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The word ‘cancer’ itself is enough to frighten us. And with good reason. Liver cancer is the 6th most common cancer worldwide and the 2nd most common cause of death.
Worldwide, an estimated 905,677 people were diagnosed with liver cancer in 2020, and an estimated 830,180 people died from this disease.
Before we know how someone can get liver cancer, we must know the liver cancer and the organ ‘liver’ from the roots.
1. Liver: The Largest Internal Organ of Our Body
The liver is the largest digestive organ of our body, situated in the right upper abdomen. It weighs about 1600 g in males and 1300 g in females. The liver is reddish-brown in colour, soft in consistency, and very friable in any living being.
If your liver is affected, the relative organs might get affected too.
1.1. Functions of the Liver
The liver performs a wide range of functions in our body:
- It filters the blood.
- The liver plays a major role in the metabolism and detoxification of blood.
- Role in bile formation.
- The liver also has a role in vitamin metabolism.
2. Liver Cancer: A Complete Guide
Liver cancer is among the most common cancers in the world. There are different types and stages of liver cancer. How does someone get this? What are the symptoms? What to do if you are diagnosed with it? Everything is explained.
3. Types of Liver Cancer
On account of where it is found, there are 2 types of liver cancer:
3.1. Primary Liver Cancer
In about 16,000 to 20,000 cases a year in adults, they’re diagnosed with cancer that originates in the liver, which is known as Primary liver cancer1. The most common is Hepatocellular Carcinoma2.
3.2. Hepatocellular Carcinoma
This is the most common type of primary liver cancer3. It develops from underlying diseases like cirrhosis, hepatitis b, and hepatitis c. It is the 3rd most common form of cancer globally and one of the leading causes of death.
3.3. Angiosarcoma
It is also known as Hemangiocarcinoma, and according to the Cancer Treatment Centers of America, it makes up 1% of all liver cancers. Angiosarcoma begins in the blood vessels of the liver and grows rapidly. They are generally diagnosed at an advanced stage.
3.4. Cholangiocarcinoma
This is bile duct cancer4. The bile duct is the small duct that mainly carries the bile from the liver to the gall bladder. This type of cancer primarily occurs inside the bile duct. Cholangiocarcinomas make up about 10-20 per cent of primary liver cancers.
3.5. Angiosarcoma or Hemangiosarcoma
This type of primary liver cancer is rare. It accounts for about only 1 per cent of liver cancer. They spread fast and affect the thin layer of cells that line blood vessel walls in the liver.
3.6. Hepatoblastoma
This is a childhood cancer that affects fetal liver cells. This is the most common pediatric liver cancer. According to F1000 research, the survival rate is 70-80 per cent.
Learn more about Primary liver cancer: Clinical Trial, from the experts of The National Cancer Institute.
3.7. Secondary Liver Cancer
Secondary liver cancer does not originate in the liver itself. Rather, it develops in the other organs, like- the colon, rectum, and pancreas, and the cancer cells metastasise to the liver. There, the malignant cells grow and cause this type of liver cancer.
Colon or rectum cancer is the most common cause of liver metastasis or secondary liver cancer. Up to 70 per cent of people with colorectal cancer eventually develop liver cancer.
Almost 85% of liver cancer diagnosed is this type of liver cancer, and it is more dangerous than the others.
4. What Are the Causes of Liver Cancer?
Unfortunately, the exact reason behind liver cancer has not been found yet. There are some risk factors from which it can develop. The major factors include liver cirrhosis, chronic hepatitis, alcoholism, and chronic liver infection.
The main risk factors are discussed below:
4.1. Lifestyle
The place where you live, what you eat, and drink, and even your job play a major role in increasing the risk of cancer in your body. Let’s discuss them one by one.
4.2. Food Habit
Eating unhealthy junk foods, processed food, packaged food and drinks, and unhealthy fats increases the risk of fatty liver, consequently increasing liver cancer risk.
Here is the list of healthy foods that you might consider for your good liver.
