Adult primary liver cancer originates in the liver. There are two types of liver cancer. These are hepatocellular carcinoma and cholangiocarcinoma, which affects the liver’s bile duct. According to the National Cancer Institute, hepatocellular carcinoma is the most commonly diagnosed type of liver cancer.

There are many risk factors that increase a person’s chance of developing hepatocellular carcinoma. Long-term infection with hepatitis B or hepatitis C viruses increases a person’s risk. Infection with both hepatitis B and hepatitis C viruses causes an exponential increase in the chance of getting liver cancer, according to the National Cancer Institute. Cirrhosis caused by excessive alcohol consumption also increases the risk of liver cancer. Some additional risk factors include having metabolic syndrome, diabetes or experiencing a severe injury to the liver. Consuming foods tainted with aflatoxin is a risk factor affecting a small number of liver cancer patients.

Causes of Liver Cancer

Cancer of the liver results from DNA damage that causes cellular mutations and overgrowth of cells. The cells develop into a mass called a tumor. Multiple tumors may develop on the liver. The Mayo Clinic explains that if a person is infected with hepatitis B virus or hepatitis C virus, this is typically the cause of the patient’s cancer. Excessive alcohol consumption also causes DNA mutations that may lead to liver cancer. Cirrhosis, or scarring of the liver, causes permanent damage to liver cells and their DNA.

Overindulgence of alcohol is the leading cause of cirrhosis of the liver. Overindulgence of alcoholic drinks is a common practice during the holiday season. For many people, consumption of alcohol is a holiday tradition, but the amount consumed could get out of hand. Drinking more than three drinks per day for women or four drinks per day for men is considered excessive alcohol consumption. Alcoholic holiday drinks such as eggnog with rum, wine, or liquor are popular parts of the seasonal celebrations. Some people may turn to alcoholic drinks as a way of coping with holiday stress. A person might drink to excess on one or more days during the holiday season in order to try to cope with problematic family relationships, financial problems, and other types of holiday stress. Just a couple of weeks of overindulgence of alcohol consumption may be enough to trigger the early stages of liver cirrhosis.

Signs and Symptoms of Liver Cancer

Although the liver is a large organ about the size and shape of a football, the Mayo Clinic states that many people do not notice signs or symptoms of liver cancer until the disease has advanced. Some of the early signs of primary liver cancer include loss of appetite and losing weight without trying. Nausea and vomiting are also some early symptoms of primary liver cancer. Many people experience fatigue and general weakness, which could be related to the lack of nutrients as well as the growth of the cancer.

Additional early symptoms include:

  1. Easy bruising
  2. Easy bleeding
  3. Persistent low-grade fever
  4. Pain between the shoulder blades
  5. Feeling full after eating a small meal
  6. A hard lump on the right side, just underneath the ribs

As the tumor or tumors grow, they may cause upper abdominal pain around the right and center parts of the abdomen. This is because the tumors put pressure on other organs in the abdomen. Continued growth of the tumors and damage to the liver often leads to jaundice. The person may develop yellowing of the sclera of the eyes and yellowing of the skin. Urine may turn brown while stools turn a chalky white color. At this stage, the abdomen is often swollen, distended and painful.

Fatty Liver Disease, Diabetes and Risk of Liver Cancer

Several research studies have found an association between type 2 diabetes and liver cancer.

In a study published in 2012 by the University of Rochester Medical Center, scientists found that the presence of diabetes was associated with a more invasive form of liver cancer. In the study, 33 percent of the 265 primary liver cancer patients with diabetes had liver cancer that had already spread to distant organs at the time of their diagnosis. Only 9.7 percent of the patients without diabetes had liver cancer that had already metastasized.

Patients who had to use insulin to control their diabetes had higher rates of liver cancer metastasis compared to those who were able to control their diabetes with oral medications or dietary changes. Patients with diabetes also had their liver cancers diagnosed at a later stage of the disease compared to people who did not have diabetes. The liver is responsible for the regulation of sugar metabolism, and diabetes may cause damage and overworking of the liver.

Diabetes is also associated with fatty liver disease. In a 2017 study published in the Annals of Translational Medicine, researchers Mantovani and Targher discovered that the liver inflammation caused by type 2 diabetes promoted fat buildup in liver cells. Fatty liver disease is related to oxidative stress on the liver cells. This oxidative stress damages the DNA of liver cells, leading to mutations that may trigger the start of a cancer. People with type 2 diabetes develop more severe non-alcoholic fatty liver disease compared to people without diabetes. Fatty liver disease is associated with insulin resistance. The resistance to insulin boosts the growth of liver cells, which may also be a trigger to the development of cancer. Fatty liver disease alone is a risk factor for liver cancer. Mantovani and Targher’s study demonstrated that the co-existence of diabetes more than doubles the person’s risk of developing liver cancer.

In Mantovani and Targher’s study, patients who controlled their diabetes with metformin had a lower risk of hepatocellular carcinoma. With the rate of type 2 diabetes doubling in the United States in the past 20 years, there could be a corresponding increase in the rates of hepatocellular carcinoma. The researchers at the University of Rochester Medical Center noted that diabetes may now be the most common risk factor in the development of hepatocellular carcinoma in the United States. When liver cancer is diagnosed after it has spread to other organs, survival rates are low. Of the 265 patients followed by the University of Rochester Medical Center in their study, 237 died within six and one-half months. These studies show that treating diabetes may improve outcomes in people with primary liver cancer. Additional research is needed in order to learn more about the direct causative relationships between diabetes, alcohol overindulgence during the holidays, fatty liver disease and primary cancer of the liver.