Primary liver cancer has been relatively rare in the U.S., but the incidence — and death rate — is on the rise, says Dr. Ghassan Abou-Alfa, a medical oncologist at Memorial Sloan Kettering Cancer Center. According to the Centers for Disease Control and Prevention, liver cancer incidence increased 2.3 percent per year between 2003 and 2012, and the rate of deaths is increasing faster than for other types of cancer.
The liver performs many vital tasks, including cleaning toxic substances from the blood, helping with digestion and releasing sugar for energy. Often, cancer in the liver is actually metastatic disease — cancer that has spread from another location. “This is more common than liver cancer itself,” says Dr. Debashish Bose, a surgical oncologist at Orlando Health UF Health Cancer Center.
[Read: Liver Cancer Is Spreading With Deadly Intent.]
Risk Factors for Liver Cancer
Although many of the known risk factors for liver cancer, such as hepatitis infection or alcohol abuse, which leads to cirrhosis of the liver, are so-called lifestyle issues, Abou-Alfa says it’s wrong to correlate liver cancer with how people live. For example, he says, only one-quarter of patients who develop liver cancer abuse alcohol, and only 5 out of 100 people with hepatitis C — often linked with IV drug use and needle sharing — will develop liver cancer.
“It’s important not to connect the disease to specific behaviors or particular populations. Liver cancer can affect anyone,” Abou-Alfa says. Furthermore, he says, people can become infected with hepatitis C without engaging in high-risk behaviors. Before widespread (and effective) testing of donated blood, people were at risk for contracting hepatitis C after receiving a blood transfusion.
The incidence of liver cancer may be increasing for another reason: nonalcoholic fatty liver disease, or NAFLD. This is directly associated with the growing obesity problem, Bose says. NAFLD doesn’t directly increase your risk for liver cancer, but it can lead to cirrhosis, which is a significant risk factor. (Cirrhosis is chronic liver disease, where scarred tissue replaces healthy tissue and causes the liver to fail.) According to the American Liver Foundation, NAFLD causes the buildup of extra fat in liver cells, causing the liver to swell. In fact, the foundation says, if more than 5 to 10 percent of your liver’s weight is fat, you have NAFLD, which affects up to 25 percent of people in the U.S.
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
Treating Liver Cancer
Unfortunately, the prognosis for liver cancer is generally not great, Bose says. Much of this grim outlook relates to the degree of cirrhosis. If you have end-stage liver disease, you have a limited lifespan, usually less than one year without treatment. For patients who qualify for a liver transplant (a big if, based on the criteria), about 50 percent are alive two years later.
When you detect liver cancer early, you can take the tumor out, Abou-Alfa says. However, since liver cancer is usually diagnosed after the disease is advanced, this option is not available to most patients.
Bose says if you remove the part of the liver with the tumor, about 65 percent of those patients will be alive two years later. “It depends on how much of the liver you leave behind and how well the remaining part of the liver functions,” Bose says. If you take out too much, liver function is severely compromised and patients can go into liver failure and die. Patients with many tumors, or large tumors, are not generally candidates for surgery. And, even after surgery, the five-year recurrence rate is high.
A liver transplant is an option for a small subset of liver cancer patients. To qualify for a liver transplant, patients must have very limited disease, which Bose describes as one small tumor (less than 5 centimeters) or up to five smaller tumors. Bose says there are additional criteria as well — including if it involves the main blood vessels and if the disease is outside the liver — that are developed to match patients who are most likely to do well following a liver transplant with the very limited supply of available organs. Bose says liver transplant patients can actually develop new cancer in their donor liver. “This means we haven’t really eradicated the system-wide reservoir of cancer cells floating around in the patient’s body,” he says.
[See: What Causes Cancer? 5 Unlikely Claims Explained.]
The majority of patients are in end-stage liver disease at diagnosis, and their disease isn’t curable. For patients who are not candidates for transplant, combination treatments may control the tumor for a while. For example, transarterial chemoembolization uses a catheter placed in an artery that supplies blood to the tumor. The treatment blocks the blood supply that feeds the tumor and leaches chemotherapy agents into the tumor. “This is really a ‘let’s try to slow it down’ tactic,” Bose says.
For most Americans, the best way to prevent liver cancer is to follow a healthy lifestyle. Maintain a good weight, drink in moderation, get regular physical activity and don’t engage in high-risk behavior, such as IV drug use. “Maintaining a healthy weight is a really important preventive measure,” Bose says. As nonalcohol fatty liver disease becomes a bigger issue, he says we should expect to see more cases of liver cancers.
More from U.S. News
Liver Cancer Is Spreading With Deadly Intent
Fatty Liver Disease Is a Growing Problem for U.S. Kids
What Causes Cancer? 5 Unlikely Claims Explained
What You Should Know About Liver Cancer originally appeared on usnews.com
