Medical Oncologist
CION Cancer Clinics
Pain in liver cancer and where it comes from | CION Cancer Clinics
Most pain in liver cancer comes from the covering around the liver being stretched, and is felt as a dull ache under the right ribs that can reach the back or right shoulder. Fluid in the abdomen, spread to bone, treatment and unrelated problems cause pain too. This page explains each source, the warning signs that need hospital today, and how your doctor works out which one it is. At CION Cancer Clinics, our team supports patients and families through symptoms, follow-up and life during and after treatment.
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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
- Why does liver cancer hurt, and where is the pain felt?
- What are the different sources of pain in liver cancer?
- What will the doctor do to find the cause of the pain?
- Which words help your doctor understand the pain?
- What families often believe about liver cancer pain
- What this page cannot tell you
- Common questions about pain in liver cancer
The short answer
Why does liver cancer hurt, and where is the pain felt?
Most pain in liver cancer comes from the thin covering around the liver being stretched as the liver swells. It is usually felt as a dull ache or heaviness under the right ribs, and it can spread to the back or the right shoulder. Pain can also come from fluid in the abdomen, from cancer that has spread to bone, from a treatment, or from something unrelated to the cancer at all.
Why the liver itself rarely hurts
The inside of the liver has very few pain nerves. That is why small tumours often cause no pain. The covering around it, called the capsule, does have nerves. When a tumour grows near the edge, or the liver enlarges, the capsule stretches, and that is what you feel.
Primary or secondary, the pain works the same way
This page applies to cancer that started in the liver and to cancer that spread there from somewhere else, such as the bowel or breast. If you are not sure which one you have, read the two very different things called liver cancer.
Knowing where the pain comes from is what lets your doctor choose the right treatment for it.Where pain comes from
What are the different sources of pain in liver cancer?
Several of these can be present at once. Each one is treated a little differently.
A stretched liver capsule
A dull, steady ache or fullness under the right ribs, sometimes worse when you lie on your right side or take a deep breath. This is the most common kind.
Pain felt somewhere else
The nerve that serves the top of the liver also carries feeling from the shoulder, so the brain can read liver pain as pain in the right shoulder or shoulder blade.
Also common
- An ache across the upper back
- Discomfort that spreads around the ribs
Fluid, bone and nerves
Fluid in the abdomen, called ascites, causes a tight, swollen, pressing discomfort. Cancer that has spread to bone causes a deep, local ache. A tumour pressing on nerves at the back can cause a band of pain that is hard to describe.
Treatment and other causes
Pain, fever and nausea after TACE, a treatment that blocks the tumour's blood supply, are common and usually settle. A blocked stent, gallstones, an ulcer or a strained muscle can also cause pain that is not the tumour itself.
Not sure whether this applies to you?
Ask an oncologist
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Pain that cannot wait until the next appointment
Sudden, severe pain in the abdomen with dizziness, fainting, a cold sweat or a fast heartbeat can mean bleeding from the tumour. Go to hospital today, by the quickest safe route. Also go to hospital today for pain with fever when there is fluid in the abdomen, pain with fever and new yellowing of the eyes, or pain with vomiting blood or black stools. See your doctor this week if the usual pain is clearly getting worse or your painkillers have stopped working.
At the appointment
What will the doctor do to find the cause of the pain?
Ask you to describe it
Where it is, what it feels like, what makes it better or worse, and whether it wakes you at night. A few notes kept at home make this much easier.
Examine you
The doctor feels the liver edge, checks for fluid in the abdomen and presses on any bones that ache. This alone often points to the source.
Check blood tests and scans
Liver tests show whether the liver is coping. CION arranges a scan through its diagnostic partners if the doctor needs to see whether a tumour has grown, bled or spread.
Treat the pain and its cause together
That may mean a painkiller chosen for a damaged liver, draining fluid, radiation to a painful spot, or a nerve block. The cancer treatment itself can also shrink the source.
Describing your pain
Which words help your doctor understand the pain?
- Dull or heavy
- Typical of a stretched liver capsule or fluid in the abdomen. Say if it is there all day or comes and goes.
- Sharp or stabbing
- Can point to a gallstone, bleeding or a problem with the covering of the lung. Say exactly where you feel it.
- Burning or tingling
- Often a sign of a nerve being pressed or irritated. This kind may need a different medicine from ordinary painkillers.
- Referred pain
- Pain felt in one place but coming from another, such as liver pain felt in the right shoulder.
- Breakthrough pain
- A flare of pain that breaks through a regular painkiller. Tell your doctor how often it happens.
