“The liver is one of the organs that people may not think so much or talk about much, but it’s a very important organ,” says Dr. Anjana Pillai, MD, associate professor of medicine and medical director of the Liver Tumor Program at the University of Chicago Medicine. The liver’s most important role is filtering harmful substances out of the blood, which are then passed out of the body, according to Cleveland Clinic. It also makes bile, a substance that helps digest fat, and processes what you eat and drink into nutrients that are used for energy. Liver cancer occurs when abnormal cells grow so quickly that they displace normal cells. Primary liver cancer starts in the liver’s tissue, and the most common type is hepatocellular carcinoma. Another type, called metastatic liver cancer, starts in another part of the body and moves to the liver. What’s tricky is that liver cancer (and other liver diseases) usually don’t have symptoms in the early stages, Pillai says. But, there are several things you should know about the condition, including who’s at risk, when to get screened, and how it’s treated.
Who’s most at risk for liver cancer?
People most at risk for liver cancer have other liver diseases, such as cirrhosis, chronic hepatitis B, chronic hepatitis C, and non-alcoholic fatty liver disease, according to the American Liver Foundation. The risk goes up, too, for people with a family history of the cancer. Liver diseases are often linked with alcoholism, which stigmatizes the conditions, said Dr. Tamar Taddei, MD, the American Liver Foundation’s national medical advisory council co-chair and associate professor of medicine at the Yale School of Medicine. The truth, she says, is that millions of Americans suffer from liver disease, and they’re not necessarily alcohol drinkers. Though alcohol is toxic to the liver, and long-term alcohol abuse can increase the risk for cirrhosis, according to Cleveland Clinic. Viral hepatitis and conditions like obesity and diabetes also raise the risk for cirrhosis. Fatty liver disease occurs when liver cells store too much fat. Patients tend to excess fat around their abdomens and may also have conditions like diabetes, obesity, and high blood pressure and cholesterol, Dr. Pillai says. Hepatitis is caused by viruses that lead to inflammation of the liver. Hepatitis B is more common in other parts of the world, including Africa and the western Pacific. It’s treatable, and there’s a vaccine available to prevent it. Hepatitis C is commonly spread from person to person through blood and mostly affects people who use intravenous drugs or who received a blood transfusion before 1992. Hepatitis C is treatable but can still lead to liver cancer. “People who got their hepatitis C treated, who have advanced fibrosis or cirrhosis remain at high risk for liver cancer,” Taddei says. “The virus already exerted its damage on the liver in the form of scarring and they still need to be in a surveillance program for liver cancer.”
What are the signs of liver cancer?
Symptoms usually don’t appear in the early stages of liver cancer, Pillai said, “They present with more advanced disease.” Those symptoms include:
A lump below the rib cagePain on the right side of the abdomen or near the right shoulderJaundice, or yellowing eyes or skinUnintentional weight loss or loss of appetiteNausea or vomiting bloodFatigueDark-colored urineBloating from fluid in the abdomen
“If you have any of these symptoms, you need to see the doctor right away,” Pillai says. It may not necessarily mean you have liver cancer, but it’s a good idea to get checked out.
Can you reduce your risk for liver cancer?
Liver cancer can be prevented in some cases if you’re able to reduce your risk factors, according to the American Cancer Society. Maintaining a healthy weight is one way to lower the risk. Pillai says eating a balanced diet, with limited processed foods and excess fat. Get plenty of exercise, too. Limiting alcohol use and smoking also help. Alcoholism is a disease, Taddei said, and instances of excessive drinking have gotten worse during the pandemic. “Alcohol needs to be addressed front and center, head-on, and completely destigmatized,” she said. “Just like we talk about wellness around mindfulness with eating and mindfulness with exercise, we need to talk about mindfulness with alcohol.”
When to get screened for liver cancer
People at high risk for liver cancer—especially those with cirrhosis, hepatitis B, and hepatitis C—should get screened every six months. Liver cancer can be diagnosed in several different ways, depending on the case, according to Cleveland Clinic. Blood tests can show the presence of the substance alpha-fetoprotein (AFP), which may signal liver cancer, cirrhosis, or hepatitis. High levels of AFP are considered a tumor marker. Ultrasounds, CT scans, MRIs, angiograms, and biopsies may also be used. Having an annual physical exam and knowing your family history is important, Pillai says. “Everyone should be checked for hepatitis C and hepatitis B because those are treatable,” she adds. “Preventive medicine is very important in getting annual physicals. And then follow up if you do see any abnormalities in your liver enzymes.”
How liver cancer is treated
Treatments and your chance of recovery depend on the stage when liver cancer is discovered. Other factors include your overall health, how well your liver is functioning, what symptoms you have, and your AFP levels. If you have a good functional status and the cancer is caught early, Pillai says it could be cured by removing part of the liver or through a liver transplant. The five-year survival rate for people with early-stage liver cancer and who had a liver transplant is 60% to 70%, according to the American Cancer Society. Other treatments could include ablation therapy, where tumors are destroyed without being removed, and chemotherapy, immunotherapy, and loco-regional therapy, where heat or radiation-emitting beads are injected into blood vessels. Next, read 25 facts about cancer that could save your life.
Sources
Dr. Anjana Pillai, MD, associate professor of medicine and medical director of the Liver Tumor Program, University of Chicago MedicineDr. Tamar Taddei, MD, co-chair, American Liver Foundation’s national medical advisory council; associate professor of medicine, Yale School of MedicineAmerican Cancer Society: “Can Liver Cancer Be Prevented?”American Cancer Society: “Liver Cancer Survival Rates” American Liver Foundation: “6 Things You Should Know About Liver Cancer” Cleveland Clinic:“Cirrhosis of the Liver” Cleveland Clinic: “Hepatitis B” Cleveland Clinic: “Hepatitis C”Cleveland Clinic: “Viral Hepatitis” Cleveland Clinic: “Liver Cancer” Journal of Clinical Oncology: “Future of Hepatocellular Carcinoma Incidence in the United States Forecast Through 2030”
