Hepatitis and Liver Cancer

Viral Hepatitis

Hepatitis can be defined as the inflammation of the liver. Viruses are the most common cause of hepatitis. Viral hepatitis is recognized as the usual cause of liver cancer. There are 5 different viruses that can cause hepatitis. Hepatitis A and Hepatitis E are spread through human waste, contaminated water, and food. Hepatitis B, Hepatitis C, and Hepatitis D are spread through an infected individual’s body fluids or blood. Vaccines have the potential to protect against Hepatitis A and Hepatitis B. However, no vaccines are available for Hepatitis C, Hepatitis D, and Hepatitis E.

In the United States, an estimated 3.5 million people are living with the hepatitis C virus; and approximately 850,000 people are living with the hepatitis B virus.  Many people are unaware of their infection due to few noticeable symptoms. Hepatitis B and hepatitis C are serious illnesses that disproportionately affect some populations more than others and cause potentially devastating consequences, including liver failure and liver cancer, if left untreated.

Hepatitis C

Hepatitis C is a condition characterized by inflammation of the liver, resulting from infection with the hepatitis C virus (HCV). Hepatitis C is primarily spread through contact with the blood of an infected person, sharing needles or other drug-injecting equipment. Though less common, HCV can also be spread through having sexual contact with an infected person, sharing personal care items – such as toothbrushes and razors – that may have come into contact with the blood of an infected individual, or being born to a mother with hepatitis C. It is well established that infection with HCV can increase a person’s risk of liver cancer. The CDC states that 1-5 in every 100 people with HCV die from liver cirrhosis (scarring of the liver tissue) or liver cancer.

It is very important to know that people with hepatitis B have an increased risk of liver cancer. Unlike hepatitis C, people with hepatitis B are at risk for liver cancer even if they do not have cirrhosis.

Liver Cancer

There are two categories of liver cancer—primary and secondary. Primary refers to cancer that starts in the liver. The most common primary liver cancer in adults is Hepatocellular Carcinoma (HCC), sometimes called hepatoma. Hepatitis B causes 60-80% of primary liver cancer cases worldwide. Secondary or Metastatic Cancer, occurs when cancer starts in another part of the body and spreads to the liver.

Risk Factors for Liver Cancer

The majority of HCC occurs in people with risk factors. The more the risk factors, the greater the chances are for developing liver cancer. Anything that leads to cirrhosis is a liver cancer risk. Cirrhosis is linked to more than 80 per cent of all HCC. Some risk factors for HCC include:

  • Viral hepatitis (especially chronic hepatitis B)
  • Age (greater than 60 years old),
  • Male sex,
  • Long-term, heavy alcohol consumption,
  • Family history of liver cancer,
  • Tobacco use, and heavy smoking,
  • Obesity, poor diet, and inadequate exercise,
  • Diabetes
  • Use of anabolic steroids or male hormones
  • Certain inherited diseases, such as hemochromatosis (excess iron storage), and
  • Exposure to certain industrial chemicals

Signs and Symptoms

One of the reasons that liver cancer is particularly life-threatening is because signs and symptoms often do not appear until it is in its later stages. Symptoms of liver cancer include:

  • Pain or discomfort in the upper right side of the abdomen,
  • Lump on right side or heavy feeling in abdomen,
  • Pain in the back or right shoulder,
  • Appetite loss or feeling extremely full after a small meal,
  • Unexplained weight loss,
  • Bloated or swollen belly,
  • Unexplained fatigue or weakness,
  • Itching,
  • Fever,
  • Nausea or vomiting,
  • Jaundice (yellow skin and eyes),
  • Dark tea-colored urine,
  • Pale, clay-colored stools,
  • Tremors, confusion, disorientation,
  • Enlarged veins on the belly that can be seen through the skin,
  • Abnormal bruising or bleeding,
  • Breast enlargement (gynecomastia) and/or shrinkage of the testicles in men, and
  • Low blood sugar levels (hypoglycemia).

Diagnosis and Screening

The diagnosis of primary cancer of the liver is made by liver imaging tests that include CT scan and abdominal ultrasound with the combination of measurement of alpha-fetoprotein and blood vessels. However, the final diagnosis is made by the biopsy needle. Experts recommend regular liver cancer screening for all people who have chronic hepatitis B infection. Typically this entails regular blood tests every 6 months along with an annual ultrasound exam. Early detection and treatment of liver cancer can prevent further damage, which will increase the probability of long-term survival.

Treating Liver Cancer

There are a number of treatment options, including ablation, chemotherapy, embolization, immunotherapy, liver transplantation, radiation, surgery, and targeted therapy.






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