Liver cirrhosis is responsible for 2.4% of deaths annually — about 2 million people. This is almost one-third of Singapore’s population! In fact, liver cirrhosis is one of the top ten most common causes of disease-related deaths, showing how dangerous this condition can be.
This is not surprising. Multiple problems including alcoholism, fatty liver diseases, viral hepatitis, and more can cause liver cirrhosis. It could even develop into liver cancer, bringing a new range of health complications.
However, not all hope is lost. With an early diagnosis, timely treatment, and a healthy lifestyle, liver cirrhosis can have a positive prognosis. Read on to find out more about what liver cirrhosis is, its relation to cancer, and what you can do to mitigate its effects.
Understanding Liver Cirrhosis
Liver cirrhosis is a condition where liver cells become damaged and are replaced by scar tissues. However, these scar tissues do not function normally. When there are more scar tissues than normal liver cells, the liver stops functioning, causing metabolic problems.
Liver cirrhosis is a progressive condition. During the compensated phase, the liver can still function normally, hence patients do not exhibit any symptoms. However, as scarring progresses, the liver function starts to decline, causing visible symptoms. This is also known as decompensated cirrhosis. This process is characterised into 4 stages:
Stage I: Steatosis
The bile duct or liver gets inflamed as the body fight against the disease or infection. This stage is the easiest to treat, though patients typically do not exhibit any visible symptoms.
Stage II: Fibrosis/Scarring
Scar tissues start to form around the liver, obstructing blood flow.
Stage III: Cirrhosis
Scar tissues have permanently replaced the good liver tissues. The effect at this stage is severe as the damage is no longer reversible, and liver function starts to deteriorate. Patients will experience symptoms like fatigue, diarrhoea, bleeding etc.
Stave IV: Liver Failure
Life-threatening stage where the liver has completely failed to function, and a liver transplant is required.
Risk Factors
Liver cirrhosis is influenced by both lifestyle and genetic factors:
Excessive alcohol consumption:
The liver is the main organ that helps to break down alcohol. Drinking too much alcohol may lead to fat buildup in the liver, which may progress to hepatitis (inflammation). As this continues, the liver tissues start to degrade, forming alcohol-related cirrhosis and even liver failure.
Chronic viral hepatitis:
Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) is one of the major causes of cirrhosis. As our body’s immune system attempts to fight off the virus, it also releases pro-inflammatory chemicals that can damage liver cells. Cirrhosis is a consequence of when the liver attempts to repair the damaged tissues by forming scar tissues over it. However, too much scar tissue will obstruct blood flow to the liver, affecting its function.
Fatty liver disease:
Caused by a myriad of factors such as alcoholism, obesity, diabetes and more, fatty liver disease can develop into steatohepatitis (inflammation), which increases the risk of developing into liver cirrhosis.
Autoimmune diseases:
Autoimmune diseases are when the immune system mistakenly attacks our body’s tissues. Certain diseases such as autoimmune hepatitis and primary biliary cirrhosis (PBC) induce inflammation and scarring in the liver and bile duct.
Metabolic disorders:
Certain inherited metabolic problems disrupt the balance in the GI tract, which leaves the liver more vulnerable to cirrhosis. For example, hereditary hemochromatosis is a condition where too much iron is absorbed and stored in the body, which can cause inflammation and oxidative stress, increasing the risk of liver damage and scarring.
Liver cirrhosis takes several years and even decades to develop, and most people do not experience any signs until the damage is already irreversible. At this stage, patients will experience various symptoms including:
- Fatigue
- Itchy and red skin
- Rectal bleeding
- Vomiting blood
- Diarrhoea
- Loss of appetite
- Easily bruised
- Jaundice (Yellow eyes and skin)
- Hepatic encephalopathy (cognitive impairment e.g. confusion, forgetfulness as the liver cannot eliminate toxins fast enough)
The symptoms of liver failure or cirrhosis can overlap with other health conditions. Hence, it is important to get an accurate diagnosis to ensure that you receive a targeted and effective treatment. The diagnosis process typically includes a thorough examination of your medical history, followed by a screening which involves imaging tests, blood tests, and biopsy (tissue extraction).
Can liver cirrhosis cause cancer?
People with cirrhosis have an increased risk of cancer, with the most common type being hepatocellular carcinoma (HCC), a type of liver cancer whereby the cancer cells begin in the liver cells. A cohort study in Taiwan found that patients with severe liver cirrhosis are significantly more likely to develop HCC than those without cirrhosis, or if their condition is still in the earlier stages. If anything, this supports the need for regular screenings to detect cirrhosis and other liver complications while they are still in the early and treatable phase.
