- Hepatocellular adenoma is a rare type of benign liver tumour.
- It is most common in women.
- Hepatocellular adenoma is usually harmless.
- Hepatocellular adenoma can sometimes cause severe bleeding
- In rare cases hepatocellular adenoma can change to become cancer.
- Men and women tend to have different types of hepatocellular adenoma.
- The treatment for hepatocellular adenoma in men is usually surgery.
- The treatment for hepatocellular adenoma in women depends on the size of the tumour.
Hepatocellular adenomas are caused by mistakes or damage in your DNA. Your DNA contains all the instructions for making your body. It also tells cells when they should grow and when they should stop.
A tumour forms when changes in your DNA mean it tells cells to grow and divide when they should not. Most hepatocellular adenomas do not cause any problems. So they can start to form years before you have any symptoms.
It is thought that hepatocellular adenoma growth is linked to hormones. The condition is more common in women than in men. It is most often found in women aged 35-40.
Taking the contraceptive pill for more than 5 years seems to add to this risk. But it is still very rare.
The number of men with hepatocellular adenoma seems to be increasing. This is often linked to the use of anabolic substances for sports or bodybuilding.
Metabolic syndrome and being overweight seems to increase the risk of hepatocellular adenoma for women and men.
Hepatocellular adenoma has also been linked to a range of other medical conditions. These conditions are usually diagnosed in childhood. They include haemochromatosis, Beta-thalassemia, McCune Albright syndrome and glycogen storage diseases. But sometimes there is no obvious cause.
There are 4 types of hepatocellular adenoma. 3 of the types are based on changes to genes and how the tumour looks. The fourth group of hepatic adenomas are those which don’t fit into any of the other types.
Men are more likely to have a type called “beta-catenin activated hepatocellular adenoma”. This type has a higher risk of causing cancer. So hepatocellular adenomas in men are usually removed.
For women, the type of hepatocellular adenoma that can cause cancer is very rare. The size of the tumour is the best guide to whether it will need treatment.
Doctors can sometimes work out which type of hepatocellular adenoma you have by looking at it on a scan. But if doctors need to find out for sure which type you have, you may need surgery or a biopsy. This will remove part or all of the tumour so that it can be tested in a lab.
Surgery and biopsy both have risks. And most hepatocellular adenomas in women cause no problems. So most women will be advised to have regular scans to check on the tumour instead of tests to find out the type.
You can find out more about the different types of hepatocellular adenoma in the drop-down boxes below.
Around 1 in 2 hepatocellular adenomas are inflammatory. This is the most common type. A few different genes can be changed in people with this condition. But most people only have one of these changes.
The condition is more common in people who have other issues that can increase inflammation. This includes people living with obesity or metabolic syndrome and people who drink a lot of alcohol.
Most inflammatory hepatic adenomas will cause no serious problems. It is very rare for this type of hepatocellular adenoma to cause cancer. If the tumour is over 5cm there is a higher risk of bleeding, so you might need treatment to prevent this.
This is the second most common type of hepatocellular adenoma. Out of 10 cases of hepatocellular adenoma, 3 to 4 will be hepatocellular adenoma inactivated for HNF-1alpha.
In this type, there is a change (mutation) in a gene called HNF-1alpha (sometimes called HNF1A). This gene usually controls how liver cells grow.
In most cases the change in this gene happens by chance (a somatic mutation). In people who have more than 10 hepatocellular adenomas, the changed gene can be passed on in families (inherited). This condition is sometimes called hepatocellular adenomatosis. But most people who inherit the changed gene will not get the condition.
Most hepatocellular adenomas inactivated for HNF-1alpha will cause no serious problems. It is very rare for this type of hepatocellular adenoma to cause cancer. If any of the tumours are over 5cm, there is a higher risk of problems including bleeding. So you might need treatment to prevent this. If you have a lot of tumours and they are making your liver very big you might also need surgery.
Most cases of hepatocellular adenoma are found in women. But men can also develop the condition. When they do, they are far more likely than women to have the beta-catenin activated type.