- Pain score
- A number from nought to ten that you give your pain. It is not a test. It helps your doctor see whether a treatment is working.
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Commonly believed
What families often believe about liver cancer pain
"More pain means the cancer is spreading."
Not always. Fluid, a blocked stent, a gallstone, a treatment reaction or a strained muscle can all cause new pain. Only an examination and sometimes a scan can tell the difference.
"No painkiller is safe with a damaged liver."
Several are, when chosen and adjusted by a doctor who knows how your liver is working. Paracetamol is often still allowed in careful amounts, while some common pain tablets bought over the counter are not safe. Read about painkillers that are safe for a damaged liver.
"Morphine is only for the last days and causes addiction."
Morphine and similar medicines are used at many stages to control pain, and when they are used for cancer pain under supervision, addiction is uncommon. In liver disease they are started carefully and watched closely for drowsiness.
"Being brave means not complaining."
Hidden pain is harder to treat. Telling your doctor early lets them find the cause and act on it before it takes over sleep, eating and mood.
Being straight with you
What this page cannot tell you
It cannot tell you where your own pain is coming from, or whether a new pain means the cancer has changed. Pain under the right ribs has many causes, and most people searching for it do not have cancer. If you have no diagnosis yet, read pain in the upper right side of the abdomen instead.
It cannot choose your pain treatment
The right medicine depends on how well your liver and kidneys are working, what else you take and what kind of pain it is. Your oncologist or palliative care doctor will decide. Palliative care means expert symptom care, and it can run alongside cancer treatment from the start. Some pain is best helped by a procedure such as a nerve block, which your team can arrange through partner hospitals.
Who this does not apply to
Children with liver tumours need specialist paediatric care, and pain after an operation follows its own plan from the surgical team. Ask them directly.
Questions we are asked
Common questions about pain in liver cancer
Where exactly is liver cancer pain felt?
Most often under the right ribs or in the upper middle of the abdomen. It can spread to the back and the right shoulder or shoulder blade. Pain elsewhere, such as in the hips or spine, may come from spread to bone or from something unrelated, and needs to be checked separately.
Why does my right shoulder hurt?
The top of the liver sits under the diaphragm, and the nerve there shares a pathway with the shoulder. So irritation near the liver can be felt in the shoulder. A shoulder problem can also simply be a shoulder problem. Tell your doctor, who can examine both.
Does a bigger tumour always hurt more?
No. A large tumour deep inside the liver may cause little pain, while a smaller one near the edge can stretch the capsule and hurt. Pain level is not a reliable guide to tumour size or stage, which is why scans and blood tests are used instead.
Is pain after TACE normal?
Pain, fever and nausea in the days after TACE are common and usually settle with medicines. Your team will tell you what to expect. Severe pain that keeps getting worse, or high fever with shivering, needs a call to the team the same day. See post-embolisation syndrome.
Can radiation help with liver pain?
Sometimes. A short course of radiation can ease pain from a stretched liver or from cancer in bone. It is coordinated through partner hospitals. Read palliative radiation for a painful liver to see who it suits.
Can I take a pain tablet from the chemist?
Ask first. Some common pain tablets can cause bleeding or kidney problems in people with liver disease, and some contain paracetamol hidden in a mixture. Show your doctor or pharmacist the pack before taking anything new, even if it is sold without a prescription.
What if the pain keeps him awake at night?
That is a clear sign the plan needs changing, not something to put up with. A regular painkiller taken on a schedule, rather than only when pain is bad, often helps. Call the treating doctor and describe the nights. Poor sleep makes pain feel worse.
Who should we call when the pain changes?
Call your treating oncologist or the CION helpline and describe what has changed. If the pain is sudden and severe, with dizziness, fever or vomiting blood, do not call first. Go to hospital today and tell them about the liver cancer.
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
- American Cancer Society — Signs and Symptoms of Liver Cancer
- NHS — Symptoms of liver cancer
- National Cancer Institute — Palliative Care in Cancer
- Cancer Research UK — Symptoms of liver cancer
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
Painkillers That Are Safe for a Damaged LiverWhich pain medicines suit a liver that is strugglingPain in the Right Shoulder Blade and the LiverWhy liver pain can turn up in the shoulderNerve Blocks and Procedures for Liver PainWhen tablets are not enoughPalliative Care Alongside Treatment, Not Instead of ItExpert symptom care from the start
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Is the pain getting harder to manage?
Tell us where it hurts, how it has changed and what has been tried. Our team can review the cause and the pain plan with you. One helpline serves every CION centre.