In the last 43 years, liver cancer cases have increased more than threefold, making it one of the leading causes of cancer-related deaths worldwide.
In 2023, an estimated 41,210 new cases of liver cancer will be diagnosed in the United States, which will result in approximately 29,280 deaths. Texas is expected to account for 4,000 of these cases alone and 2,700 deaths, per Texas Oncology.
The Dallas Express conducted a Q&A session with Dr. Amit Singal, a professor in the Department of Internal Medicine at UT Southwestern Medical Center. Dr. Singal specializes in hepatocellular carcinoma and serves as the medical director of the UT Southwestern Liver Tumor Program. He is a Dedman Family Scholar in Clinical Care and holds the Willis C. Maddrey, M.D. Distinguished Chair in Liver Disease.
DX: Cases of liver cancer have more than tripled since 1980. What has contributed to the increase in liver cases since 1980?
The increase in liver cancer cases over the past several decades is related to several causes. Previously, this was mostly driven by an aging population of patients with hepatitis C, although the introduction of direct-acting antiviral agents has curbed hepatitis C-related liver cancer in recent years.
Unfortunately, we have seen parallel increases in alcohol-related liver disease and metabolic dysfunction associated steatotic liver disease (previously called non-alcoholic fatty liver disease), which is related to obesity and diabetes. These causes of liver disease both can cause cirrhosis and significantly increase one’s risk of liver cancer.
DX: With symptoms sometimes not presenting themselves until the disease is in its later stages, the importance of screening is paramount. Can you please speak to this?
One of the strongest drivers of prognosis for patients with liver cancer is early detection. Patients found at an early stage are amenable to curative therapies and have an average survival of over 10 years. Conversely, those found at later stages rarely can undergo curative therapies, and the average survival is 1-3 years. Given the stark difference in prognosis, liver cancer screening is recommended in high-risk populations.
The primary high-risk populations in the United States are patients with cirrhosis and those with chronic hepatitis B. Screening is relatively simple, using a non-invasive abdominal ultrasound every six months. Unfortunately, many high-risk patients do not undergo screening, so many cases of liver cancer continue to be found at a late stage.
DX: Many may think liver cancer is caused by drinking too much and wonder if they can get it even if they do not drink.
There are many different causes of cirrhosis and liver cancer. While many people think of alcohol use or viral hepatitis, one of the most common causes today in the United States is metabolic dysfunction associated steatotic liver disease. This condition is related to obesity and diabetes, which can cause fat deposits in the liver that can lead to liver damage and scar tissue over time.
There are racial and ethnic disparities in chronic liver disease and liver cancer, with some of the highest incidence rates seen in Hispanic persons. This high risk is related to several causes, including increased underlying genetic risk. These trends highlight the importance of having a healthy diet and exercise to maintain a healthy weight.
DX: How much alcohol would someone drink per day/week to be concerned about being at high risk for liver cancer?
Although the exact amount of drinking to cause liver disease and an increase in one’s risk of liver cancer can vary between persons, the defined levels that are concerning are more than 14 drinks per week in men or more than seven drinks per week in women.
DX: At what age should someone consider getting a liver cancer screening if they show no symptoms or do not have any past health issues?
In contrast to other cancers, the risk of liver cancer is not simply defined by age or other demographic factors. The strongest risk factor is underlying liver disease and cirrhosis. There are recommendations for all adults to get screening for hepatitis C, which is now easily treatable and curable.
Persons with heavy alcohol use or risk factors for metabolic dysfunction associated steatotic liver disease (i.e., obesity or diabetes) may talk to their doctor about assessing for liver disease. Patients with cirrhosis (i.e., advanced liver disease) should undergo liver cancer screening using an abdominal ultrasound every six months.
DX: How does UT Southwestern’s multidisciplinary liver tumor clinic care for patients suffering with liver cancer?
Given the high burden of liver cancer in Texas, including Dallas, we created a multidisciplinary liver tumor clinic at the UT Southwestern Comprehensive Cancer Center. The clinic is aimed at providing high-quality, efficient care to patients with liver cancer or suspected liver cancer.
We have multiple specialists in the same “one-stop-shop” clinic, including transplant hepatology, medical oncology, surgeons, and interventional radiologists. Given the complexity of liver cancer treatment, with multiple treatment options for each stage, we have shown this multidisciplinary format significantly improves chance of cure, overall survival, and patient satisfaction.
DX: Is there anything else you would like to share with The Dallas Express readership?
Chronic liver disease is common among Americans, with many having metabolic dysfunction associated steatotic liver disease, viral hepatitis, or alcohol-associated liver disease. Unfortunately, many people do not find out until they become symptomatic. It’s important that people speak to their primary care doctor about assessing for chronic liver disease and starting treatment early to prevent it from getting to more advanced stages. By doing so, we can curb the high mortality related to liver disease and liver cancer in Texas. As Ben Franklin famously said, “An ounce of prevention is worth a pound of cure.”
For more information about liver cancer and where to get a screening, visit againstlivercancer.com.