A new report from the Centers for Disease Control and Prevention’s National Center for Health Statistics found that liver cancer deaths have increased in the U.S. by 43 percent for men and 40 percent for women between 2000 and 2016. The disease is much more common in men than women, and is expected to kill about 30,200 people this year. Death rates for other forms of cancer have been on a steady decline over the same period.

NorthShore hepatologist Claus J. Fimmel, MD, answers questions about this surprising trend.

What is causing the rise in deaths related to liver cancer?

Several trends contribute to the rising incidence of primary liver cancer, also known as “hepatocellular cancer.” This cancer typically develops on the basis of chronic liver disease, specifically cirrhosis. Cirrhosis in the U.S. is most often caused by hepatitis C, alcohol, and non-alcoholic fatty liver disease.

While alcoholic liver disease has long been a cause of cirrhosis and continues to play a major role, non-alcoholic fatty liver disease is emerging as the fastest growing cause of cirrhosis. This is due to the obesity epidemics in the U.S. and many other countries, which is also contributing to the rise of diabetes and other problems. Fatty liver disease is overtaking hepatitis C and alcohol as the main cause of cirrhosis, and this trend will continue over the next decades.

Who is most impacted by this?

The majority of U.S. patients with hepatitis C-related cirrhosis are now in their 50’s to 70’s – also known as “baby boomers.” Many acquired the infection in their younger years – possibly due to the fact that blood transfusions and organ transplants were not screened for hepatitis C until 1992 – and developed progressive liver disease and cirrhosis over a time period of several decades. They are now presenting with hepatocellular cancer as one of the manifestations of their cirrhosis.

As a physician with expertise in this area were you surprised to hear this? Or have you seen this in your practice?

This report is entirely consistent with the clinical experiences “in the trenches.” I see more new liver cancers now than 10 or 20 years ago, and I know that my hepatology colleagues in Chicago and elsewhere in the U.S. share this experience. In our NorthShore Liver Clinic, we diagnose on average one new patient each week, a few years back, this was a much less common problem.

What can people do to try to avoid developing liver cancer?

With liver cancer, Benjamin Franklin’s famous axiom holds true “an ounce of prevention is worth a pound of cure!” Since this cancer typically develops on the basis of cirrhosis, it can be prevented by avoiding becoming cirrhotic in the first place. The key strategies are:

• Avoid alcohol abuse
• Get tested for hepatitis C, especially if you are a baby boomer or if you have risk factors for getting infected
• Ideally, avoid becoming obese, as obesity will predispose you to fatty liver disease.
• If you have a history of “fatty liver” or have risk factors for fatty liver disease, such as obesity or diabetes, or if you have chronically elevated liver tests, ask your primary care physician about the best way to take care of your liver disease. This typically involves a visit with the hepatologist and a few special tests, such as Fibroscan – a noninvasive ultrasound test that will tell us whether you have a serious problem.

 Are there any new treatments or diagnostic tools in this area that have you excited?

I am very excited about liver cancer screening in patients with known cirrhosis. This typically consists of a liver ultrasound and blood tests done every 6 months. With this simple strategy, we can catch liver cancer at its earliest stage, which gives us the best chance to treat and often cure the disease.

With regard to treatments, we have a wide range of tools available, ranging from surgical removal of the tumor, radiologic procedures to target the tumor with heat, localized radiation or chemotherapy, all the way to liver transplantation.   

The treatment of hepatocellular cancer is particularly challenging because we have to deal with the tumor as well as with the underlying liver disease. This is best accomplished in a multidisciplinary clinic.  At NorthShore, we see hepatocellular cancer patients in a dedicated clinic at the Kellogg Cancer Center at Evanston Hospital. All of the specialists participate, which streamlines diagnosis and treatment.

What advice do you have for people who have been diagnosed with this disease?

First, and most importantly, do not panic – hepatocellular cancer is almost always treatable, and is often curable. Next, make sure that you see a liver specialist (“hepatologist”) as quickly as possible to develop a tailored treatment plan.