The burden of non-alcoholic fatty liver disease (NAFLD) is substantial. Approximately 30-40% of the  population suffers from some form of fatty liver disease. Most people, even in the developing countries are either unaware of the condition or have not been evaluated for it. Development of Non-Alcoholic Steato-hepatitis (NASH) is a cause of much greater concern. It indicates the advancement of the disease with inflammation of the liver cells and the increase in the circulating levels of liver enzymes. This is an indicator of ongoing liver damage.

In  predisposed individuals NASH may proceed to Liver Fibrosis and then to Cirrhosis. Hepatocellular Carcinoma (HCC) or Liver Cancer is also under-recognized. Only 20% patients receive appropriate surveillance before their diagnosis of Liver Cancer. The deficiency in screening is particularly troublesome in patients with NAFLD.

Patients who are detected to have liver cancer in a background of fatty liver disease are generally diagnosed at a later stage. In these patients the tumor is more advanced and have poorer survival. These patients are rarely offered a liver transplant which is the only curative option.  NASH cirrhosis is projected to become the leading indication for liver transplantation by 2020, surpassing alcohol and chronic hepatitis C infection.

Various studies have been conducted to identify the risk factors for development of Liver cancer in patients who suffer from NASH or Fatty Liver. The convergence of NASH and HCC makes it imperative to establish more effective screening methodologies to identify fatty liver and in turn to detect Hepatocellular Carcinoma in these patients.

 

Factors which could lead to Liver Cancer in Fatty Liver

  • Male Gender
  • Non-Hispanic Ethnicity
  • Older Age
  • Higher BMI (Obesity)
  • Diabetes Mellitus
  • Metabolic Syndrome

The presence of these factors in patients who have had a diagnosis of fatty Liver disease should be an eye-opener to both the clinician and the patient to be watchful for the development of advanced liver disease and especially Hepatocellular Carcinoma.

Identifying Fatty Liver Disease

NAFLD is often diagnosed after a Liver Function Test produces an abnormal result and other liver conditions, such as viral hepatitis, are ruled out. However, blood tests don’t always pick up NAFLD. The condition may also be spotted during an ultrasound scan of the abdomen. 

Once a diagnosis of fatty liver disease is made, further tests may be required to stage the condition. A special type of ultrasound scan (Fibroscan) helps quantify the stage and evaluate whether there is risk of development of NASH or Cirrhosis of Liver. In rare instances a liver biopsy may be needed.

 

World J Hepatol. 2017 Mar 8; 9(7): 385–390.