Liver cancer rates are on the rise in the United States. According to the American Cancer Society, liver cancer cases have more than tripled since 1980, with more than 43,000 people diagnosed every year.
The most common cause of liver cancer is liver disease. In this video, San Diego Health host Susan Taylor talks with Catherine Frenette, MD, a hepatologist and medical director of the Liver and Hepatocellular Cancer Program at Scripps MD Anderson Cancer Center, about the increase in liver disease and liver cancer.
The liver filters blood from many places in the body, so many types of cancer that start in other organs and tissues spread to the liver. However, liver cancer begins in the liver itself.
The leading cause of liver cancer in the United States is underlying liver disease that creates chronic inflammation and damage, and scar tissue begins to replace healthy liver cells. Advanced scarring is called cirrhosis. When this develops, the normally smooth liver becomes lumpy and bumpy, and loses its ability to function properly.
Excessive alcohol use is the leading cause of cirrhosis, and it doesn’t take much to increase your risk.
“That’s more than one drink a day for women and two drinks a day for men,” says Dr. Frenette. “Having more alcohol than that doubles your risk of liver cancer.”
Alcoholic hepatitis is a severe form of alcoholic liver damage that most often happens in people 30 to 50 years old. Severe acute alcoholic hepatitis can be fatal for 30 to 80% of patients.
Obesity and diabetes are also risk factors. If your body mass index is more than 30, your risk of liver cancer increases by 60%. Diabetes doubles your risk. Hepatitis A, B and C also raise the risk.
“Just like sun damage over the years causes skin cancer, all the damage that contributes to developing cirrhosis can cause liver cancer,” Dr. Frenette says. “Many of these are lifestyle things that we can change to keep our liver healthy, such as avoiding alcohol and maintaining a healthy weight.”
Diagnosing and treating liver cancer
In most cases, liver cancer has no symptoms until it has reached an advanced stage. That’s why it is important for people who have liver disease to have screenings, including blood tests and an imaging exam, such as an ultrasound or MRI, every six months.
“We do both imaging and bloodwork because neither alone is very good at picking up liver cancer. But when you combine them, they’re much better at finding early liver cancer,” explains Dr. Frenette. “Six months is about the time it takes for a cancer in the liver to double in size. So, if we screen every six months, we’re going to find it when it’s small enough to treat, but yet big enough to actually see on the images.”
When liver cancer is found early, the cure rate is about 75 to 90%. The most appropriate liver cancer treatment options depend on several factors, including how advanced the cancer is and whether the patient has any other liver disease or health conditions. Treatments may include radiation, chemotherapy, drug therapy and surgery.
Liver resection, which involves surgically removing the diseased section of the liver, may be an option for smaller tumors when the rest of the liver is healthy. Scripps physicians often perform this procedure using minimally invasive robotic-assisted surgery.
For many patients with advanced cirrhosis, a liver transplant may be the recommended treatment. Liver transplantation removes the diseased liver and replaces it with a healthy liver from a donor.
“Scripps is an international leader in liver transplantation,” says Dr. Frenette. “Our surgeons are absolutely phenomenal, and we have one of the highest success rates for liver transplant for liver cancer in the country. We really do a very good job.”