Liver cancer rates are increasing rapidly, mainly due to liver damage

By Jessica Saenz

Liver cancer is the sixth most common cancer in the world. While it's less common in the U.S. than globally, the incidence is increasing at an alarming rate. Since 1980, liver cancer cases in the country have more than tripled, and liver cancer deaths have nearly doubled, according to the National Cancer Institute.

While rates for other types of cancer are increasing without a clear cause, hepatocellular carcinoma (HCC), the most common type of cancer that originates in the liver, has several known risk factors that can be attributed to 80% of cases.

Most of these risk factors have one thing in common: liver damage.

"Unlike other cancers, we know what the culprit is for the most part — and that's anything that damages the liver," says Tanios Bekaii-Saab, M.D., a medical oncologist who specializes in liver and gastrointestinal cancers at Mayo Clinic Comprehensive Cancer Center. Dr. Bekaii-Saab is the David F. and Margaret T. Grohne Professor of Novel Therapeutics for Cancer Research.

Dr. Bekaii-Saab explains common causes of liver damage, how it can lead to liver cancer, and what you can do to prevent it.

The link between liver damage and cancer.

The liver has an unusual ability to regenerate. Even when most of the liver is removed for liver surgery or living donation, it can regrow to near full size and function in a matter of months. But the liver has limits, and long-term damage and inflammation can take a toll on its ability to regenerate.

"Anytime the liver is damaged, it forms scarring that can ultimately lead to cirrhosis, which increases your risk of developing liver cancer, " says Dr. Bekaii-Saab. Cirrhosis is severe scarring of the liver, and it can be caused by diseases and conditions that affect the liver, as well as certain medications and substances, including alcohol.

Every time your liver repairs itself and forms scar tissue, there's a risk of DNA mutations in liver cells that can cause them to grow out of control and form a tumor. "If we can prevent or limit damage to the liver, we can reduce the likelihood of cancer developing," says Dr. Bekaii-Saab.

The most common causes of liver damage.

In the Western world, steatotic liver disease (formerly called nonalcoholic fatty liver disease), hepatitis B, hepatitis C and alcohol-related liver disease are the most common causes of liver damage and the leading risk factors for liver cancer.

Fat accumulation in the liver

"The incidence of hepatocellular carcinoma is increasing in the U.S., primarily driven by what we used to call nonalcoholic fatty liver disease," says Dr. Bekaii-Saab.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the accumulation of fat in the liver, which can cause inflammation that leads to scarring. At its most severe stage, MASLD can lead to cirrhosis.

Fat can build up in the liver due to alcohol use, obesity, type 2 diabetes, hypertension, high cholesterol, and other diseases and conditions that affect metabolism.

Hepatitis B and C

Chronic infection with viral hepatitis, including hepatitis B and C, can lead to inflammation of the liver, which can cause cirrhosis.

While there is no cure for hepatitis B, it is preventable. "Hepatitis B has become less common. With the advent of vaccination, its incidence is decreasing," says Dr. Bekaii-Saab.

Hepatitis C is less preventable because there is no vaccine, but medications can treat and cure it. "We're still learning whether the cure for hepatitis C with medicine will eliminate or decrease the risk of developing liver cancer," he adds.

The bottom line about alcohol

Consuming alcohol can damage your liver. "Frankly, there is no real safe amount of alcohol. Drinking alcohol in any amount will have a health risk. There's no doubt about it," says Dr. Bekaii-Saab. "Heavy drinking can be quite problematic and significantly increases the risk of liver disease, liver damage, liver cancer and many other cancers."

Despite these risks, excessive drinking continues to increase in the U.S.

If you choose to drink alcohol, moderation is key, but it doesn't eliminate risk. "For moderate alcohol intake, the risk is low, but it's not zero," says Dr. Bekaii-Saab.

The Centers for Disease Control and Prevention (CDC) defines moderate alcohol intake as two standard drinks or less in a day for men and one standard drink or less in a day for women. Standard drink volumes are less than most people think:

• 12 ounces of beer with 5% alcohol.
• 8 ounces of malt liquor with 7% alcohol.
• 5 ounces of wine with 12% alcohol.
• A shot or 1.5 ounces of liquor or distilled spirits (80-proof liquor/40% alcohol).

Keeping a pulse on your liver health.

"Primary care physicians closely follow health concerns that may lead to liver disease," says Dr. Bekaii-Saab. "Understanding and acknowledging all the factors that can increase the risk of liver cancer is important," he adds.

Ongoing and honest discussions with your primary care physician will allow them to evaluate your risk factors and recommend appropriate tests and screening to prevent or treat liver damage.

"You can be screened for hepatitis B and C in certain settings, but more adults need to be screened because people don't often know they have it until the damage is done in the liver," says Dr. Bekaii-Saab.

When symptoms of liver damage such as fatigue, jaundice and swelling appear, liver damage might already be extensive. Getting ahead of liver damage with the hepatitis B vaccine and lifestyle changes is the best prevention.

The CDC recommends the hepatitis B vaccine for all infants, children and adults up to age 59 who have not been vaccinated. The vaccine also is recommended for adults 60 and older who have risk factors for hepatitis B.

If you are diagnosed with liver cancer, there's hope.

If you are diagnosed with liver cancer or a high-risk factor like MASLD or cirrhosis, you should know that treatments are better than ever and liver cancer clinical trials are exploring more new and improved options.

"Years ago, we had zero options for patients outside of surgery and transplant for eligible patients," says Dr. Bekaii-Saab. "Immunotherapy has revolutionized how we treat liver cancer. We can treat patients in the most advanced stages and improve their outcomes and survival. We can also treat more patients who would not have been candidates for surgery or transplant in the past."

The best possible outcome begins with an accurate diagnosis from an expert team that can oversee all aspects of your care. "If someone is diagnosed with liver cancer, they should be cared for by a healthcare team that includes all the disciplines typically involved in liver care — radiation, surgical and medical oncology, hepatology, interventional and diagnostic radiology. They should also have a strong transplant center," says Dr. Bekaii-Saab.

Mayo Clinic’s collaborative multidisciplinary liver program includes experts in all these areas and delivers more lifesaving solid organ transplants than any other transplant center in the U.S.

Learn more

Learn more about liver cancer and cirrhosis and find a liver cancer clinical trial.

Join the Liver Cancer Support Group on Mayo Clinic Connect, an online community moderated by Mayo Clinic for patients and caregivers.

Also, read these articles:

• To reduce your liver cancer risk, prevent liver disease — and cirrhosis
• Treating liver cancer
• Living in the moment: Susan Parrott
• Researchers hope to eliminate hepatitis, a common risk factor for liver cancer