Global rates of liver cancer are projected to rise sharply in the coming decades, with a recent report in The Lancet predicting a 75% increase by 2050. Despite this trend, experts note that more than 60% of liver cancers could be prevented.
The main drivers of liver cancer globally remain hepatitis B and C infections, which account for over one-third of cases worldwide. In the United States, widespread childhood vaccination against hepatitis B and effective treatments for hepatitis C have reduced these risks domestically. However, alcohol-related liver damage is responsible for 19% of global cases, while obesity-related disease contributes another 8%.
In Colorado and across the U.S., alcohol consumption and obesity are now the predominant risk factors for liver disease that can lead to cancer. Dr. James Burton, a transplant hepatologist at the University of Colorado School of Medicine who treats patients at UCHealth Hepatology Clinic – Anschutz Medical Campus, discussed how these factors contribute to rising rates of advanced liver disease and cancer.
Burton explained that most primary liver cancers develop from cirrhosis—a condition characterized by irreversible scarring resulting from chronic inflammation. He noted that about half of UCHealth patients needing transplants have advanced alcoholic liver disease due to long-term drinking, while another quarter suffer from metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD).
“‘Nonalcoholic’ described what it wasn’t,” Burton said regarding the name change to MASLD.
Burton emphasized that both MASLD and alcoholic liver disease appear identical under microscopic examination: “If you handed me two biopsies, one from someone with fatty liver disease and the other from someone with alcohol-associated liver disease, I couldn’t tell which was which.”
MASLD arises when fat accumulates in the liver; if this leads to inflammation, it can progress through stages including fibrosis and ultimately cirrhosis. With nearly three-quarters of American adults classified as overweight or obese—an important risk factor—the prevalence of MASLD is estimated at up to one-third among U.S. adults. Burton has observed younger patients developing MASLD.
“You’ve got to lose weight now,” he advises his younger patients. “Because, if you don’t start looking after your health now, in your 20s and 30s, by the time you’re in your 50s and 60s, you could end up with cirrhosis.”
While early-stage MASLD is not inherently dangerous on its own, progression increases risk significantly. When fat comprises more than five to ten percent of a person’s total liver weight, inflammation may trigger advancement into metabolic dysfunction-associated steatohepatitis (MASH). About five percent of people with MASLD develop MASH; among them roughly ten percent go on to experience cirrhosis or organ failure.
A Swedish study found eight percent of those with cirrhosis developed cancer within five years; twelve percent did so within ten years.
There are currently no medications approved specifically for MASLD itself; however two drugs—resmetirom (approved March 2024) and Wegovy (semaglutide)—are available for treating MASH following recent FDA decisions (FDA approval announcement). Clinical trials demonstrated their effectiveness in reducing both fat accumulation and scarring in affected livers.
Diagnosis often requires deliberate screening since symptoms may not appear until late stages. Testing begins with blood tests measuring enzyme levels; further imaging such as ultrasound may be recommended if results are abnormal alongside other risk factors like diabetes or obesity. Advanced imaging technologies help assess severity; sometimes biopsy confirms diagnosis.
Patients diagnosed early can manage their condition through lifestyle changes—including diet modification toward higher protein intake and lower carbohydrates—and regular exercise aimed at weight loss or maintenance. Those with established fibrosis related to MASH may also benefit from new drug therapies.
For individuals who progress to cirrhosis due to any cause—including alcohol use or metabolic conditions—regular monitoring via ultrasound every six months is advised for tumor detection; additional imaging follows if suspicious masses are found.
“That liver cancer is a big problem is really just an illustration that liver disease is a big problem,” Burton said. “In America, if people are concerned about getting liver cancer, well, you should be concerned about having liver disease.”
