Fatty liver disease and the link to liver cancer

Liver Cancer Tumor

Fatty liver disease (FLD), otherwise known as steatosis, is an accumulation of fat in liver cells. FLD is on the rise, particularly among middle-aged Americans. This year, more than three million new cases of FLD will be diagnosed in the United States alone.

If FLD progresses to cirrhosis, then the risk of Hepatocellular cancer is high. In fact, NASH (Nonalcoholic Steatohepatitis) is a condition of FLD with significant inflammation leading to possible cirrhosis. NASH is projected to become the leading cause of hepatocellular carcinoma (HCC) in many countries.

What causes fatty liver disease?

The liver is a central detoxification organ, filtering harmful substances from the blood. Excessive alcohol consumption and overuse of drugs, including so-called "harmless" ones — such as over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen — can reduce liver function and damage liver tissue. Any damage to the liver that builds up over time can lead to fatty changes, and a buildup of fat inside liver cells can potentially lead to inflammation (hepatitis) and scarring (fibrosis).

Like many health conditions, FLD is caused by a combination of genetic and lifestyle factors. Possible causes include excessive weight gain, physical inactivity, uncontrolled blood sugar, and a diet high in sugar and fat.

Current studies estimate that 75% to 90% of adults with obesity or diabetes also have a fatty liver. FLD is also common among patients with metabolic syndrome, a cluster of conditions including high blood sugar, excess body fat (particularly around the waist), increased blood pressure, and high blood cholesterol or triglyceride levels.

Fatty liver symptoms

Most of the time, FLD does not cause any symptoms. If you do experience symptoms, they will likely be vague and nonspecific, such as fatigue or right-sided abdominal discomfort. Most often, FLD is discovered incidentally, such as during imaging done for a suspected gallstone.

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Link between FLD and liver cancer

Although FLD is usually a benign condition, it’s a clear sign that your liver is hurting. Over time, liver inflammation can lead to cirrhosis or liver failure. Steatohepatitis and cirrhosis are risk factors for hepatocellular carcinoma, the most common form of liver cancer.

We don’t yet know why some patients with FLD will develop liver cancer while others will not, but we do know that obesity, metabolic syndrome, diabetes and hepatitis can increase the risk that fatty changes in the liver will lead to the development of liver cancer, especially if these conditions develop at a younger age.

As FLD and its associated conditions become more common, it is possible that FLD might someday replace viral hepatitis as the leading cause of cirrhosis, the biggest risk factor for liver cancer.

Fatty liver treatment

The liver is a resilient organ with the ability to reverse fatty changes and replace severely damaged cells with new, healthy ones. Therefore, mild cases of FLD can be improved with healthy lifestyle changes, such as eating a healthy and well-balanced diet, losing weight, limiting or avoiding alcohol, and participating in a regular exercise program.

Choices for pharmacologic, liver-targeted therapy to treat the fatty inflammation of FLD are limited but there is a lot of research ongoing to develop options.

The best defense against any liver problem is a healthy lifestyle. If you think you are at risk for FLD, talk to your doctor about the steps you can take to protect your liver.