Hepatitis and liver cancer


Hepatitis causes inflammation of the liver and is most often caused by a virus, of which there are 6 types: hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), hepatitis E (HEV), hepatitis G (HGV). All of these viruses affect the liver and have similar symptoms, however they are spread in different ways, have different treatments and have different long term affects. HAV, HBV and HCV are the most common types of hepatitis virus, with HBV and HCV infection being the biggest risk factors for liver cancer. In fact, hepatitis B and hepatitis C cause approximately 71% of liver cancer cases worldwide, with people infected with both HBV and HCV most at risk.

Hepatitis B
Hepatitis B is the most common liver infection in the world. HBV is spread through contact with infected blood, semen or other bodily fluids. During the first 6 months after infection it is considered to be 'acute' hepatitis. If hepatitis B virus (HBV) tests continue to be positive for more than 6 months after infection the affected person is considered to have 'chronic' hepatitis B. Up to 1 in 4 people with chronic hepatitis B will die from either liver cancer or liver failure due to cirrhosis unless they receive appropriate care and treatment. Chronic hepatitis B causes prolonged liver damage which may result in cirrhosis (liver scarring) and lead to liver cancer.

Worldwide, an estimated 257 million people have been infected with HBV, with approximately 887,000 deaths resulting from this viral infection in 2015. Almost 240,000 people have chronic hepatitis B in Australia, however there is thought to also be a large number of people in Australia living with hepatitis B that have not yet been diagnosed.

There has been a hepatitis B vaccine available since 1982, with the vaccination programme commencing in Australia in 1988. The vaccine provides over 90% protection against hepatitis B and is your best defence against this disease.

Hepatitis C
Hepatitis C is the other major type of viral hepatitis responsible for increasing your risk of liver cancer. Over 90% of cases in Australia are caused by HCV 1a and 1b (54% prevalence) and HCV 3a (37% prevalence) genotypes. The biggest risk of contracting HCV is from injecting drugs, particularly if you share needles or use dirty needles which may have come into contact with infected blood. Other potential sources of infection include unhygienic needles being used for tattooing or piercings, with an additional (yet smaller) risk of contracting HCV through unprotected sexual intercourse with an infected person. Hepatitis C can cause mild to serious illness, also with the potential to become chronic, cause cirrhosis and lead to liver cancer.

Globally, approximately 71 million people have chronic hepatitis C infection, with approximately 399,000 people dying each year. An estimated 230,000 people in Australia are currently living with hepatitis C infection.

There is currently no vaccine for HCV, however a number of preventative strategies are advised to tackle the issue of HCV infection. HCV can be treated relatively easily, with the current recommended treatment being direct acting antivirals (DAAs). DAAs have changed the therapeutic landscape for hepatitis C with an estimated 90% curative rate. However, HCV infection continues to have significant morbidity and mortality with traditionally less than 2% of affected Australians receiving treatment.


According to the an AIHW report on Cancer in Australia 2017, liver cancer has had the second highest percentage change in incidence rate of all cancers over the last 35 years with an increase of over 300%. Reducing viral hepatitis is a key step in reducing primary liver cancer.

Useful resources

Hepatitis Australia

WHO Hepatitis B fact sheet

WHO Hepatitis C fact sheet

Cancer council Victoria

Better Health Victoria

Cancer in Australia 2017

Taking steps to prevent liver cancer

There are a number of risk factors associated with liver cancer. Some of these risk factors cannot be avoided such as certain genetic conditions, your age and gender. However, other risk factors can be reduced through lifestyle changes and taking preventative measures. Understanding your risk factors and how you can reduce your risk gives you the best chance of protecting yourself against the development of liver cancer.

Protect yourself from viral hepatitis infections

An estimated 71% of liver cancer cases worldwide are caused by infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). Hepatitis causes swelling and inflammation of the liver, and the accumulation of this liver damage over time can increase the risk of liver cancer. People infected with both HBV and HCV have an even greater risk of liver cancer.

Get vaccinated against hepatitis B
The hepatitis B vaccine has been available since 1982, with the vaccination programme commencing in Australia in 1988, and provides over 90% protection against hepatitis B. Hepatitis B infection is one of the leading risk factors for liver cancer, and keeping up with your vaccinations is your best defence against this disease.


Take measures to prevent hepatitis C
Infection with HCV is a major risk factor for liver cancer. There is currently no vaccine for HCV, however a number of preventative strategies are advised to tackle the issue of HCV infection. The biggest risk of contracting HCV is through injecting drugs, with other sources of transmission including sexual intercourse and unsafe needles used for tattoos or piercing. To help prevent HCV infection, practice safe sex, don't inject illegal drugs (or if this isn't currently an option, do not share needles and ensure your needle is sterile), and seek hygienic tattoo and piercing stores.


Reduce your risk of cirrhosis:

Cirrhosis, or liver scarring, which is one of the main risk factors for liver cancer. Cirrhosis is caused by prolonged liver damage that results in scar tissue replacing healthy liver tissue, preventing proper blood flow through the liver and affecting its ability to function.
Cirrhosis can result from other liver conditions such as non-alcoholic fatty liver disease (NAFLD) or infection with viral hepatitis.

