Alcohol and Liver Cancer Risk
- Excessive drinking harms the liver and can make the organ swollen and scarred, increasing liver cancer risk.
- Heavy alcohol use is defined by daily and weekly consumption limits. According to the U.S. government’s Dietary Guidelines, “heavy drinking” is defined as consuming five or more drinks in a day or 15 or more per week for men, and four or more drinks in a day or eight or more per week for women.
- Reducing alcohol intake can lower the chance of developing liver cancer and even improve the results of treatment.
- Regular screenings catch liver damage early, improving treatment success.
In fact, heavy drinking on a regular basis is considered one of the biggest risk factors for liver cancer.
Read MoreAlcohol & cancer risk
When you drink too much alcohol, your liver works overtime to break it down. This process produces harmful substances that can damage liver cells. Over time, this damage leads to inflammation and scarring, known as cirrhosis.
Cirrhosis makes it hard for the liver to function properly and increases the risk of developing liver cancer.
Specifically, alcohol abuse can cause a condition called alcoholic liver disease, which progresses from fatty liver to hepatitis (liver inflammation), and then to cirrhosis. Each stage increases the likelihood of liver cancer, making alcohol a significant risk factor for the disease.
Dr. Rosario Ligresti, chief of gastroenterology at Hackensack Medical Center in New Jersey notes that heavy alcohol use becomes especially risky if a person also has one or several viruses, like hepatitis, or a scarring of the liver known as cirrhosis, that further magnify damage to the liver.
“If they have a co-infection and they consume alcohol, they certainly are probably among the highest risk of getting liver cancer,” he says. “If they’re alcoholics and they have cirrhosis or hepatitis or fatty liver with inflammation, these are the most important patients that should be screened every 6 to 12 months.”
What is Heavy Alcohol Consumption?
To understand what counts as heavy drinking, it’s important to understand what counts as a drink.
The National Institute on Alcohol Abuse and Alcoholism defines one drink as 14.0 grams (0.6 ounces) of pure alcohol. Translated it looks like this:
- 12 ounces of regular beer (which is usually about 5% alcohol)
- 8–10 ounces of malt liquor (which is typically about 7% alcohol)
- 5 ounces of wine (which is about 12% alcohol)
- 1.5 ounces, or a “shot”, of distilled spirits (rum, vodka, gin, whiskey)
All of these sizes are typical of the amount you would get in a single serving at a bar or in a can or bottle at home.
According to the federal government’s Dietary Guidelines for Americans, 2020–2025, moderate drinking is considered a limit of 2 drinks per day for men and 1 drink per day for women.
Further, the guidelines define a heavy drinker as follows:
- For men, consuming five or more drinks on any day or 15 or more per week
- For women, consuming four or more drinks on any day or eight or more drinks per week
Related: Bile Duct Cancer and Liver Cancer — Same Organ But Different Diseases
How does drinking alcohol increase cancer risk?
While the exact mechanisms by which alcohol contributes to cancer development are not fully understood, it appears to affect the body in the following ways:
- DNA damage: When you drink alcohol, your body breaks down ethanol (the alcohol in your drinks) into a substance called acetaldehyde. Acetaldehyde is bad for your DNA, the material that makes up your genes. This damage can build up over time and increase your chances of getting cancer. Also, drinking alcohol can lead to oxidative stress, where harmful molecules called free radicals damage your cells and DNA, making cancer more likely.
- Liver damage: Drinking too much can hurt your liver, causing inflammation and cirrhosis. A scarred liver has a hard time working properly and is more likely to develop liver cancer.
- Elevated estrogen levels: Drinking alcohol can raise the levels of estrogen, a hormone, in your body. While elevated estrogen itself is not a direct cause of liver cancer in the same way it is with say, breast cancer, the underlying liver conditions associated with hormonal imbalances, such as cirrhosis, significantly increase the risk of developing liver cancer.
- Disruption of detoxification and nutrient absorption: Alcohol can make it harder for your body to break down and get rid of harmful chemicals. It can also stop your body from absorbing important nutrients from food properly. This means harmful substances, like those in tobacco smoke, can enter your body more easily and you don’t get as much benefit from the nutrients in your food.
- Exposure to carcinogenic substances: Sometimes, harmful substances that can cause cancer get into alcohol during its production. These substances can increase your risk of cancer.
The risk of developing cancer due to alcohol consumption varies depending on factors such as the amount and frequency of alcohol consumed, individual genetics, and other lifestyle factors like diet and exercise.