This type of hepatocellular adenoma has changes in a gene called Beta-catenin (sometimes written as CTNNB1). About 1 in 2 cases of beta-catenin activated hepatocellular adenoma will also have the same gene changes as the inflammatory type.
This type of hepatocellular adenoma has a higher chance of turning into a type of cancer called hepatocellular carcinoma (or HCC). You can find out more about hepatocellular carcinoma here.
Because this type of hepatocellular adenoma is far more common in men and carries a higher risk of cancer, most men with hepatocellular adenoma will be advised to have it removed.
Around 1 in 10 hepatocellular adenomas do not fit into any of the other 3 groups. They do not have any of the changes to genes or appearance that are used to identify the others.
These tumours usually cause no problems. If they grow to be more than 5cm then you might need treatment to reduce the risk of a severe bleed.
The symptoms of hepatocellular adenoma are very different for different people. About half of people with hepatocellular adenoma have no symptoms. The condition is often found by accident when you have a scan for something else.
If you do have symptoms the most common are:
- Pain or discomfort in your tummy, often on your right side, under your ribs
- Feeling bloated
In rare cases the tumour can be damaged and cause severe bleeding (haemorrhage or rupture). The symptoms of this are:
- Severe pain in your abdomen
- Blood in your poo
- Vomiting blood (being sick with blood)
- Feeling lightheaded
A haemorrhage can be very dangerous. If you develop these symptoms, you should seek medical help straight away.
The best way to test for hepatocellular adenoma is with an MRI scan. This is not painful and should take less than an hour. You can find out more about having an MRI scan here.
The MRI scan will show what your hepatocellular adenoma looks like, where it is, and how big it is.
An MRI scan can diagnose some of the different types of hepatocellular adenoma. But sometimes more tests are needed to rule out other conditions. Including a type of cancer called hepatocellular carcinoma (HCC). You can read more about hepatocellular carcinoma here.
In some cases doctors will suggest a liver biopsy to help diagnose hepatocellular adenoma. And to find out which type you have.
A biopsy uses a needle to take a very small sample of your liver. You will have a local anaesthetic and usually won’t need to stay in hospital. The liver sample will be sent to a lab to be looked at under a microscope.
Some people find a biopsy painful or uncomfortable. There can be complications such as bleeding. This is rare but ask your doctor to explain what the risks are in your case.
You should always be referred to a specialist if you need treatment. The treatment for hepatocellular adenoma will depend on:
- If you are a man or a woman
- The size of your tumour
- The type of hepatocellular adenoma
Treatment for hepatocellular adenoma in women
When you are first diagnosed with hepatocellular adenoma you might be advised to make some changes in your everyday life.
- If you are taking the contraceptive pill, you will be asked to stop .
- You might be asked to lose weight.
You can find out more about making these changes here
After 6 months you will have another MRI scan to look at the size of your tumour. The results of this scan will determine what happens next.
It is unlikely that you will have any problems. So the risks of surgery to remove the tumour are higher than the risks of leaving the tumour alone. You will be asked to carry on with any changes you have made to your life. You should have a scan once a year to check that nothing has changed.
A bigger tumour means that there is a bigger risk of a problem such as serious bleeding. So if your tumour is over 5cm, or seems to be growing, then you might be offered an operation to remove it. This will usually be surgery to remove part of your liver (a resection). You can find out more about this here.
You will be advised to have surgery to remove the hepatocellular adenoma, even if it is small. In this case the risks of surgery are probably less than the risk of getting cancer. But talk to your doctors about your case as it will be different for everyone.
Hepatocellular adenoma can be found, or start to grow, during pregnancy. If this happens you will need to have regular ultrasound scans every 6-12 weeks. These will check on the size of the tumour.
If the tumour seems to be growing, and there is a high risk of a severe bleed, you might need treatment. This could be liver surgery or a treatment called embolisation.
You will need to see a benign liver tumour specialist and an obstetrician. They should work together with you to decide the best treatment options.
There is no evidence that you must have a caesarean birth if you have a hepatocellular adenoma. But everyone is different. Talk to your doctors and midwife about the risks and benefits of different types of birth for you.
If you have 10 or more adenomas in your liver, you might be told you have adenomatosis.