4.3. Alcohol Abuse
If you do not consume alcohol, that’s the best for your health and body. But if you do so, the consumption should be limited. Excessive consumption of alcohol increases the risk of cirrhosis drastically, which in turn causes liver cancer.
4.4. Smoking or Chewing Tobacco
Some anecdotal reports say that people who have been smoking for a long time are more prone to liver cancer than new smokers, and non-smokers are less.
4.5. Workplace
If you work in an area near a radioactive plant, or your job needs to work with X-rays, vinyl chlorides, thorium dioxide, and other radioactive substances, you should handle them with utmost care. Chronic exposure to radioactive substances may lead to liver cancer.
4.6. Arsenic in Water
If your drinking water contains arsenic, it may increase the risk of liver cancer.
4.7. Gender
Men are more likely to develop hepatocellular carcinoma than women. The fibrolamellar subtype of HCC is more common among women.
4.8. Liver Cirrhosis
Cirrhosis is late-stage progressive hepatic fibrosis. It is the scarring of liver tissue. Extensive scarring can prevent the liver from functioning well.
It is one of the leading causes to develop liver cancer. Excessive alcoholism is the main cause of cirrhosis which is considered one of the leading causes of liver cancer. But there are several causes of cirrhosis5 discussed below:
- Common causes of liver cirrhosis include chronic viral hepatitis, alcoholic liver disease, and hemochromatosis.
- Less common causes are autoimmune disease, medications, Wilson’s disease, and celiac disease.
4.8.1. Non-alcoholic Fatty Liver Disease
This can be seen in obese people. This type of disease is known as NASH (Non-Alcoholic Steatohepatitis6). This might develop liver cirrhosis7. Patients with cirrhosis due to NASH have a 6-7% chance of developing liver cancer within 10 years.
4.8.2. Autoimmune Liver Disease
Autoimmune disease is a special type of disease where your immune cells can’t detect the body cells and start attacking them. The root cause of autoimmune hepatitis8 or autoimmune liver disease is not exactly known yet, but they play an important role in developing liver cancer and liver cirrhosis.
4.8.3. Inherited Metabolic Diseases
People with Wilson disease (copper overload and damage to the liver, and the nervous system), and hemochromatosis (iron overload in the liver) have a high risk of liver cancer.
Learn more from this amazing video.
4.8.4. Obesity
Obesity may result in fatty liver disease and liver cirrhosis. They increase the risk of liver cancer.
4.9. Viral Hepatitis
Generally, there are five types of hepatitis, of which type B and type C are the most common and dangerous.
4.9.1. Hepatitis B
An estimated 820,000 people die each year from hepatitis B and related complications such as liver cancer. Hepatitis b is caused by the infection of hepatitis b virus and it is the primary cause of liver cancer, which is the 2nd leading cause of cancer deaths worldwide.
It can spread through infected blood transfusion, body secretion, unprotected sex, and contaminated needles, from infected mothers to newborns.
The symptoms are fever, G.I. disturbance, dark urine, jaundice, liver damage, yellowish eyes, and light-coloured stool.
The rate of affected people by this virus is higher in Asian countries than in the U.S.
If some affected person drinks too much alcohol, the situation worsens.
4.9.2. Hepatitis C
In the U.S., hepatitis c is the most common cause of hepatocellular carcinoma. This is chronic viral hepatitis with an incubation period of 2-22 weeks. The symptoms are less likely to develop, but the liver damage caused by the hepatitis c virus is severe.
There is no such vaccine to date for HCV as HBV.
Other hepatitis viruses, A, D, and E also cause liver damage but are not so severe that they can cause cancer. HDV can cause hazardous liver sometimes.
4.10. Type-2 Diabetes
Type-2 diabetes is the type of diabetes where the insulin receptors of the cells do not respond. The beta cells of the islet of Langerhans’ of the pancreas produce insulin. In type-1 diabetes, the production of insulin is reduced.