However, reducing alcohol intake or abstaining from alcohol altogether can help lower the risk of developing alcohol-related cancers.
“So if somebody has liver disease from drinking, absolutely stopping alcohol is going to not only help the remaining liver recover, but it’s also going to prevent further inflammation and possible that driver for cancer development as patients have liver disease because of metabolic syndrome, losing weight, controlling diabetes is directly shown to potentially reduce the risk of recurrence and have a better response to treatment,” Dr. Mariam Eskander, a surgical oncologist and assistant professor of surgery at the Rutgers Cancer Institute of New Jersey, says.
Related: Understanding Liver Cancer Treatment
Screening and early detection
Screening and early detection are important in the fight against liver cancer, particularly for individuals with a history of heavy alcohol use.
Doctors recommend regular screenings are recommended for anyone at increased risk due to their drinking habits, as early identification of liver damage can significantly improve treatment outcomes and survival rates.
As Dr. Ligresti noted, screening is especially important for anyone with a history of excessive alcohol consumption and who also has other risk factors such as a hepatitis viral infection or cirrhosis.
The primary tests used for screening and early detection of liver cancer include:
- Ultrasound imaging is frequently the first test used for routine screening for early signs of cirrhosis, liver cancer, or both.
- Blood tests that check for alpha-fetoprotein (AFP) levels, a tumor marker that can be elevated in liver cancer. However, AFP alone is not sufficient for a comprehensive diagnosis, as it can be elevated in conditions other than cancer. Therefore, imaging tests are also necessary.
- Imaging procedures like ultrasound, CT (computed tomography) scans, and MRI (magnetic resonance imaging) that identify any abnormalities or tumors.
- Liver biopsy if other tests identify suspicious areas. This involves taking a small sample of liver tissue to examine under a microscope for signs of cancer.
For anyone with a significant history of alcohol use, it’s essential to have an open dialogue with your care team about the appropriate frequency of screenings. Your doctor may recommend screening at least twice a year.
The goal is to catch liver cancer at its earliest stage, when treatment options are more effective and less invasive.
Treatment options
Treatment options for liver cancer, especially in cases related to alcohol use, focus on both addressing the cancer itself and managing the underlying liver damage caused by alcohol.
The approach to treatment varies based on the cancer’s stage, the overall health of the liver, and the patient’s general health condition.
For early-stage liver cancer in patients with a history of alcohol use, surgical treatments such as resection (removing the cancerous part of the liver) or a liver transplant may be options. These treatments aim to remove or replace the liver tissue affected by cancer.
However, eligibility for surgery depends on the liver’s ability to function post-operation, which can be compromised in patients with significant alcohol-related liver damage.
Ablation therapies use heat, cold or a technique to cut off the cancer’s blood supply. These methods are particularly useful for small tumors and when surgery is not an option due to the liver’s condition or other health factors.
TACE (transarterial chemoembolization) is another treatment that can be used, particularly in cases where cancer has not spread beyond the liver. This procedure involves delivering chemotherapy directly to the liver tumor and blocking its blood supply, effectively starving and killing the cancer cells.
Stopping alcohol is a crucial part of all treatment plans
Continued alcohol use can further damage the liver, reduce the effectiveness of treatments, and increase the risk of cancer recurrence.
Patients are strongly encouraged to stop drinking alcohol to help improve their liver’s health and enhance their response to cancer treatment.
Doctors will also encourage nutritional support, medications to manage symptoms of liver disease, and interventions to treat alcohol dependency.
If I am not a heavy drinker, can I still get liver cancer?
Even if you’re not a heavy drinker, you can still develop liver cancer.
While excessive alcohol consumption is a known risk factor, liver cancer can also stem from various other conditions such as:
- Chronic infections with hepatitis B or C viruses,
- Non-alcoholic fatty liver disease (NAFLD), and its more severe form, non-alcoholic steatohepatitis (NASH), are significant contributors. NASH involves inflammation and liver cell damage, further increasing cancer risk. Additionally, metabolic dysfunction-associated fatty liver disease (MAFLD), which is closely linked to obesity, type 2 diabetes, and metabolic syndrome, can lead to liver cancer.
- Exposure to aflatoxins found in contaminated foods and mold and other environmental factors
- Genetic factors
Related: Surgery For Liver Cancer
Getting help
If you’re struggling with alcohol use, support is available to help you. Reach out to the National Helpline at 1-800-662-HELP (4357) or visit their website. They can provide you with resources and guidance to move towards recovery.
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