Hepatocellular Carcinoma (HCC) is the most common form of liver cancer. This aggressive cancer is frequently diagnosed in individuals with advanced liver disease, such as cirrhosis. Understanding the factors that increase the likelihood of developing HCC is important for early detection and prevention strategies. The severity of HCC makes awareness of its risk factors a significant public health concern.
Chronic Viral Hepatitis
Chronic infections with certain viruses represent a significant cause of HCC. The hepatitis B virus (HBV) and hepatitis C virus (HCV) are primary contributors to liver damage that can lead to cancer. These viruses cause ongoing inflammation and injury to the liver over many years. Chronic HBV infection can lead to persistent liver inflammation and damage, which increases the risk of HCC. Globally, an estimated 254 million people were living with chronic hepatitis B infection in 2022, resulting in about 1.1 million deaths, mostly from cirrhosis and liver cancer. Vaccination against HBV is a widely available and effective way to prevent this infection and, consequently, reduce the risk of HBV-related HCC. Similarly, chronic HCV infection also leads to liver inflammation, which can progress to fibrosis and cirrhosis, substantially increasing HCC risk. While there is no vaccine for HCV, direct-acting antiviral (DAA) medications can cure over 95% of individuals with chronic HCV infection.
Metabolic and Lifestyle Factors
Beyond viral infections, several metabolic conditions and lifestyle choices contribute to the development of HCC. Non-alcoholic fatty liver disease (NAFLD), now often referred to as metabolic dysfunction-associated steatotic liver disease (MASLD), and its more severe form, non-alcoholic steatohepatitis (NASH), are increasingly recognized as causes of HCC. These conditions are frequently associated with obesity and type 2 diabetes. NAFLD/NASH can cause fat accumulation in the liver, leading to inflammation and cellular damage, which may progress to fibrosis, cirrhosis, and ultimately HCC, sometimes even without cirrhosis.
Obesity and type 2 diabetes play direct and indirect roles in increasing HCC risk. They contribute to insulin resistance and a proinflammatory state, which promotes liver damage. Excessive alcohol consumption is another significant lifestyle factor, leading to alcoholic liver disease and cirrhosis.
Other Contributing Factors
Several other distinct factors can contribute to HCC risk, independent of viral hepatitis or common metabolic conditions. Inherited metabolic diseases, such as Hemochromatosis and Alpha-1 Antitrypsin Deficiency, can damage the liver and elevate HCC risk. Hemochromatosis involves excessive iron accumulation in the body, particularly the liver, which can lead to cirrhosis and a significantly increased risk of HCC. Alpha-1 Antitrypsin Deficiency involves abnormal protein accumulation in liver cells, which can result in liver injury and, in some cases, cirrhosis and HCC.
Environmental toxins also pose a risk. Aflatoxins, which are toxic compounds produced by certain molds found on crops like peanuts and corn, are strongly linked to HCC. These toxins can cause DNA mutations in liver cells, initiating cancer development, particularly when combined with chronic hepatitis B infection. Smoking is also considered an independent risk factor for HCC. It can exacerbate existing liver diseases or exert direct carcinogenic effects on the liver, increasing overall HCC risk in a dose-dependent manner.
Reducing Your Risk
Taking proactive steps can help reduce the risk of developing HCC, particularly for individuals with existing risk factors.
- Vaccination against HBV is highly effective and widely recommended to prevent infection and subsequent HCC.
- For individuals with chronic viral hepatitis, regular screening is advised. This typically involves semi-annual ultrasound examinations, sometimes combined with alpha-fetoprotein (AFP) blood tests, to detect HCC at an early, more treatable stage.
- Maintaining a healthy lifestyle is also important. This includes maintaining a healthy weight through a balanced diet rich in fruits and vegetables, and engaging in regular physical activity.
- Limiting or avoiding excessive alcohol intake is also crucial to prevent alcoholic liver disease and cirrhosis.
- Managing underlying conditions such as type 2 diabetes is also important, as uncontrolled blood sugar can contribute to liver damage.
- Minimizing exposure to environmental toxins like aflatoxins, often found in moldy foods, is another preventative measure.
- Regular discussions with healthcare providers about individual risk factors and appropriate screening schedules can help tailor a personalized prevention plan.