver UK (formerly British Liver Trust) — About liver disease
- MedlinePlus — Liver Function Tests
- American Cancer Society — What Is Liver Cancer?
- Merck Manual Consumer Version — Portal Hypertension
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
The two very different things called liver cancerWork out which kind you are facing firstWhy the liver can repair itself and where that stopsThe regrowth that makes surgery possibleThe parts of the liver and why segments matterHow surgeons map the liverWhat cirrhosis isThe scarring behind most primary liver cancer
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Want someone to explain what your liver tests mean for treatment?
Bring your blood reports and scans, and an oncologist will explain what they show and which options your liver can safely handle. One helpline serves every CION centre.