With high rates of obesity, diabetes and high cholesterol, it's no surprise that more Kentuckians also have fatty liver disease, also known as nonalcoholic fatty liver disease, which occurs when fat is deposited in the liver of people who do not drink alcohol excessively.
While most patients with fatty liver disease do not experience symptoms, it can lead to much larger health problems, such as non-alcoholic steatohepatitis (NASH). This is a liver inflammation caused by the buildup of fat in the liver from fatty liver disease. The inflammation then can lead to the formation of scar tissue within the liver that can cause cirrhosis. Cirrhosis can progress to liver failure and some individuals may develop a type of cancer known as hepatocellular carcinoma.
While we don't know why some people with a buildup of fat in the liver develop the inflammation that occurs in NASH and some don't, we do know the factors that contribute to this condition — obesity, diabetes, high cholesterol, high triglycerides and metabolic syndrome.
While there is no specific treatment for NASH, damage to the liver can be limited by managing conditions that increase the risk for the disease or make it worse. For example: reducing cholesterol, properly managing diabetes, maintaining a healthy weight, and exercising regularly.
HCC is the most common type of primary (non-metastatic) liver cancer, and the incidence of HCC is rising along with the increasing incidence of NASH. Screening for HCC is usually done using ultrasound. If irregularities are found in the liver, a CT scan or MRI is used for further diagnosis.
In most cases, the pictures obtained from a CT or MRI can prevent the need to biopsy any abnormalities that may have been seen on the ultrasound. There are times, though, that a biopsy might be necessary. Sometimes, however, a biopsy that does not diagnose cancer is incorrect and the biopsy needle has simply "missed" the abnormality. In this situation, it is very important to have a follow up CT/MRI 3-6 months after the biopsy. There is also a blood test for alpha-fetoprotein which can be abnormally high in patients with HCC. However, a normal alpha-fetoprotein reading does not necessarily mean that HCC is not present but a very high level may indicate HCC.
There are many treatment options for HCC. Common options include: transcatheter arterial chemoembolization, a minimally invasive procedure that restricts a tumor's blood supply and administers chemotherapy directly into the tumor; radiofrequency ablation, which uses high-energy radio waves to heat and destroy cancerous cells; partial surgical removal of a portion of the liver and liver transplantation.
In order for liver transplant to be an option, there are strict criteria for the number and size of the tumor(s). In some cases, a patient may be told that the tumors are too large or there are too many tumors and that transplant is not an option. However, tumors can sometimes be treated by therapies listed above, and if the size/number of the tumors then meet the criteria, liver transplantation may then become an option.
Symptoms of liver cancer usually do not show up until the disease is in an advanced stage and as with many cancers, early detection can impact treatment options.
The best defense against liver disease is a healthy lifestyle. However, if you have NASH or other liver diseases, such as hepatitis B or C, or alcoholic liver disease, it is important to talk with your doctor about twice yearly ultrasound and alpha-fetoprotein examinations to examine the liver and allow for early detection and treatment of any liver tumors.
Dr. Michael Marvin, is chief of the Division of Transplantation and Director of Liver Transplantation at Jewish Hospital, part of KentuckyOne Health