The Weight of Risk: Exploring the Link Between Obesity and Liver Cancer

Abstract

Obesity is a chronic, preventable condition, and has a significant public health concern. Its implications extend beyond metabolic syndrome, casting a shadow over the development and prognosis of various cancers, with a particularly strong tie to hepatocellular carcinoma (HCC) among all cancer types. Non-Alcoholic Fatty Liver Disease (NAFLD) is now a leading cause of liver cancer, along with the treatment of hepatitis B and C. Liver cancer is the fourth most common cause of cancer related deaths worldwide, with obesity, exacerbating the risk especially two times higher in Body Mass Index (BMI) above 30 and four times higher in BMI above 35. Visceral adiposity, measured by waist circumference, is considered more important risk factor than general adiposity. Several mechanisms have been proposed to explain the pathophysiology of how obesity can trigger HCC, but the precise mechanisms that control the progression from steatosis to steatohepatitis and tumor initiation remain unclear. Hepatocellular cancer may occur in patients with NAFLD without cirrhosis. The diagnosis of HCC in NAFLD can be challenging due to an increase in poor-quality ultrasound in obese individuals, which necessitates a more accurate and cost-effective surveillance strategy for early detection. The delay in diagnosis, older age, and the presence of relevant comorbidities limit the possibility of therapeutic intervention. Weight management through lifestyle changes and surgical interventions like bariatric surgery offers promise in mitigating both metabolic syndrome and the risk of HCC. Diagnosis hinges on advanced imaging techniques like multiphase Magnetic Resonance Imaging or Computed Tomography scan using specific criteria. Treatment modalities for HCC are multifaceted, depends upon tumor characteristics, metastasis, cirrhosis, and overall liver function. However, despite advancements, there remains a pressing need for more efficacious interventions to combat obesity and curb the trajectory of HCC, given its persistently high mortality rate. Surveillance protocols for HCC in cirrhotic patients entail regular abdominal ultrasounds with or without Alpha Fetoprotein testing at six-month intervals. However, there is a need for cost effective surveillance strategies for HCC in non-cirrhotic NAFLD.