Cirrhosis and Primary Liver Cancer: How Chronic Liver Damage Increases Cancer Risk

The liver plays an important role in the body by filtering toxins, metabolizing nutrients, and supporting many bodily functions, but it is vulnerable to damage from a variety of sources. Cirrhosis, a condition in which the liver is scarred due to long-term damage, can compromise liver function and potentially increase the risk of primary liver cancer. Primary liver cancer refers to cancer that starts in the liver. While there are several types of liver cancer, including bile duct cancer and secondary liver cancer, this article is mainly about the most common type of liver cancer, hepatocellular carcinoma (HCC).

Understanding the connection between cirrhosis and liver cancer is crucial, as early detection and lifestyle changes can significantly impact outcomes.

Cirrhosis refers to the permanent scarring of the liver due to damage and injuries sustained to it. Each time the liver is damaged, it tries to repair itself. However, if the liver is exposed to consistent damage, whether by chronic infections or another cause, more scar tissue forms and impedes liver function. As such, advanced cirrhosis can be life-threatening, as the liver is unable to function normally, if at all. Unfortunately, cirrhosis and the liver damage it causes cannot be undone without a liver transplant. However, it can take many years of liver damage to lead to cirrhosis. As such, if diagnosed early, the underlying cause may be treated and the damage may be limited.

There are several main causes of cirrhosis.

Chronic alcoholism

Consumption of alcohol causes the liver to swell. Prolonged and excessive consumption of alcohol over time can lead to cirrhosis.

Chronic viral hepatitis

Chronic viral hepatitis infections, especially hepatitis C, can cause cirrhosis. In fact, hepatitis C is one of the leading causes of cirrhosis in the United States. It causes the liver to swell, which can lead to cirrhosis over time. Hepatitis B and hepatitis D can also lead to cirrhosis.

Metabolic dysfunction-associated steatohepatitis (MASH)

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), refers to the condition where there is fat accumulation in the liver, not caused by alcohol use. Over time, MASLD can progress to MASH, which causes the liver to swell and can cause cirrhosis over time.

Bile duct diseases or blockages

The liver produces a solution that helps digest fats and eliminate waste products called bile, and bile ducts carry bile from the liver to the small intestine. When bile ducts get blocked or damaged, bile can back up into the liver, causing damage to the liver cells and may cause cirrhosis over time. Blocked bile ducts are most commonly caused by gallstones.

Bile duct diseases that can damage the liver include:

• Primary sclerosing cholangitis
  This condition causes inflammation in the bile duct walls of the bile ducts, both inside and outside of the liver, which can narrow and scar the walls. This may eventually lead to cirrhosis.
• Primary biliary cholangitis (previously known as primary biliary cirrhosis)
  This condition is a chronic autoimmune disease in which the bile ducts within the liver are inflamed and damaged over time, which can lead to cirrhosis. 

Genetic diseases

Genetic diseases that may increase the risk of cirrhosis include:

• Wilson disease
• Hemochromatosis
• Glycogen storage diseases
• Alpha-1 antitrypsin deficiency
• Autoimmune hepatitis

Cirrhosis generally does not cause any symptoms in its early stage. However, it may start to present some symptoms as it progresses. Symptoms include:

• Nausea and vomiting
• Unintended weight loss
• Abdominal pain
• Tiredness
• Loss of appetite
• Severe itching
• Muscle loss and weakness
• Muscle cramps
• Jaundice
• Bruising and bleeding easily
• Painful swelling of the legs (edema) and abdomen (ascites)
• Confusion, drowsiness or slurred speech

Do note that having any of these symptoms does not necessarily mean you have cirrhosis. However, any unexplained symptoms should be checked by a healthcare professional as soon as possible.

Yes, liver cancer is a potential complication of cirrhosis. 80% to 90% of individuals with HCC have cirrhosis. However, it is important to note that a cirrhosis diagnosis isn’t a cancer diagnosis. Though cirrhosis and liver cancer have a strong relationship, not everyone who has cirrhosis will have liver cancer.

Here are some ways to maintain liver health:

• Maintaining a healthy lifestyle, including a healthy diet and regular exercise
• Limiting or removing alcohol consumption
• Practicing safe sex
• Using clean needles for tattoos or piercings
• Avoiding sharing needles, razors or other personal items with others
• Limiting salt intake
• Getting hepatitis A and hepatitis B vaccinations
• Avoiding consumption of raw shellfish

While these methods can help in reducing the risk of cirrhosis, they do not guarantee it, especially if you have certain genetic or health predispositions.

Treatment for cirrhosis will heavily depend on the severity of cirrhosis and the level of liver damage. Medications and lifestyle changes may be recommended when the causes and complications are treatable or for less severe cases. However, the main intention for treatment for less severe cirrhosis is to prevent further damage, alleviate symptoms and prevent complications. More severe cases of cirrhosis, or end-stage liver disease, would require a liver transplant, as they cannot be managed through medication.

Cirrhosis is not only a debilitating liver condition but also a significant risk factor for primary liver cancer. Recognizing the early signs of liver damage and seeking prompt medical care is essential for managing cirrhosis and reducing the risk of liver cancer. If you have cirrhosis, making lifestyle changes, such as limiting alcohol consumption, maintaining a healthy diet, and managing hepatitis infections, as well as going for regular screenings and medical monitoring, are crucial for early detection and improved outcomes. Being proactive in taking these steps can reduce your liver cancer risk and improve your overall liver health.