Thomas Jefferson University Hospital
 

 


Return to the Table of Contents

Liver Cancer: Who’s at Risk?

Patients with cirrhosis, chronic liver infections and/or family history of liver cancer should be screened.

Primary, or actual, liver cancer  – also known as malignant hepatoma or hepatocellular carcinoma – originates in cells in the liver, as opposed to cancer that metastasizes, or spreads, to the liver from other organs. The exact causes of primary liver cancer are unknown. However, scientists have established that people with certain risk factors are more likely than others to develop liver cancer.

Dr. Navarro

Cirrhosis           
Cirrhosis is a chronic disease that develops when liver cells are damaged and replaced with scar tissue over many years.  Patients with cirrhosis are at risk for developing serious health problems, according to Victor Navarro, MD, Medical Director, Liver Transplantation Program and Director of Hepatology, Thomas Jefferson University Hospital, and Clinical Associate Professor of Medicine in the Division of Gastroenterology and Hepatology at Jefferson Medical College of Thomas Jefferson University. 

“Cirrhosis is an especially significant risk factor for hepatoma. Domestically, it is the setting in which hepatoma most often develops,” Dr. Navarro says. 

The most common causes of cirrhosis in the United States include hepatitis C virus, fat accumulation in the liver due to obesity and diabetes, and alcohol. Each year, patients with cirrhosis have about a 5 percent risk of developing liver cancer.

Chronic Liver Infection (Hepatitis)
Certain viruses can infect the liver. The infection may be permanent, or chronic. The most important viruses that cause chronic liver disease leading to liver cancer in the United States include hepatitis C and hepatitis B. These viruses can be passed from person to person through blood (such as by sharing needles) or sexual contact. An infant may catch these viruses from an infected mother.

“In the case of hepatitis C, which affects as much as 2 percent of the population of the United States, only patients who have developed cirrhosis are at risk for liver cancer.  However, hepatitis B can also lead to liver cancer – even in patients who have no cirrhosis,” says Dr. Navarro. “Fortunately, hepatitis B vaccine can prevent chronic hepatitis B infection and thus protect against liver cancer.  There is also a vaccine to protect against hepatitis A, which has not been shown to cause chronic liver disease or cirrhosis.  Unfortunately, there is no vaccine to protect against hepatitis C.

“In the United States, routine hepatitis B vaccination of newborns has been available since 1991. Patients who were not vaccinated for hepatitis B during their infancy, including immigrants from Asia and Africa; people who received blood transfusions prior to 1992, when effective testing of donated blood for hepatitis C was unavailable; and all those who have ever used needles to inject themselves with recreational drugs, should talk with their doctors about their risk for infection and the benefit of vaccination.”

Other Risk Factors 
Among other risk factors for liver cancer pertinent, as noted by the National Cancer Institute, are:  

  • Being male – Men are twice as likely as women to get liver cancer.
  • Family history – People who have family members with liver cancer may be    more likely to get the disease.
  • Age – In the United States, liver cancer occurs more often in people over age 60 than in younger people.

To that list, Dr. Navarro adds fatty liver, or the accumulation of at in the liver cells.  “Fatty liver is very common in patients who are obese or overweight, which accounts for about half of the entire population of the United States, as well as in people who have diabetes, high blood triglycerides (stored animal tissue fat) or high blood pressure,” he says. “Although fatty liver is itself benign, it can lead to cirrhosis and then liver cancer.”

The more risk factors a person has, the greater the chance that liver cancer will develop. However, many people with known risk factors for liver cancer do not develop the disease.

People who think they may be at risk for liver cancer should discuss this concern with their doctor.

Diagnosing Liver Cancer
Malignant liver tumors are detected through liver imaging tests such as abdominal ultrasound and CT scan in combination with the measure of blood levels of alpha-fetoprotein. These tests should be taken semiannually by patients with cirrhosis, Dr. Navarro suggests. Occasionally, malignant tumors may also be detected in patients without chronic liver disease when they undergo an imaging test of the abdomen. Often, patients find out that they have liver disease through routine medical testing or in the screening process for life insurance.

“An elevated level of liver enzymes, as detected by blood tests, indicates inflammation of the liver, though it doesn’t indicate the cause,” Dr. Navarro notes. “In such cases, a physician will then conduct additional tests for viral diseases – particularly hepatitis B and hepatitis C, scan the liver for tumors and send the patient to a liver sub-specialist.  If a liver tumor is detected, a biopsy may be done to determine whether the tumor is malignant.” 

Treatments for liver cancer include chemotherapy infused directly into the liver, high-frequency radio waves or pure ethanol applied directly to the tumor to destroy it, and surgery, including liver transplantation.

The next issue of Thomas Jefferson University Hospital’s CancerCARE Online Newsletter will examine treatment options for liver cancer and contributing chronic liver diseases, including cirrhosis.