Liver lesions are abnormal growths on the liver. While often asymptomatic and frequently discovered incidentally during imaging for unrelated conditions, they can cause pain. However, the presence or absence of pain does not indicate the lesion’s severity or type.
Mechanisms of Liver Lesion Pain
Pain from liver lesions can arise through several mechanisms. One primary cause involves the stretching of Glisson’s capsule, a thin, fibrous membrane that encases the liver. This capsule is rich in nerve endings, so when a lesion grows rapidly or significantly, it can distend this capsule, leading to pain.
Liver lesions can also cause pain by exerting pressure on nearby organs. As a lesion expands, it may compress adjacent tissues such as the stomach, gallbladder, or diaphragm, leading to referred or localized pain. This mass effect can disrupt normal organ function and trigger pain signals.
Another mechanism involves the obstruction of bile ducts. A lesion located near or within these ducts can block bile flow, causing a buildup of bile within the liver. This backup can lead to increased pressure and inflammation, resulting in pain.
Pain can result from internal bleeding or rupture of the lesion. If a lesion bleeds internally, it can cause swelling and pressure within the liver or the surrounding abdominal cavity. A more acute and severe pain can occur if the lesion ruptures, potentially leading to bleeding into the peritoneal cavity, which is a medical emergency.
Characteristics of Liver Lesion Pain
The pain associated with liver lesions can manifest in various ways. The most common location for liver-related pain is the upper right abdomen. This pain can also radiate to other areas, including the back, right shoulder, or occasionally the chest.
The sensation of pain can vary widely, ranging from a dull ache or pressure or fullness to sharp, stabbing pain. Some individuals describe it as a pulsating pain. The severity of the pain is also highly variable, from mild and intermittent to severe and debilitating pain that significantly impacts daily activities.
Pain from liver lesions can be constant, or it may occur intermittently. Certain movements, positions, or even eating can sometimes exacerbate the discomfort.
Common Liver Lesion Types and Associated Pain
Liver lesions are categorized as benign (noncancerous) or malignant (cancerous), and their likelihood of causing pain differs. Benign lesions are common and often do not cause symptoms. Examples include hemangiomas, which are abnormal masses of blood vessels, and focal nodular hyperplasia (FNH), characterized by proliferating liver cells around a central scar.
Most hemangiomas and FNH lesions are asymptomatic, especially when small. However, if they grow very large, they can cause pain due to stretching of the liver capsule or compression of adjacent organs. Liver cysts, fluid-filled sacs, are another common benign type that usually causes no symptoms unless they become large enough to create pressure or, rarely, rupture.
Malignant liver lesions, such such as hepatocellular carcinoma (HCC), which is the most common primary liver cancer, and metastatic lesions (cancers that have spread to the liver from other parts of the body), are more frequently associated with pain. As these cancerous lesions grow, they can invade surrounding tissues, press on nerves, or obstruct blood vessels and bile ducts, leading to pain.
While pain is a common symptom in advanced malignant lesions, it is often not the first sign. Many individuals with cancerous liver lesions may not experience pain in the early stages of the disease. The size and specific location of any liver lesion, regardless of whether it is benign or malignant, often play a more significant role in determining whether it will cause pain.
When to Consult a Doctor
Seeking medical attention is important if you experience new, persistent, or worsening pain in your upper right abdomen. This is especially true if the pain is unexplained or is significant. Early evaluation can help determine the cause and appropriate course of action.
Consult a doctor if abdominal pain is accompanied by other concerning symptoms. These may include unexplained weight loss, yellowing of the skin or eyes (jaundice), dark urine, pale stools, fever, persistent nausea, or unusual fatigue. These additional symptoms can sometimes indicate a more significant liver issue that requires prompt assessment.
Individuals with a known liver condition, or those with risk factors for liver disease, should be particularly vigilant about new or changing symptoms. A healthcare professional can accurately diagnose the cause of your symptoms through a comprehensive evaluation, which may include imaging studies and blood tests.