Adenomatosis is very rare. It is almost always found in women. And does not seem to increase your risk of getting liver cancer.
The treatment for adenomatosis is based on the size of your biggest tumours. If any of the tumours are larger than 5cm they can increase your risk of severe bleeding. To prevent this, you might be offered a liver operation called a resection.
Adenomatosis seems to be linked to female hormones. So if you are taking the combined pill you will be asked to stop. Your doctor might also recommend trying to lose weight. Both things can help to stop your tumours getting bigger.
You should have regular scans to check on the size of your tumours. And if they are growing or shrinking,
Treatment for hepatocellular adenoma in men
The type of hepatocellular adenoma with a higher risk of becoming cancer is more common in men. Because of this, it is recommended that all hepatocellular adenomas in men are removed. Even if they are quite small when they are first found. You will be offered an operation called a liver resection.
Liver surgery for hepatocellular adenoma (for men and women)
Surgery to remove the part of the liver with the tumour in (a resection) can cure the condition and stop the risk of cancer. But like all major surgery it has risks. It is only done if doctors think that there is a high risk of cancer or severe bleeding.
These risks will be a bit different for everyone. Talk to your specialist about what this means for you. It can be a lot to take in. You might want to write a list of questions before your appointment. You can also take someone with you. Or ask to record the appointment on your phone so that it is easier to remember it all afterwards. You can ask for time to go away and decide if you want the operation.
If you have the operation, you will be given a general anaesthetic, so you will be asleep. The surgeon will remove the tumour and .
Your liver has an amazing ability to repair itself. If the rest of your liver is healthy it will regrow the part that was removed. This usually takes a few months.
You will have to stay in hospital after your operation. If possible, arrange to have some help for when you go home. You will probably need pain relief and might find it hard to move around for a few weeks. You might also have some pain, or feel very tired, while your body heals. This can take several months. These problems are normal, but they can be difficult and make it hard to do all your normal activities. Ask for help if you need it. And talk to your doctor about medicines that could help with pain.
Treatment for severe bleeding (haemorrhage or rupture)
Sometimes a hepatocellular adenoma can start to bleed a lot. If this happens it can be very dangerous, and you will need treatment straight away.
You will have to go to hospital and have a CT scan. If you have lost a lot of blood you might need to have a blood transfusion.
You might also need a treatment called an embolisation to stop the bleeding. If this is not available at your local hospital you will have to be transferred.
Once the bleeding has stopped you should be referred to a specialist benign tumour team. They will do more tests and work out if any other treatments are needed.
Changes in your everyday life
If you are taking the pill, you might be told to stop. This is because the hormones in the pill can make your hepatocellular adenoma get bigger. If coming off the pill could be a problem for you, talk to your doctor about the risks and benefits.
If you decide to stop the pill it is important to find a new contraceptive. Being pregnant can also increase the risk from hepatocellular adenoma. So talk to your doctors about your options.
Being overweight increases the risk of hepatocellular adenomas getting bigger. This is probably because fat cells make hormones including oestrogen. It is thought that increased levels of oestrogen can send signals to the tumour to tell it to grow.
Losing weight will reduce the amount of oestrogen that gets to your tumour. This can stop and sometimes even reverse the growth of your tumour.
But losing weight can be easier said than done. You can find more advice on keeping a healthy weight here. You can also ask your specialist and GP if there is any support available in your area to help with weight loss.
Support for you
Most people with hepatocellular adenoma will be able to carry on with life. Others will need to have surgery. So it is normal to feel worried, even if you have been told your risk is low.
People with hepatocellular adenoma can also have another type of benign liver tumour called focal nodule hyperplasia. These are harmless and a lot more common than hepatocellular adenoma. You can find out more about them here.
Everyone’s experience of hepatocellular adenoma will be different. But whatever you are going through, the British Liver Trust has support for you. And for your friends and family. We offer support groups and an online forum where you can connect with other people who are living with all kinds of liver conditions. You can find out more about these here.
You can also call our helpline and talk to one of our specialist liver nurses on 0800 652 7330
Publication date: 10/08/2023
Review date: 10/08/2026