Liver cancer is one of the fastest rising causes of cancer-related deaths in the UK, and the third leading cause of cancer deaths worldwide.
More than 6,000 people die from liver cancer in the UK each year. Its major drivers are largely preventable, but public awareness of the scale of the problem remains low.
Most liver cancers develop in people with long-term liver disease. Strikingly, recent estimates suggest that around one in three adults worldwide are living with some form of liver disease.
Although liver disease is often mild in its early stages, some people will progress to more serious liver damage and a higher risk of liver cancer. Early action can help reduce this risk.
Obesity, type 2 diabetes, excess alcohol consumption and viral hepatitis are among the most common causes of liver disease.
As liver disease becomes increasingly common, rates of liver cancer will continue to rise without urgent action.
Modifiable risk factors
At least 60% of primary liver cancers – cancers that start in the liver – may be preventable by modifying risk factors
The liver is a remarkable organ and, when changes are made early, significant improvements can occur. Risks of both liver disease and liver cancer can be reduced by stopping or significantly cutting down on alcohol intake, quitting smoking, limiting ultra-processed foods, maintaining a healthy diet and staying physically active.
Importantly, these lifestyle changes not only benefit the liver. They also reduce the risks of many other cancers, heart disease, and other major health conditions.
Stigma is an underappreciated barrier for people living with liver disease and liver cancer.
The root of this stigma is complex and often arises from misconceptions of liver disease being “self-inflicted” or only affecting certain groups.
Stigma can discourage people from seeking help and delays diagnosis. It may also cause healthcare systems to be less likely to prioritise liver disease over other medical conditions. Greater awareness is needed about the fact that alcohol dependence is a common addiction. We must also understand obesity and viral hepatitis as health conditions with no blame attached, and where support from healthcare professionals can improve outcomes.
Another major challenge is that many people living with liver disease are not aware they have it, as many don’t feel unwell in the early stages. The same is true for liver cancer – so unfortunately it’s still often detected at more advanced stages when symptoms do occur. Early detection can improve survival and is a key focus of current research.
You can speak to your GP about screening for liver disease if risk factors are present. These include type 2 diabetes, obesity, and regular alcohol consumption.
Viral hepatitis B and C are other important causes, and may be transmitted during childbirth, through blood exposure, unprotected sex with an infected person or through the use of non-sterile needles for injected drug use.
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Symptoms of liver cancer can include unintended weight loss, persistent fatigue, loss of appetite, abdominal pain or swelling, and yellowing of the skin and eyes. It’s important to see your GP if any of these symptoms develop.
Urgent action needed
While it’s possible for people to make lifestyle changes to lower their liver cancer risk, current trends will not reverse without urgent government action and wider policy reform.
Many evidence-based tools for change are already well recognised. These include restrictions on advertising alcohol and unhealthy foods, particularly to children and adolescents, alongside health warning labels and regulating taxation on alcohol and ultra-processed foods. Research even shows the introduction of minimum unit pricing for alcohol in Scotland was associated with a significant reduction in deaths directly caused by alcohol.
Alcohol is considered a carcinogen, meaning that it’s capable of causing cancer – even at light drinking levels. Measures which aim to reduce alcohol consumption may help to lower rates of many types of cancer, including liver cancer.
Greater funding for addiction services and community liver health checks is needed – particularly for populations with greater socioeconomic challenges, where the rates of liver disease are often the highest.
Expanding access to viral hepatitis testing must also remain a priority. Viral hepatitis C can now be cured with treatment, and vaccination against hepatitis B can help to prevent infection and reduce liver cancer risks.
Progress has been made, but current trends suggest we are not on track to meet the World Health Organization goal of eliminating viral hepatitis by 2030. Limited access to screening, treatment and vaccination remains a challenge.
Scaling up prevention and treatment programmes globally, as well as actively identifying people at risk, would help reduce future cases of liver cancer.
Progress in tackling the preventable causes of liver cancer has been slow. Part of the reason for this is because the burden of prevention is currently heavily placed on the person.
This has clear parallels with smoking and lung cancer. Decades passed before it became clear that industry interests were shaping the policy debate. Change only accelerated once the conversation shifted from an individual’s responsibility to recognising industry-related harm. Tobacco control policies have led to a reduction in cigarette smoking and lower rates of lung cancer cases and deaths.
Placing accountability on alcohol and food industries can restrict their influence on lobbying government, while recognising that the government have a central responsibility to introduce policy reform on a wider scale.
We have the knowledge and the tools to act. Greater public awareness combined with coordinated policy action could reduce pressures on the NHS, and most importantly, help curb the rise in preventable deaths from liver cancer in the years ahead.
Nekisa Zakeri receives research funding from the Wellcome Trust.
