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CION Cancer Clinics
Is it liver cancer or gallstones? How the symptoms differ | CION Cancer Clinics
Pain under the right ribs is far more often gallstones, acidity or a fatty liver than liver cancer. Gallstone pain usually comes in attacks after meals and then settles, while early liver cancer rarely hurts at all. This page explains how the two differ, why an ultrasound is the test that sorts them out, and which signs mean you should see a doctor this week or go to hospital today. At CION Cancer Clinics, our team goes through your scan, blood test and biopsy reports with you and plans the next step.
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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
- Is pain under my right ribs gallstones or liver cancer?
- How do gallstone pain and liver cancer symptoms differ?
- What else causes pain on the right side under the ribs?
- What tests will tell gallstones apart from a liver problem?
- Do gallstones turn into liver cancer?
- What this page cannot tell you
- Common questions about gallstones and liver cancer
The short answer
Is pain under my right ribs gallstones or liver cancer?
Far more often it is gallstones, or something else ordinary such as acidity, a strained muscle or a fatty liver. Gallstones are very common in India, especially in women and in people with diabetes. Liver cancer is much rarer, and in its early stages it usually causes no pain at all.
Why the two get confused
The gallbladder sits tucked under the liver, on the right side, just below the ribs. Pain from either can be felt in the same place and can spread to the right shoulder blade. Both can cause nausea, and both can occasionally cause yellow eyes. So it is natural to worry, and natural for a family to fear the worst.
How they are told apart
The way the pain behaves gives a strong clue, and a simple ultrasound usually settles it. Gallstones show up clearly on ultrasound. So does a lump in the liver. What nobody can do is tell the difference from the symptoms alone, which is why the scan matters more than any checklist. This page is about pain and the fear of primary liver cancer. Cancer of the gallbladder itself is a separate disease, covered on the gallbladder cancer pages.
Pain that comes after meals and then goes is the classic gallstone pattern, not the liver cancer one.Side by side
How do gallstone pain and liver cancer symptoms differ?
Gallstones (biliary colic)
Liver cancer
Sudden, strong pain that builds, then eases
Usually no pain early; later a dull, constant ache
Often starts after a heavy or oily meal, or at night
Not linked to meals
Well between attacks
Gradual tiredness, poor appetite, weight loss
Common in people with no liver disease
Mostly in people with cirrhosis, hepatitis B or C, or long-standing fatty liver
Shows clearly on an abdominal ultrasound
Seen on ultrasound, then confirmed with a contrast CT or MRI
Not sure whether this applies to you?
Ask an oncologistUsually something ordinary
What else causes pain on the right side under the ribs?
Doctors run through a short list before they think about cancer. Most people find their answer somewhere on it.
Acidity and gastritis
Burning in the upper abdomen, sour belching and discomfort that changes with food. Very common, and easily mistaken for liver pain. See liver cancer or acidity.
Fatty liver and hepatitis
A swollen, inflamed liver can cause a heavy, dragging feeling under the ribs. Viral hepatitis may add fever, nausea and yellow eyes.
Muscle and rib strain
Pain that changes when you twist, cough or press on one spot often comes from the chest wall, not from an organ.
Kidney and bowel problems
Kidney stones, a kidney infection and trapped wind in the bowel can all be felt on the right side.
The full list
!
When this cannot wait
Go to hospital today if right-sided pain comes with a high fever and shivering, yellow eyes with fever, pain so strong you cannot stay still, repeated vomiting, or confusion. These can mean an infected gallbladder or a blocked bile duct, which need treatment the same day. See a doctor this week for yellow eyes or skin without pain, dark urine, pale stools, weight loss you cannot explain, or a lump you can feel under the right ribs.
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What happens next
What tests will tell gallstones apart from a liver problem?
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A careful history and examination
When the pain comes, how long it lasts, what brings it on, and whether you have hepatitis, diabetes, cirrhosis or a family history of liver disease.
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An abdominal ultrasound
The first and most useful test. It shows stones, a swollen gallbladder, a widened bile duct and most lumps in the liver.
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Blood tests
A liver function test shows whether bile flow is blocked or liver cells are irritated. A blood count checks for infection.
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A contrast CT or MRI, only if needed
If the ultrasound shows something in the liver itself, a scan with contrast is the next step. CION arranges these through diagnostic partners, and the tumour board reviews the result if cancer is suspected.
