Lou Reed, End-Stage Liver Disease, and What It Has to Do With Liver Cancer

What the public record actually says

Lou Reed, the songwriter and guitarist behind the Velvet Underground, died on October 27, 2013 at his home on Long Island. He was 71.

The verified record is about his liver, and it is specific. Dr. Charles Miller of the Cleveland Clinic, who did the operation, told the New York Times that Reed had a liver transplant earlier that year. ABC News reported Miller saying Reed came back to the clinic the week before his death, then chose to go home once his end-stage liver disease could no longer be treated. "We all agreed that we did everything we could," Miller said.

His wife, the artist Laurie Anderson, described the surgery to the Times of London. "It's as serious as it gets. He was dying. You don't get it for fun," she said.

Two things follow. Outlets differ on the month of the transplant. ABC News reported April. The Guardian's June 1, 2013 piece said "last month," meaning May. More importantly, no reputable outlet we could verify reported that Lou Reed was diagnosed with liver cancer. The record shows end-stage liver disease and a transplant, and the summary above now says only that.

What follows is about liver cancer as a disease. The two conditions are closely linked, but none of it describes his case.

Where liver cancer comes from

NCI splits primary liver cancer in two. Hepatocellular carcinoma, or HCC, starts in the main liver cells. The other type is intrahepatic bile duct cancer.

The key fact about HCC is that it usually grows in a liver that is already damaged. NCI notes that cirrhosis — scarring that replaces working liver tissue — is involved in as many as 80% of cases.

NCI's risk factor list runs long. Chronic hepatitis B or hepatitis C. Cirrhosis. Heavy alcohol use. Food contaminated with aflatoxin B1. Nonalcoholic steatohepatitis. Tobacco. And several inherited disorders, among them hereditary hemochromatosis, alpha-1 antitrypsin deficiency, glycogen storage disease, porphyria cutanea tarda, and Wilson disease. Age is the largest risk factor for most cancers, this one included.

HCC is uncommon in the United States, but NCI says its incidence is rising, mainly with the spread of hepatitis C. Worldwide it is the sixth most prevalent cancer and the third leading cause of cancer deaths. Our page on hepatitis C and liver cancer risk covers that link.

Why this cancer is staged differently

Most cancers are staged by the tumor alone. HCC cannot be, because the liver it grows in is usually failing at the same time.

NCI puts it plainly. Unlike most solid tumors, the outlook in HCC rests on both the tumor stage and how well the liver still works. Three things guide treatment. First, how far the tumor extends: its size, the number of lesions, whether it has entered blood vessels, whether it has spread outside the liver. Second, the person's performance status. Third, how much liver function is left, scored by the Child-Pugh system.

That is why more than ten staging systems exist worldwide with none accepted everywhere. NCI calls the Barcelona Clinic Liver Cancer system the most accepted for HCC and the most useful for early tumors. Our page on liver cancer stages explains how it differs from ordinary staging.

What treatment involves

Only 10% to 23% of people with HCC are candidates for treatment intended to cure, NCI reports.

Surgical removal of part of the liver gives a five-year overall survival between 27% and 70%, depending on tumor stage and how well the remaining liver works.

Transplant is the other curative route. It has an advantage no other treatment has, because it takes out the cirrhosis along with the tumor. The limit is the supply of donor organs. Under the Milan criteria, a single tumor under 5 cm, or two to three tumors each under 3 cm, makes someone eligible. Transplant is considered when removal is ruled out by multiple small lesions or by poor liver function. NCI reports roughly 70% five-year overall survival for people who meet those criteria, and a range of 44% to 78% for early HCC generally.

The numbers

For 2026, the American Cancer Society projects 42,340 new US cases of liver and intrahepatic bile duct cancer and 30,980 deaths. SEER lists that estimate; the measured figures below are NCI's own.

Five-year relative survival across all stages, for cases diagnosed in 2016 through 2022, is 21.9%. The median age at diagnosis is 68. By spread: 45% of cases are found confined to the liver, at 37.4%; 23% in nearby nodes, at 13.4%; and 21% after spread to distant organs, at 3.6%.

These are averages across a whole population. They are shaped as much by underlying liver disease as by the tumors.

When to get checked

Liver cancer often causes nothing noticeable until late. These are reasons to see a clinician:

• Yellowing of the skin or the whites of the eyes
• Pain or a full, heavy feeling under the right ribs
• Losing weight without trying, or losing your appetite
• Swelling of the abdomen or the ankles
• Stools that turn pale, or urine that turns dark

The stronger point is about who should be watched before symptoms start. Anyone with cirrhosis, chronic hepatitis B, or chronic hepatitis C should ask their clinician about liver cancer surveillance. Hepatitis C is now curable with a course of tablets, and hepatitis B has a vaccine. Our page on hepatitis and liver cancer covers both.

What this does not mean

• Public reporting establishes end-stage liver disease and a liver transplant. It does not establish that Lou Reed was diagnosed with liver cancer, and nothing here should be read as saying it does.
• A liver transplant is done for many reasons. Most transplants are not for cancer.
• Cirrhosis is a risk factor for HCC, not the same thing. Most people with cirrhosis do not develop liver cancer.
• The 21.9% figure pools two different cancers across a whole population. It says nothing about one person.
• NCI's survival ranges for surgery and transplant come from people who met strict criteria. Most people with HCC do not.

Sources

• ABC News, New Details: Singer Lou Reed Died From Liver Disease (October 2013) — https://abcnews.go.com/blogs/entertainment/2013/10/new-details-singer-lou-reed-died-from-liver-disease
• The Guardian, Lou Reed recovering after liver transplant (June 1, 2013) — https://www.theguardian.com/music/2013/jun/01/lou-reed-liver-transplant
• The Guardian, Lou Reed obituary (October 28, 2013) — https://www.theguardian.com/music/2013/oct/28/lou-reed
• NCI PDQ, Primary Liver Cancer Treatment (Health Professional Version) — https://www.cancer.gov/types/liver/hp/adult-liver-treatment-pdq
• SEER Cancer Stat Facts, Liver and Intrahepatic Bile Duct Cancer — https://seer.cancer.gov/statfacts/html/livibd.html

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

The National Cancer Information Foundation publishes Cancer Explained. This page is for learning. It is not medical advice and does not suggest a test or treatment.

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