Other non-hepatic cancers such as cholangiocarcinoma (bile duct cancer) and colon cancer, have also been found to be more prevalent in patients with liver cirrhosis. Some studies, though rare, had suggested that liver damage would upset reproductive hormone balance such as estrogen, which could contribute to menstrual irregularity and breast cancer.
The risk of cancer development varies depending on the cause of liver cirrhosis. It is found that hepatitis-related cirrhosis has a higher risk of causing cancer than alcohol-associated cirrhosis.
Various pathways connect liver cirrhosis to cancer, which makes it such a risky condition:
- Chronic inflammation: Liver cirrhosis is associated with persistent inflammation, which triggers cellular changes that can promote the growth of cancerous cells. Inflammatory chemicals like cytokines can also promote cancer cell growth and proliferation.
- Genetic mutations: In response to ongoing liver injury and tissue damage, the liver attempts to repair itself by regenerating new cells to replace the damaged tissues. This involves more cell division, which increases the likelihood of DNA mutations. This can cause cells to divide continuously, forming a cancerous tumour.
- Carcinogenic substances: Some of the factors that cause liver cirrhosis such as chronic alcohol consumption and smoking are carcinogens (cancer-causing agents). Continued exposure to these substances can further increase the risk of cancer development in individuals with cirrhosis.
The Importance of Early Detection and Prevention
Early detection facilitates early treatment. However, as liver cirrhosis is asymptomatic in its initial stages, this disease can remain undetected until it is too late. Hence, regular liver screening is important to detect the presence of any scarring or other risk factors like fatty liver or tumour growth while they are still easily manageable.
At Centre of Screening & Surgery, we provide a holistic liver screening involving imaging and blood tests to detect any abnormalities in the liver, such as excess fats, scarring, infection, and tumours. Imaging tests use ultrasounds, MRI, or CT scans to visualise the liver. Typically, a small tissue sample will be extracted to be assessed in the laboratory for any infections or other abnormalities.
Viral hepatitis tests and blood count tests are performed sometimes to confirm whether you have liver hepatitis or other types of infection. Blood tests are conducted to check for abnormal levels of proteins or waste products indicative of liver dysfunction. Some proteins that we look out for include:
- Alanine transaminase: An enzyme in the liver that converts proteins to energy. If the liver is damaged, the enzymes would be released into the bloodstream, and the levels will be elevated
- Bilirubin: It is a product formed when red blood cells break down and excrete via the liver. A high bilirubin level meant that the liver failed to excrete bilirubin, indicating liver damage.
- Alpha-fetoprotein (AFP): It is usually in low amounts among healthy adults. An elevated level of AFP is a tumour marker for liver cancer.
Prevention and Treatment Options
While some causes of liver cirrhosis are genetically related, keeping a healthy lifestyle will minimise the risk of alcohol or metabolic-related liver cirrhosis, in turn lowering the chances of developing liver cancer. Minimise your alcohol intake to 2 drinks per day for men and 1 for women. Keep a well-balanced diet rich in fibre and proteins. With obesity being a risk factor for fatty liver disease and liver cirrhosis, weight management goes a long way towards building longevity. Try to get at least 150 minutes of moderate exercise per week. If you are busy, find ways to incorporate movement into your daily lifestyle. For example, take the stairs instead of the lift, or walk instead of taking the bus to hit that daily 10k steps.
As the effects of liver cirrhosis are irreversible, there is no cure. Nonetheless, there are other treatment options tailored to the specific cause of liver cirrhosis to slow down the damage. Medications are provided to reduce the swelling or bleeding caused by liver cirrhosis. For cirrhosis caused by viral hepatitis B and C infection, antiviral therapies can stop the virus from spreading.
In the case where liver cirrhosis had worsened to liver cancer, targeted therapies like chemotherapy and immunotherapy are the first line of treatment to shrink the tumour. In severe cases, surgical resection may be performed to remove a section of the liver affected by cirrhosis or cancer. A liver transplant is typically the last resort when liver cirrhosis is in its most severe stage, and the liver can no longer function properly.
Conclusion
Liver cirrhosis is the body’s response to various health problems like viral infection, obesity, alcoholism, and fatty liver disease by forming scar tissues. If left untreated, the liver will eventually harden and stop functioning. Consequently, the inflammation and constant regeneration of liver cells increase the risk of liver cancer, which can be life-threatening.
As liver cirrhosis is irreversible, it is best to protect yourself from developing it altogether. Maintaining a healthy lifestyle through a good diet and regular exercise is one of the most effective ways of building a strong body resistant to health complications.
Protect Your Health Today
If you suspect that you may have liver cirrhosis, feel free to visit us at the Centre for Screening and Surgery. Our clinic specializes in cancer screening and treatments of cancers at an early stage with minimally invasive procedures. Call us to book an appointment today!
