Primary liver cancer has become more common in the UK over the past 20 years. There were just over 4 cases for every 100,000 people in 1997. By 2017, it was nearer 10 cases for every 100,000.
One type of liver cancer – hepatocellular liver cancer (HCC) – has become 3 times more common, although the increase has now levelled off. There are also more bile duct cancers that started inside the liver (intrahepatic bile duct cancer).
Doctors and researchers have looked into why this is. They’ve found that serious liver damage and other liver disease have also become more common. Doctors call severe liver damage ‘cirrhosis’ (say: sih-row-sis). Cirrhosis is a major risk factor for HCC and may also increase risk of bile duct cancer.
The risk factors for cirrhosis, liver disease and liver cancer are similar. The good news is that there are things you can do to reduce the risks. In the UK the most important risk factors are:
- Infection with a hepatitis virus
- Drinking alcohol
- Being overweight
- Having type 2 diabetes
The risk of liver cancer from being overweight and type 2 diabetes is not as high as for viral hepatitis. But because these factors affect so many people in the UK, they’re actually responsible for a significant number of cases. The increase in the number of people who are overweight or have type 2 diabetes has also contributed to the large increase in liver cancer cases in the UK.
There are several types of hepatitis virus. Hepatitis B and C are spread by contact with infected blood. In the UK, Hepatitis C is much more common. It’s mainly spread by people sharing needles when they inject drugs. It’s possible to get it through unprotected sex, but that’s rare.
Hepatitis symptoms can be mild and you may not know you have it. But untreated, both B and C can both become long-term (chronic) infections. This causes severe liver damage (cirrhosis) and can lead to liver cancer. About 3 out of 4 people who become infected with hepatitis C will go on to develop a chronic infection.
Looking at the figures, doctors and researchers found that HCC cases went up as more people became infected with chronic hepatitis C. And the increase in HCC levelled off at the same time as better treatments became available. So it looks as if chronic hepatitis C infection was driving the increase in liver cancers.
There is no vaccine for hepatitis C. If you think you’re at risk, it’s important to get a blood test. If you have the virus, you take anti viral tablets for 8-12 weeks. It’s really important to finish the course, to make sure the infection goes completely. Treatment for hepatitis C is now much better, most people find the new medicines easy to take with few side effects.
There is a vaccine for hepatitis B that is now part of the routine childhood vaccination programme in the UK. If you weren’t vaccinated as a child, the vaccine is recommended for:
- healthcare workers
- people who inject drugs
- men who have sex with men
- children born to mothers with hepatitis B
- people travelling to parts of the world where the infection is more common
It’s a bit of a myth that liver disease and liver cancer are always caused by alcohol. Fewer than 1 in 10 hepatocellular liver cancers (HCC) are diagnosed in people with existing liver disease resulting from drinking. Even so, it’s the second most important cause of liver cancers.
Although most people who drink stick within the limits, around 1 in 4 people drink alcohol in a way that could harm their health.
Alcohol is broken down by the liver. This produces harmful chemicals that can damage and kill liver cells. If this type of damage happens too often, the liver can’t keep up with repairing itself. Scarring develops. If the damage continues, it will become severe (cirrhosis).
If you’re worried that alcohol has damaged your liver, ask your GP for a liver fibrosis test. Finding liver disease early makes a big difference. It also means that you can be regularly checked for signs of HCC if you’re at risk. The earlier HCC is diagnosed, the greater the likelihood of curing it.
Weight, diabetes and fatty liver disease
Being overweight or living with conditions like type 2 diabetes can increase your risk of ‘non-alcohol related fatty liver disease’ – or NAFLD for short.
Being overweight and having diabetes both affect how your body uses and stores energy (metabolism). If you eat a diet high in sugar and fat for years, it can affect how your body reacts to insulin (the hormone that controls blood sugar). The excess calories are stored as fat in the liver.
To start with, this is reversible. If you start to eat healthily, exercise more and lose weight, the fat in your liver will go. But if it builds up, the fat can cause liver scarring that can lead to cirrhosis, and then potentially to liver cancer.
Can liver cancers be passed on in our genes?
Some cancers, such as breast and prostate cancers, are linked to known genetic faults that can be passed down through families.
When it comes to liver cancers, this doesn’t seem to be the case for bile duct, gallbladder or fibrolamellar cancers, or for angiosarcoma or hepatoblastoma. Though it is hard to be sure as many cases of liver cancer don’t have a known cause.
There is evidence that your risk of developing HCC liver cancer is 2.5 times higher if a close relative has the condition, compared to the average person. A close relative means a parent, brother, sister, or child. Remember that the average risk of developing liver cancer is low, and 2.5 times a low risk is still low.
This increased risk may be linked to a specific genetic fault, but so far none have been found.