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A plan for whatever is found
Gallstones that cause pain are usually referred to a surgeon. A liver lesion follows its own path. Do not skip a follow-up scan you are booked for, even if the pain has gone.
Commonly believed
Do gallstones turn into liver cancer?
"Gallstones will turn into liver cancer if left alone."
Gallstones do not cause primary liver cancer. Long-term gallstones are linked to gallbladder cancer, which is a different and less common disease. Your surgeon will tell you whether your stones need removing.
"If it hurts, it must be serious, and if it does not hurt, it is fine."
It is often the other way round. Gallstone pain can be severe and harmless in the long run. Early liver cancer is usually painless, which is why people at high risk have regular scans.
"Stones can be dissolved with home remedies or a special diet."
There is no reliable home remedy, and some herbal products can harm the liver. Tell your doctor about anything you take and let a scan guide the decision.
"Yellow eyes always mean cancer."
A stone stuck in the bile duct is a common cause of jaundice, and so is hepatitis. Yellow eyes do need a doctor quickly, but most turn out to have a non-cancer cause. See jaundice that is not cancer.
Being straight with you
What this page cannot tell you
It cannot tell you what is causing your pain. Symptoms overlap, and even experienced doctors examine, test and scan before they decide. A list read online can lower your worry or raise it, but it cannot replace an ultrasound and a doctor who has seen you.
Who this page does not apply to
If you already have cirrhosis, hepatitis B or C, or a liver lesion under watch, new pain on the right side should go to your liver specialist or oncologist rather than being put down to gallstones. The same applies if an earlier scan showed a thickened gallbladder wall or a gallbladder polyp. People with these conditions need their own plan, not general reassurance.
Who can help
A family doctor or physician is the right first stop for most right-sided pain. A surgeon deals with troublesome gallstones. An oncologist becomes involved only when a scan raises the question of cancer.
If you have a scan report and are unsure what it means, call the helpline and someone will tell you who to see.Questions we are asked
Common questions about gallstones and liver cancer
Can an ultrasound tell gallstones from liver cancer?
An abdominal ultrasound shows gallstones very clearly and picks up most lumps in the liver. It cannot always say what a liver lump is. If something is seen in the liver itself, a CT or MRI with contrast is usually the next step to work out its nature.
Where exactly is gallstone pain felt?
Usually under the right ribs or in the centre of the upper abdomen, sometimes spreading to the right shoulder blade or the back. It tends to come in attacks, often after a heavy meal or at night, and then settle. Liver pain is more often a dull, steady ache that does not come and go.
Is liver cancer pain constant?
When liver cancer causes pain, it is usually a dull, persistent ache under the right ribs, often with tiredness, weight loss or a full feeling after small meals. Many people have no pain at all until the tumour is large. That is why scans, not symptoms, are used to find it early in people at risk.
Do gallstones cause gallbladder cancer?
Long-standing gallstones are linked to a higher risk of gallbladder cancer, which is a separate disease from liver cancer and is more common in parts of north India. Most people with gallstones never develop it. Your surgeon will tell you whether removing the gallbladder is advised in your case.
My ultrasound shows gallstones and fatty liver. Should I worry about cancer?
Both findings are very common and are not cancer. Gallstones are handled on their own merits. Fatty liver is a reason to work on weight, sugar and alcohol, and in some people to check for scarring. Read what fatty liver means for cancer risk.
Can I wait for gallstone pain to settle on its own?
A single attack that settles fully can be assessed at a routine appointment. Pain with fever, yellow eyes, repeated vomiting or pain that will not ease needs hospital the same day. Repeated attacks are a reason to see a surgeon rather than keep putting up with them.
What if the ultrasound shows a spot on the liver as well?
Most spots found this way are harmless, such as cysts or haemangiomas, which are clusters of blood vessels. Some need a contrast scan to be sure. Keep any follow-up scan you are booked for. Read what a spot on the liver means.
Can CION look at my scan report?
Yes. If a scan has raised the question of cancer, CION can arrange a consultation and have the images reviewed by the tumour board. If the problem is gallstones alone, the team will tell you honestly that a surgeon or physician is the right person to see.
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
- NHS — Gallstones
- NHS — Symptoms of liver cancer
- American Cancer Society — Signs and Symptoms of Liver Cancer
- RadiologyInfo.org (RSNA/ACR) — Abdominal Ultrasound Exam
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.
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