Water pollutants: An increasingly etiological factor for liver cancer

Liver cancer, primarily hepatocellular carcinoma and intrahepatic cholangiocarcinoma, is a growing global health concern. The widespread administration of hepatitis B vaccines has reduced the incidence of virus-associated liver cancer, but the rise in nonviral-related cases remains overlooked. Water pollutants, as critical environmental carcinogens, may contribute significantly to the increase in cases by acting as potential etiological agents. This review summarized the literature up to March 2025 on PubMed and drew conclusions regarding the roles and mechanisms of water pollutants in liver cancer initiation and progression. Inorganic contaminants, such as heavy metals, arsenic, and nitrates, can trigger a cascade of liver injury, gene mutations, precancerous lesions, and ultimately cancer. Similarly, organic pollutants, including organochlorine pesticides, flame retardants, per- and polyfluoroalkyl substances, and cyanobacterial toxins, promote liver cancer through diverse molecular pathways. To counter the increasing burden of nonviral liver cancer, there is an urgent need to establish efficient pollutant monitoring systems and optimize intervention strategies to mitigate the global liver cancer burden.