Published 06 August 2019
The liver is your body’s chemical processing plant; a powerhouse crucial to remove toxins, as well as to distribute and store essential nutrients. The immune system, hormones, digestion and more come under its protection.1 Fortunately, this organ has the unique ability to regenerate itself, even when damaged by the toxins that it processes for you.2
Knowing that, you would be forgiven for thinking the liver was indestructible. However, liver cancer is one of the few cancers that are on the rise,3 and hepatocellular carcinoma (HCC), the primary type of liver cancer, accounts for 90% of those cases.4
But what is causing this increase?
The destructible liver
You’re probably aware of the link between alcohol and the liver, but have you thought about what else impacts your liver?
Worldwide, the most common risk factor for HCC is viral hepatitis6 – known to cause inflammation of the liver.4 Chronic hepatitis B accounts for approximately 50% of all cases of HCC, and the majority of cases of childhood HCC.7 Other risk factors include aflatoxin – a carcinogenic mould found in contaminated foods such as rice, in hot and humid climates.4
An increasingly important risk factor for the development of HCC is non-alcoholic fatty liver disease (NAFLD), linked with fatty foods and obesity.8 For example, in the US, the number of liver cancer cases have doubled since the mid-1980s, the fastest-growing rate of any cancer; this is thought to be driven in part by this risk factor, along with alcohol use.9 In recent years, NAFLD has spread to other regions, such as Asia.10
The power of prevention
Viral hepatitis B has a particularly high prevalence in most countries in Asia,6,11 and this prevalence directly contributes to higher incidences of HCC in the region.6
In North America and Europe, hepatitis C (HCV) is the predominant cause of HCC12 – in the US, HCV is linked to 34% of cases of HCC.12
In the 1980s and 1990s, great strides were made in China and elsewhere in Asia to tackle hepatitis B, in an effort to reduce the number of HCC cases, through universal vaccination programmes.13,14
I estimate that the incidence of liver cancer will decline significantly in the next 10 to 20 years because the incidence of hepatitis will drop.”
Professor Zhenggang Ren, Director of Hepatology, Zhongshan Hospital, China
Thanks to these efforts, data show that the incidence of HCC is beginning to fall in some high-incidence areas in Asia7 – for example, Taiwan halved the incidence of childhood HCC within a decade.14
Similarly, if caught early enough and appropriate diet and exercise changes are made, some of the damage caused by liver disease, as a result of poor diet and lifestyle, can be reversed.15
Find out more about how HCC has been tackled in parts of Asia – HCC the ‘silent killer’.
Early diagnosis, healthier liver
Being faced with a cancer diagnosis can be devastating, but imagine if you had been living with HCC for a while without realising; by the time you were diagnosed, it’s likely your treatment options would be limited.4,16,17,18
Many cases of liver cancer are diagnosed at an advanced stage, usually once symptoms appear,4 where less than 50% of people with advanced HCC will survive more than a year after diagnosis.16 If diagnosed early, it may be possible to remove the cancer completely.4,18
About 40% of liver cancer patients are diagnosed at an advanced stage, so raising awareness to help the patient get diagnosed as early as possible is very important.”
Jane Tsai, Formosa Cancer Foundation (patient group), located in Taiwan
There are limited treatments available for people across all stages of liver cancer, and even less if diagnosed at the advanced stage.
Current treatment options include:18
- Liver transplant
- Embolisation, which involves blocking blood cells in the liver that supply the tumour
- Destroying cancer cells with heat or cold (ablation procedures)
- Chemotherapy or radiation directly to cancer cells
- Radiation therapy using energy from X-rays or protons
- Targeted drug therapies such as tyrosine kinase inhibitors
Recent developments in screening, vaccinations and new treatments are great advances, but with over 756,000 new cases of HCC diagnosed each year globally,4,5 further research and understanding of this complex disease is urgently needed.
Immune checkpoint inhibitors, some of which target the PD-L1 and PD-1 proteins, are being explored as a potential new treatment option for people with HCC.19
We believe people with HCC deserve more options, and our hope for the future is to be a helping hand for those who need it.
- British Liver Trust. [Internet; cited 24 May 2019] Available from: https://www.britishlivertrust.org.uk/liver-information/.
- Michalopoulos GK. Liver regeneration. J Cell Physiol. 2007;213(2):286–300.
- Ryerson AB, Eheman CR, Altekruse SF, et al. Annual Report to the Nation on the Status of Cancer, 1975-2012, featuring the increasing incidence of liver cancer. Cancer. 2016;122(9):1312–1337.
- Llovet et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016;2:16018.
- World Health Organisation: Globocan 2018 – Liver cancer factsheet. [Internet; cited 8 May 2019] Available from: http://gco.iarc.fr/today/data/factsheets/cancers/11-Liver-fact-sheet.pdf
- Tanaka, M., Katayama, F., et al. Hepatitis B and C Virus Infection and Hepatocellular Carcinoma in China: A Review of Epidemiology and Control Measures. Journal of Epidemiology. 2011;21(6):401-416.
- El-Serag, H. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012;142(6):1264-1273.
- Dimitroulis et al. From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world. World J Gastroenterol. 2017;23(29):5282-5294.
- Islami F., Miller, K. et al. Disparities in liver cancer occurrence in the United States by race / ethnicity and state. Ca Cancer J Clin. 2017;67:273–289.
- Wong SW, Ting YW, Chan WK. Epidemiology of non-alcoholic fatty liver disease-related hepatocellular carcinoma and its implications. JGH Open. 2018;2(5):235–241.
- Shan S. Cui F. Jia J. How to control highly endemic hepatitis B in Asia. Liver International. 2018;38:122-125.
- Axley, P. et al. Hepatitis C virus and hepatocellular carcinoma: a narrative review. J Clin Transl Hepatol. 2018;6:79-84.
- Zheng et al. The landscape of vaccines in China: history, classification, supply, and price. BMC Infectious Diseases. 2018;18:502
- Chen. Hepatocellular carcinoma in Taiwan. Hepatology Research. 2007; 37:S101-S105.
- NHS. [Internet; cited 24 May 2019] Available from: https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/.
- Giannini G, et al. Prognosis of untreated hepatocellular carcinoma. Hepatology. 2015;61(1),184-190.
- Wu Q,. and Qin S., Features and treatment options of Chinese hepatocellular Carcinoma. Chin Clin Oncol 2013;2(4):38.
- Marrero, J., Kulik L., et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2).723-750.
- Okusaka and Ikeda. Immunotherapy for hepatocellular carcinoma: current status and future perspectives. BMJ ESMO Open 2018;3:e000455.