October is Liver Cancer Awareness Month, a time to raise awareness about liver cancer, its risk factors and the importance of early detection.
For this blog, we spoke with Dr. Jennifer Flemming, Professor of Medicine and Public Health Sciences at Queen’s University. With expertise in gastroenterology, hepatology and liver transplantation, Dr. Flemming cares for people across all stages of chronic liver disease, including cirrhosis and liver cancer.
Dr. Flemming shares what people should know about the connection between cirrhosis and liver cancer, who may be at greater risk, and why regular screening and early detection matter.
What is the connection between cirrhosis and liver cancer, and why does cirrhosis increase the risk?
Of all people who have liver cancer, 90% will be found to have cirrhosis. Cirrhosis is end stage scarring of the liver which is a consequence of many years of inflammation and damage to the liver from many different causes. This chronic inflammation and damage can lead to changes within liver cells which make cancer more likely to grow.
Who with cirrhosis is most at risk of developing liver cancer?
Many studies have identified factors which increase the risk of liver cancer in patients with cirrhosis. The factors that have been consistently shown include being of male sex, increasing age, the presence of hepatitis B and C (especially when it is not being treated with antiviral medication), those with diabetes and those with advanced liver disease and signs of liver failure.
How are people with cirrhosis monitored for liver cancer, and why is regular surveillance important?
Most liver societies across the world recommend screening for liver cancer in patients with cirrhosis because they are a high-risk population. Although some of the guidelines vary, the most consistent recommendation is for an ultrasound with or without a blood test for alpha fetoprotein (a tumor marker) every six months. Screening is important because liver cancer does not usually cause any symptoms, especially in the early phase. If cancer is discovered early, there are typically many more opportunities to treat and cure liver cancer. If liver cancer progresses to the point where people start to develop symptoms, then the treatment options which can cure the cancer maybe be less likely.
Can treating or managing the underlying cause of cirrhosis reduce the risk of liver cancer?
Yes, this is especially important for patients with hepatitis B or hepatitis C. Many studies have shown that in individuals who meet criteria for treatment of hepatitis B, treatment with antiviral therapy can lower the risk of developing liver cancer. Similarly, among those who have hepatitis C, achieving cure with antiviral therapy [SVR] has been consistently shown to lower people’s risks of liver cancer. Therefore, it’s very important in people who have hepatitis B and C to talk to their care providers about ways they can lower their risk of liver cancer.
Beyond cirrhosis, what are some of the most important things people should know about liver cancer risk and early detection?
Anything that can cause damage and inflammation to the liver can increase the risk of liver cancer. Therefore, it is very important in people who have cirrhosis to not consume alcohol, to stop smoking, to eat a healthy diet, and exercise regularly. Early detection of liver cancer can lead to excellent outcomes and a long life if it is identified early. Therefore, anyone with underlying chronic liver disease should talk with their health care providers about their risk of liver cancer, ways they can decrease this risk, and ensuring regular liver cancer screening is performed.
