Assoc. Prof. Dr. Wolfgang Sieghart is a specialist in internal medicine, gastroenterology, and hepatology at Wiener Privatklinik. In my practice, I often encounter cases of liver cancer where fatty liver disease plays a significant role.
What type of cancer is associated with fatty liver?
Liver cancer, specifically hepatocellular carcinoma (HCC), is a form of malignancy that often develops against the backdrop of fatty liver disease, especially when it progresses to inflammation and fibrosis. Although non-alcoholic steatohepatitis (NASH) does not always lead to cancer, it is one of the significant risk factors.
How common is HCC and in whom is it most often observed?
This is the fifth most common cancer worldwide, but its incidence is significantly higher in Africa and Asia than in Europe or the US. The disease primarily affects men, often progresses without symptoms in its early stages, and is incidentally detected during routine check-ups.
How is the disease manifested and detected?
It is typically identified as a liver lesion, spotted during a routine ultrasound. CT or MRI with contrast is used for confirmation. The tumor is characterized by initially avidly absorbing contrast, followed by rapid elimination – behavior typical of HCC.
What symptoms can occur?
In advanced stages, cancer can cause:
- Significant weight loss
- Fatigue and lack of appetite
- Symptoms of decompensated cirrhosis, including ascites and variceal bleeding
What are the main risk factors?
The risk of developing HCC increases with chronic liver damage, regardless of the cause. The main factors include:
- Chronic viral hepatitis B or C
- Prolonged alcohol consumption
- Fatty liver disease, especially in the presence of fibrosis or cirrhosis
Fibrosis is classified into 4 stages (F1–F4). In stages F3 and F4, the risk of carcinoma increases significantly; in cirrhosis (F4), it is estimated at 0.5–3% per year.
How is the diagnosis made?
In patients with cirrhosis, contrast-enhanced CT or MRI imaging is often sufficient. If the imaging is inconclusive or cirrhosis is absent, a biopsy is necessary, followed by histological analysis of the tumor tissue.
What are the treatment options?
The choice of therapy depends on:
- Tumor stage
- The function of the liver
- The patient's general health condition
In the early stages, the following can be applied:
- Surgical resection
- Liver transplantation
- Radiofrequency ablation
During intermediate stages, the following is used:
- Transarterial chemoembolization (TACE)
For advanced cases – systemic drug therapy.
All decisions are made within a multidisciplinary team to determine the most appropriate course of action.
Is there a risk of recurrence?
Yes, and he is not to be underestimated:
- After resection or ablation: approximately 80% risk of recurrence within 5 years
- In liver transplantation: the risk drops to approximately 20% (if the strict transplantation criteria are met)
Early recurrences are usually a result of a metastatic process, while late ones are associated with the appearance of a new tumor in the liver tissue already damaged by cirrhosis.