In type 2, the receptors of insulin do not respond. Consequently, the production of insulin increases so that it can get attached to the receptors, but they are of no use.
In this case, if someone drinks alcohol or they are obese, the risk of liver cancer increases.
4.11. Exposure to Aflatoxin
Aflatoxins are poisonous metabolites produced by a certain group of fungi named Aspergillus. The moulds grow on grains, and in proper conditions produce toxins. They can contaminate food crops and pose a serious health threat to humans.
Aflatoxins are potent carcinogens and may affect almost all organ systems, especially the liver and kidneys. The risk increases in the cases of:
- Hepatitis B (HBV) infected patients,
- Someone who once had been infected with HBV but didn’t get the vaccination done at the proper time.
Aflatoxins damage the DNA in liver cells. TP53 is a tumor suppressor gene, that restricts the growth of the gene to the normal. Damage to the TP53 gene can lead to the uncontrolled growth of cells and the formation of cancers. Studies have shown that aflatoxins can damage the TP53 gene which may lead to liver cancer.
4.12. Taking Anabolic steroids
Anabolic steroids are drugs that mimic male hormones. Athletes during the on-season often take anabolic steroids to increase muscle mass and performance. Misuse of these drugs may increase the risk of liver cancer.
4.13. Other Risk Factors
Other risk factors for liver cancer include:
- Advanced PBC (Primary Biliary Cirrhosis/ Primary Biliary Cholangitis)
- Tyrosinemia
- Alpha-1-antitrypsin deficiency (Protein retention in the liver, cholestasis in kids)
- Porphyria cutanea tarda
- Galactosemia
- PFIC3 (Cholestatic liver faliure)
5. How Can These Risk Factors Cause Liver Cancer? Understanding at the Genetic Level
We have different types of genes in our cells performing various types of work. Few of them control cell growth. When the risk factors affect our body, they might affect particular genes as well.
If the genes start malfunctioning, there will be uncontrolled cell division due to the loss of the property of contact inhibition.
- Proto-oncogenes are genes that help the cell grow and divide. When they are mutated, they can become oncogenes that can cause cancer.
- Genes responsible for keeping cell division under control, rectifying mistakes in the DNA, and communicating apoptosis (if necessary) are called tumour suppressor genes.
When mutations occur on these genes, the abnormal growth of cells and they turn into cancerous cells metastasis starts.
6. Symptoms of Liver Cancer
The symptoms of developing liver cancer include:
- Loss of appetite.
- Sharp pain in the upper right abdomen and worse gradually.
- The liver becomes enlarged due to cancer growing in it.
- Skin and mucous membranes turn yellow.
- Abdominal discomfort due to gradual stretching of Glisson’s capsule.
- Abdomen swells, filled with liquid.
- Increase in bilirubin blood level, due to jaundice.
- Obstructive jaundice is a strong indicator of liver cancer.
- Urine and faeces’ colour may change.
- Mild fever, fatigue, and weight loss.
- If you want to learn in detail, go through this video.
7. When Should You Visit a Doctor?
If you are having the symptoms listed, you may visit a medical practitioner. Although in some cases, they occur due to some infection, it is better to get yourself diagnosed.
When someone is infected with hepatitis or jaundice, in that case, consultation with the doctor is a must.
8. How Do You Know You Have Liver Cancer?
If you feel the symptoms, visit a professional medical practitioner, get the tests done as recommended by the doctor and he/she will confirm from the biopsy, MRI or, CT scan report whether you have liver cancer or not.
8.1. Liver Cancer Screening
8.1.1. AFP Test
The blood test for liver cancer screening includes the test for a substance called AFP, alpha-fetoprotein, that might be produced by cancer cells.
8.1.2. Biopsy
In this case, a small piece of liver tissue is taken out cultured and studied in vitro to know the presence of the cancerous cells. This is indeed a painful process for the patient.
8.1.3. Ultrasounds
An ultrasound is an imaging technique that uses waves to see inside views of the body.
