Liver cancer is spreading with deadly intent
It's time to pay more attention to liver cancer. Even as breast-cancer, lung-cancer and other cancer fatalitiescontinue to drop, liver cancer is now the fastest-rising cause of U.S. cancer deaths, a recent study shows. Since the mid-1980s, death rates from liver cancer have doubled. An estimated 41,000 new cases and 29,000 liver-cancer deaths are expected in 2017.
Only 1 in 5 patients survive after being diagnosed with liver cancer, the recent study notes. "Liver cancer does not have a good prognosis," says Dr. Farhad Islami, strategic director of cancer surveillance research for the American Cancer Society and lead author of the study published June 6 in CA: A Cancer Journal for Clinicians. "But the good thing is that most cases can be prevented."
Baby boomers, in particular, should take note: Hepatitis is the top risk factor for liver cancer, and Americans born between 1945 and 1965 are most likely by far to be infected with the hepatitis C virus. Hepatitis, an inflammation of the liver, develops in several different ways.Infectious types, hepatitis B and hepatitis C, are caused by viruses, and are usually spread via contaminated body fluids. It's not clear why people in this age group have high rates of hepatitis C, according to the Centers for Disease Control and Prevention. They may have been infected when transmission was at its highest in the 1960s through 1980s.
Although vaccination prevents hepatitis B, there's no vaccine for hepatitis C. However, medication is now available to cure hepatitis C, before it can lead to liver cirrhosis, or scarring of the liver, and cancer. Baby boomers should be screened at least once in their lifetime for hepatitis, according to the CDC. Ask your doctor for this simple blood test if it hasn't already been done.
In addition to hepatitis, obesity and diabetes also significantly increase liver-cancer risk. One reason liver cancer is so lethal is that it's often diagnosed in later disease stages, when symptoms are more likely to show up. Unexplained weight loss, appetite loss, feeling fuller than usual after small meals, nausea and vomiting, abdominal pain, yellowing eyes and skin and swelling of the belly are possible symptoms. A physical exam can reveal liver enlargement. Blood tests, imaging tests and liver biopsies are used to confirm a liver-cancer diagnosis.
Liver cancer's toll varies widely among states, Islami's study found. The District of Columbia is most affected, with 15 liver-cancer deaths per 100,000 men, and five such deaths per 100,000 women. Hawaii follows with rates of 12 and five related deaths for men and women, respectively. North Dakota had the least impact, with five-and-a-half deaths per 100,000 men and a rate of about two such deaths for women.
African-American men are more likely to develop liver cancer, and when they do, are more likely to have shorter survival than white men. The study paints a clearer picture of black-white disparities even in states with low liver-cancer death rates. The extent of the gap was surprising to Islami, who notes that in Utah, white men had a death rate of five per 100,000 men, compared to nearly 19 such deaths per 100,000 African-American men.
Prevention is key. People at higher risk for liver cancer, such as baby boomers, health care workers and injectable drug users, should be screened for hepatitis, Islami says. It's also important to maintain a normal body weight and keep diabetes under control. Diabetes is tied to obesity, but it's also an independent risk factor for liver cancer, he says. Fatty liver disease, which is also on the rise, increases cancer risk as well.
It's probably no surprise that drinking less alcohol reduces your risk for developing or worsening liver disease. Smoking is also a risk factor for liver cancer, Islami says, although not as significant as it is for lung or mouth and throat cancers.
For patients who have liver cancer, treatment advances offer hope, says Dr. William Jarnagin, a surgeon and chief of the liver, biliary and pancreas surgery service at Memorial Sloan Kettering Cancer Center in New York City. For instance, chemotherapy is being delivered directly to liver tumors in more effective ways.
A minimally invasive procedure, called ablation, is an option in some cases. Ablation uses imaging-guided probes to either super-heat or freeze tumors in the liver. While ablation can reduce complications in patients with very small tumors, Jarnagin says, surgery is the standard route for larger tumors.
An evolving surgical approach called "parenchymal-sparing liver surgery" that spares healthy liver tissue can improve survival from liver cancer and reduce complications for patients with extensive liver cancer, found a study co-authored by Jarnagin. Liver-sparing surgery can help some patients with advanced cancer who traditionally would not have been considered as operative candidates, according to the research published in the April 2015 issue of the Journal of the American College of Surgeons.
A targeted drug called sorafenib may help control advanced liver cancer. For some patients, a liver transplant offers the best hope of survival. For patients with hepatitis or cirrhosis, Jarnagin says, as well as for those with liver cancer, it's important to be cared for by specialty centers with expertise in liver disease.
The take-home message about liver cancer is that it's largely preventable, Islami emphasizes. Early detection and treatment of hepatitis C, improved vaccination against hepatitis B and increased access to high-quality diabetes care can make a big difference, he says. And for the general public, it's time to add liver-cancer prevention to the list of benefits from making healthy lifestyle changes.