Liver Cancer Risk Factors and Screening

The exact cause of liver cancer is not known, but several factors may increase the risk of developing the disease. Since there are no standard or routine screening tests for liver cancer, it's important to talk with your doctor if you have a family history of the disease or other known risk factors. If you have an elevated risk of developing liver cancer, there may be certain tests available to help identify it at an early stage, when it’s most treatable. 

Common Risk Factors for Developing Liver Cancer

Many risk factors have been associated with liver cancer. Some risk factors can be controlled, while others cannot. Not everyone with one or more of these risk factors will develop the disease, and the disease will develop in some people who don’t have any known risk factors. 

Risk factors that are out of your control

  • Cirrhosis: Cirrhosis is a condition that affects the liver and is often caused by damage to the tissues of the liver. The damaged tissues are replaced by scar tissue which reduces the ability of the liver to function correctly. The most frequent cause of cirrhosis is alcoholism or alcohol abuse. However, cirrhosis can also be caused by liver disease, hepatitis (B and C), or iron levels that are too high (hemochromatosis).
  • Hepatitis B or C: Viral hepatitis directly affects the liver and is the leading global risk factor for developing liver cancer. In addition to a personal history of hepatitis, having a close relative with both hepatitis B and liver cancer can influence your risk.
  • Gender: While liver cancer can develop in men and women, men are at a higher risk of developing liver cancer.
  • Age: Once people reach 60 years of age, they are at increased risk of developing liver cancer.
  • Race: Asian Americans and Pacific Islanders are more likely to develop liver cancer than those of other races.
  • Other conditions: Type 2 diabetes and hereditary hemochromatosis have been linked to an increased risk of liver cancer. 

Risk factors that can be controlled

  • Obesity: General obesity can cause the liver to be covered in additional fat deposits. These deposits can lead to non-alcoholic fatty liver disease. Obesity is also closely linked with diabetes. Recent research strongly suggests that these two conditions are closely related to increases in the risk of liver cancer.
  • Heavy alcohol use: Heavy alcohol use can cause cirrhosis, which is a risk factor for liver cancer. Liver cancer can also occur in heavy alcohol users who do not have cirrhosis.
  • Smoking: Cigarette smoking has been linked to a higher risk of liver cancer. The risk increases with the number of cigarettes smoked per day and the number of years the person has smoked.
  • Aflatoxin B1: Eating foods tainted with aflatoxin, a poison from a fungus that can grow on improperly stored grains and nuts, is linked to an increased risk of liver cancer.
  • Anabolic steroid use: Long-term use of anabolic steroids, male hormones used by some athletes to increase strength and muscle mass, can slightly increase the risk of liver cancer. Anabolic steroids are different from cortisone-like steroids, which do not carry the same risk.
  • Chemical exposure: Being exposed to vinyl chloride and thorium dioxide (Thorotrast) raises the liver cancer risk.

The risks associated with each of these factors are a cumulative issue. That means that the more of these factors an individual has, the more likely they will develop liver cancer. Talk to your primary care provider about whether you should start a liver screening program if you have any of the above-listed risk factors. Your doctor can also offer suggestions to help you lower your risk.

Liver Cancer Screening for High Risk Patients

Liver cancer screenings are medical tests and evaluations that determine if cancer is present, even if you don’t have symptoms. Most health insurance plans will cover liver cancer screening if your medical history indicates that you’re at an elevated risk. If you have one or more liver cancer risk factors, it’s important to talk to your doctor about liver cancer screening. Together, you can develop a plan to see if you need to be screened regularly for liver cancer. 

When you enter into a screening plan for liver cancer, there are several different methods that your doctor can use, and in some cases, they may use more than one. The most common are:

  • Physical Exam: A physical exam will include a general physical to see how your health is doing in general. Your doctor will palpate or feel your abdomen for lumps, swelling, or other changes in the liver or nearby organs.
  • Blood Test: There is a blood test that can be used to detect higher levels of AFP, a substance that is found in 50-70% of people who have a common type of liver cancer called hepatocellular carcinoma. This is the most common type of liver cancer in the United States. When elevated AFP levels are found, it warrants a look further to determine if there is cancer present, or perhaps another condition such as hepatitis B or C. 

If further testing is needed after the initial exam and blood test, the doctor may order one or more of the following: 

  • Ultrasound: An ultrasound produces an image based on bouncing waves on structures in your body. The ultrasound can look at the organs and potentially identify any tumors or masses on the liver. 
  • CT Scan: This approach creates a higher quality 3-D image that doctors can use to look closely at the liver and other organs to see if any abnormalities require further investigation. 
  • Biopsy: A biopsy evaluates the tissue collected from the suspected cancerous area to determine whether cancerous cells are present. An exploratory laparoscopic surgery is a common biopsy approach to screen for liver cancer. This method involves making small incisions and using specialized equipment to examine the body internally. Surgeons can directly view potentially cancerous tissues during this procedure and collect samples for further analysis.

Understanding the Goals of Liver Cancer Screening

Liver cancer screenings are set at periodic intervals throughout an individual’s life. You may be screened more or less frequently based on the presence or absence of specific risk factors. In individuals that have higher levels of risk for liver cancer, they’ll likely be screened more often. 

Cancer screenings have two main objectives:

  1. To lower the number of individuals who die from liver cancer. 
  2. To reduce the number of people who develop liver cancer.

The screenings help to achieve these goals by detecting cancer as soon as possible. Early detection is one of the most significant factors in the successful treatment of cancer. This approach helps to find cancer when it is smaller, before it has spread, and potentially before it causes significant adverse effects to the body. 

Early detection gives your cancer treatment a broader range of treatment options. When oncologists can treat cancer with less invasive options, at an earlier stage, patients have a shorter recovery time with a higher chance of complete removal of the cancer cells.

How to Start Liver Cancer Screening

If you believe that you may be at a higher risk of liver cancer, talk to your primary care doctor about receiving liver cancer screening. Screening tests with abnormal results will require further testing to make an official diagnosis of liver cancer. Running diagnostic tests and evaluating the results is the first step in determining the need for a liver cancer treatment plan.