8.1.4. CT Scan
This is the Computer Tomography technique, which uses multiple X-ray measurements from different angles to get tomographic images of a particular location inside the body without cutting it. Learn more about CT from the American Liver Foundation.
8.1.5. MRI
MRI is the Magnetic Resonance Imaging. This is a medical imaging technique used in radiology. MRI scanners use strong magnetic fields, their gradients, and radio waves to generate images of the organs in the body.
Learn more about hepatocellular carcinoma from the National Cancer Institute.
9. Is There Any Way to Prevent It?
The best way to prevent liver cancer is to have a healthy lifestyle and try to avoid the risk factors as much as you can.
If you are diagnosed with liver cancer, there are treatment options also available, but in some cases, they can’t be cured completely. So, it’s better to avoid the risk factors causing liver cancer.
9.1. Reducing the Risk of Liver Cancer
The ways to reduce the risk of liver cancer are listed below:
- Try to lead a healthy lifestyle.
- Avoid alcohol as the excessive consumption of alcohol leads to liver cirrhosis, which develops into liver cancer.
- Get your hepatitis b vaccination done.
- If someone is infected with hepatitis b or hepatitis c virus, immediate and complete treatment should be done.
- Avoid chewing or smoking tobacco.
- Limit to the exposure of aflatoxin, arsenic, and other cancer-causing elements.
- Anyone having type-2 diabetes, high cholesterol, or any inherited metabolic diseases should speak to their doctors about the risk and regular surveillance.
- Regular surveillance and screening for cirrhosis patients are recommended.
9.2. Treatment options
If you are diagnosed with liver cancer, there are some options available for treatment. But the treatment options also depend on some factors:
- Type of liver cancer.
- Stage of liver cancer at which it is diagnosed.
- Extension of cirrhosis.
- Health condition of the patient, whether the patient is diagnosed with any other serious disease or not.
- Size, location, and the number of tumours.
The available treatment options are:
- Chemotherapy
- Radiotherapy
- Immunotherapy
- Oral medications.
Available surgical options are:
- Liver transplant
- Partial or segmental hepatectomy.
10. So, How Do You Get Liver Cancer?
Try to lead a healthy life, maintain a healthy weight and eat nutritious food to avoid liver cancer, but sometimes it might be caused due to some other factors as discussed above. In that case, or if you are facing some symptoms or major health issues, visit a doctor, and get yourself diagnosed.
Even if you are diagnosed with this disease, try not to get worried. Medical science has improved tremendously. Nowadays a lot of treatment options are available, stay strong!
Any information found on the site does not constitute legal or medical advice. Should you face health issues, please visit your doctor to get yourself diagnosed. Icy Health offers expert opinions and advice for informational purposes only. This is not a substitute for professional medical advice.
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- Balogh, Julius, et al. “Hepatocellular carcinoma: a review.” Journal of hepatocellular carcinoma (2016): 41-53. ↩︎
- Bosch, F. Xavier, et al. “Primary liver cancer: worldwide incidence and trends.” Gastroenterology 127.5 (2004): S5-S16. ↩︎
- Seyama, Yasuji, and Masatoshi Makuuchi. “Current surgical treatment for bile duct cancer.” World journal of gastroenterology: WJG 13.10 (2007): 1505. ↩︎
- Starr, S. Paul, and Daniel Raines. “Cirrhosis: diagnosis, management, and prevention.” American family physician 84.12 (2011): 1353-1359. ↩︎
- Jansen, Peter LM. “Non-alcoholic steatohepatitis.” European journal of gastroenterology & hepatology 16.11 (2004): 1079-1085. ↩︎
- Schuppan, Detlef, and Nezam H. Afdhal. “Liver cirrhosis.” The Lancet 371.9615 (2008): 838-851. ↩︎
- Christen, Urs, and Edith Hintermann. “Pathogen infection as a possible cause for autoimmune hepatitis.” International reviews of immunology 33.4 (2014): 296-313. ↩︎
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