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Fatty liver diseases have been becoming more prevalent, especially amongst those who suffer from obesity and type 2 diabetes, among other metabolic disorders. Although the presence of excess fat within the liver does not imply the development of cancer in a person, in some individuals, continuous injury within the liver leads to inflammation and scar formation, ultimately resulting in the likelihood of developing liver cancer such as HCC. This happens because fatty liver diseases are usually silent for several years before causing harm.
Fatty Liver Starts With The Accumulation Of Fats
Fat accumulation occurs excessively during this initial stage of fatty liver. It is now being described as metabolic dysfunction associated with steatotic liver disease (MASLD). It is extremely prevalent in patients having metabolic problems such as obesity, diabetes, and elevated blood cholesterol levels.
Not all fatty liver sufferers suffer from any liver complications. However, the occurrence of metabolic disorders could result in stressing and damaging the liver.
From Fatty To Inflammatory
In certain individuals, fat accumulation is followed by inflammation and destruction of the liver cells. This disorder is referred to as steatohepatitis associated with metabolic dysfunction (MASH).
The worry now is not only the fat, but rather the inflammation and the cell injury that results. The constant cycle of cell damage and regeneration leads to changes in the structure of the liver.
Fibrosis: The Liver Starts Scarring
When there is ongoing damage to the liver, fibrosis, which means scarring, may occur. With more and more fibrosis occurring, the health of the liver starts declining, and its structure may start changing.
It is important to note that fibrosis doesn't mean that there is cancer. It means that the condition of liver disease is riskier.
Cirrhosis And Liver Cancer Risk
When extensive scarring develops, the condition can progress to cirrhosis, in which the normal structure of the liver becomes significantly distorted. Cirrhosis is an important risk factor for hepatocellular carcinoma.
However, liver cancer does not occur exclusively in people with cirrhosis. HCC can also develop in some individuals with fatty liver disease without established cirrhosis. This makes individual risk assessment important rather than assuming that the absence of cirrhosis means there is no risk.
The New Trend: Identification Of Liver Fibrosis Before Development Of Cirrhosis
Among the latest trends in hepatology, it is necessary to keep track of the development of technologies for the timely and non-invasive diagnosis of liver fibrosis rather than cirrhosis, which implies that more symptoms can develop.
It becomes possible to start the risk assessment with the help of regularly collected data and blood tests using the FIB-4 index, taking into account age, liver enzymes, as well as platelets. The next step involves conducting additional non-invasive tests, including the examination of the stiffness of the liver by means of elastography. AASLD underlines that the systematic approach to the identification of liver fibrosis should be used with respect to individuals with metabolic risk factors, such as obesity and type 2 diabetes.
The importance of the trend lies in the fact that its purpose is to diagnose the patient before the development of fibrosis or cirrhosis.
Who Is At Increased Risk?
The vast majority of patients with fatty liver do not have any chance of developing liver cancer. Nonetheless, the risk is significantly increased if fatty liver is combined with type 2 diabetes, obesity, advanced age, and liver fibrosis.
Hence, metabolism should definitely be taken into account while analysing the fatty liver behaviour.
When Should Tests Be Conducted?
There may be instances when fatty liver disease or other liver diseases have no symptoms. People with metabolic risk factors and elevated liver enzymes need to talk to their doctors about their liver function.
Based on the patient's risks, the doctor may conduct certain tests on their blood, imaging, and liver fibrosis. However, not all patients with fatty liver need liver cancer screening. There are specific criteria that indicate the need for such screening.
Not every case of development of HCC through the stages of fatty liver is inevitable. There are some cases where there is metabolic stress to such an extent that a person passes through various stages like fat accumulation, inflammation, fibrosis, cirrhosis, thereby increasing the chances of developing HCC.
Contemporary hepatology requires early and personalised risk assessment. No need for the manifestation of symptoms in order to determine the presence of fibrosis using non-invasive measures, so that doctors can figure out who needs to be targeted.
If patients have fatty liver disease, high liver enzyme levels, diabetes, obesity, or any other condition that affects the function of your liver, then they should make sure to talk to their doctor regarding fibrosis of the liver.
(By Dr Hemalatha V, Consultant Medical Oncologist, HCG Cancer Hospitals, Dr Road, Bengaluru)
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