Fibrolamellar Carcinoma (FLC)

Key points

• Fibrolamellar Carcinoma (sometimes referred to as FLC or Fibrolamellar HCC) is a rare primary liver cancer that affects adolescents and young adults
• Fibrolamellar Carcinoma can grow in someone who doesn’t have any other liver disease
• Fibrolamellar Carcinoma is hard to treat and often comes back or spreads outside the liver. But if it’s found early and surgery can be done, survival rates can be good.

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What is Fibrolamellar Carcinoma?

Fibrolamellar Carcinoma (FLC) is a rare and often aggressive form of primary liver cancer. It affects adolescents and young adults, usually between 15 and 40. About 1 in every 100 primary liver cancers is Fibrolamellar Carcinoma. Often there are no symptoms in the early stages. So it tends to be found at an advanced stage, when it may have already metastasised (spread) outside the liver.

This type of liver cancer is not linked to another liver disease. It usually happens in healthy people who don’t have an underlying liver condition.

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What are the symptoms of Fibrolamellar Carcinoma?

Often, people with Fibrolamellar Carcinoma have no symptoms in the early stages of the disease. Or there can be very general symptoms including:

• belly pain (usually on the right-hand side under the ribs) or pain in your right shoulder
• weight loss
• fatigue (feeling very tired)

Some people may have a lump that can be felt on the right side of their abdomen (belly) just under the ribs.

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How is Fibrolamellar Carcinoma diagnosed?

If you are worried about symptoms, see your doctor. They will send you to a specialist who will order imaging such as an ultrasound, CT or MRI scan.

If you have Fibrolamellar Carcinoma, the scans will show a lump inside the liver. Most lumps found in the liver in young people are benign (non-cancerous). But if your doctor suspects it’s Fibrolamellar Carcinoma, you will need a biopsy of the liver to confirm the diagnosis. This is when a small piece of tissue is removed from the liver to be examined under a microscope. Sometimes an operation to remove the tumour will be recommended without a biopsy being performed beforehand.

You may need more scans such as a PET scan or bone scan to check if the cancer has spread outside the liver (metastasised).

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Why did I get Fibrolamellar Carcinoma?

There are no known risk factors for developing Fibrolamellar Carcinoma. It’s usually diagnosed in young people with otherwise healthy livers.

Because it’s so rare, it has been difficult for researchers to find any causes.

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How is Fibrolamellar Carcinoma treated?

The most common treatment for Fibrolamellar Carcinoma is surgery to remove the diseased portion of the liver. Surgery offers the best chance of long-term survival. Surgery will be offered if the cancer is only in your liver (it hasn’t spread or metastasised), or if there are small spots outside your liver that can also be surgically removed at the same time.

But even after surgery, it’s common for the cancer to come back or spread. In half of everyone who has surgery for Fibrolamellar Carcinoma, it will come back within 3 years.  Further surgery can be an option, depending on how big the cancer is and where it has grown (i.e. inside the liver or outside the liver)

Chemotherapy and immunotherapy do not work well for this type of cancer. However, a cancer specialist may recommend some treatment with chemotherapy or immunotherapy hoping to slow down the growth of the tumour.

If the cancer has spread outside the liver (metastatic disease), then surgery isn’t always suitable. Depending on the location outside of the liver, areas of cancer may be treated with radiotherapy to reduce symptoms such as pain. Radiotherapy uses X-ray or other types of radiation to injure or kill cancer cells, which stops them from multiplying.

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Living with Fibrolamellar Carcinoma

If you have surgery, you will have regular scans for at least 5 years. Tell your specialist right away if you develop symptoms between scans including:

• worse pain in the upper right part of your belly
• nausea
• pain elsewhere in your body that is new or unusual
• anything else that is unusual for you and that you are concerned about.

Chemotherapy or systemic treatment such as immunotherapy can cause side effects. To manage these side effects, you should talk to your specialist or your nurse specialist.

If you have symptoms from your cancer, your doctor may recommend palliative care to help you manage.

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More information

Liver Foundation   Specialist Nurse Support: 1800 841 118

Rare Cancers Australia. Fibrolamellar carcinoma

Liver Cancer UK, Fibrolamellar cancer fact sheet (pdf)

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What next?

Call 1800 841 118 to speak to a liver nurse

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Reviewed April 2025