Reduce your alcohol intake
Long-term alcohol abuse is a key cause of cirrhosis. Reducing your alcohol intake, or not drinking at all, can help reduce your risk of developing cirrhosis and liver cancer. It is recommended that women do not drink more than 1 alcoholic drink a day, and men do not drink more than two alcoholic drinks per day.


Reduce your risk and treat other liver conditions:

Other liver conditions such as NAFLD cause liver damage, and over a period of time this can lead to cirrhosis and liver cancer.

Lose weight SAFELY
Obesity and being overweight is a risk factor for NAFLD which in itself if a risk factor for liver cancer. Maintaining a healthy weight, eating a healthy diet and exercising regularly is a key protective factor for numerous diseases including liver cancer. Talk to your doctor if you are concerned about your weight, and if you need to lose weight, make sure you do so safely as rapid weight loss can be dangerous. It is recommended not to lose more than 1/2-1kg per week. To lose weight safely, and maintain a healthy weight once you have reached it, you should eat a healthy diet and exercise regularly.


If you have a high risk of developing liver cancer, talk to your doctor about how you can reduce your risk.

Risk factors for the development of liver cancer


Anything that increases your chance of developing a disease is called a 'risk factor'. There are lots of different risk factors associated with every disease, including cancer. However, just because you have one (or more) of these risk factors, it doesn't mean that you WILL get the disease, it just means that you are more at risk than someone who does not have that risk factor. Risk factors often influence the development of cancer but most do not directly cause cancer. Certain risk factors can be avoided. For example, smoking and drinking excessive alcohol are risk factors for numerous diseases including liver cancer, and avoiding these risk factors can be achieved by simple lifestyle changes. However, other risk factors cannot be avoided, for example your age or inheriting certain genes. Knowing and understanding your risk factors, and avoiding those you can, will help you lower your risk of developing liver cancer.

What are the risk factors of liver cancer?

There are numerous risk factors associated with liver cancer including:

Infection with hepatitis virus
Hepatitis is caused by hepatitis virus and causes swelling and inflammation of the liver. The accumulation of this liver damage over time can increase the risk of liver cancer. Hepatitis B and/or hepatitis C that develops into chronic disease are some of the main risk factors for developing liver cancer, estimated to cause ~71% of liver cancer cases worldwide. Hepatitis B is a serious illness with the potential to become chronic, cause cirrhosis (liver scarring) and lead to liver cancer. Hepatitis B virus (HBV) is spread through contact with infected blood, semen or other bodily fluids. Hepatitis C virus (HCV) is also spread through infected blood and can cause mild to serious illness, also with the potential to become chronic, cause cirrhosis and lead to liver cancer. The longer the hepatitis infection lasts, the greater the risk of developing liver cancer. In addition, people infected with both HBV and HCV have an even greater risk.

Cirrhosis
Cirrhosis is the term used to describe extensive liver scarring. When healthy liver tissue is replaced by scar tissue, it can block the blood flow through the liver preventing it from functioning properly. Cirrhosis can be caused by chronic hepatitis infection (particularly hepatitis C) as well as chronic alcohol use.

Other liver conditions
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are conditions where fat accumulates in the liver leading to damage, cirrhosis and liver failure. NAFLD in particular is increasingly becoming a risk factor for liver cancer.

Haemochromatosis is a genetic disorder that causes the body to absorb too much iron from ingested food and can increase your risk of developing liver cancer.

Aflatoxin
Aflatoxin is a poison from a fungus that can grow on foods that have not been stored properly, such as grains and nuts. Consuming foods that contain aflatoxin may increase your risk of developing liver cancer.

Lifestyle factors
Obesity, chronic alcohol use and smoking are some of the common lifestyle factors that may increase your risk of developing liver cancer. This is because they are risk factors for developing the other liver conditions which may lead to liver cancer. For example, high levels of alcohol consumption can cause cirrhosis. Likewise, NAFLD is more common in people who are overweight or obese, particularly those who also have type 2 diabetes or abnormal cholesterol levels.

Other risk factors
Adult primary liver cancer is more common in men and people over 60 years of age.

Knowing and understanding your risk factors will help you make informed lifestyle and healthcare decisions. Discuss your concerns with your doctor who will help you reduce your risk and work towards preventing the development of liver cancer.

Useful resources

NCI’s PDQ cancer information summary about liver cancer prevention and risk factors

3 tips for keeping your bones strong and healthy


1. Increase your intake of dietary calcium
Calcium is essential for building and maintaining bone to give the bone its strength. We continuously lose calcium each day through our skin, nails, sweat and urine. Our bodies cannot make calcium, therefore all our calcium requirements need to come from our diet. When we do not get enough calcium from our diet, the calcium in our bones begins to dissolve and is used up, decreasing our overall bone strength and health. Consuming enough calcium each day will help keep your bones strong and healthy.
Dairy products such as milk, yoghurt and cheese is the main source of calcium, or it is also found in canned fish (with bones) such as salmon and sardines, fruit and vegetables, and nuts such as almonds.
As you increase your intake of calcium you also need to make sure it will be effectively absorbed by the body. Drinking too much caffeine, alcohol or soft drinks that contain phosphates may reduce calcium absorption, along with diets high in animal proteins.

2. Increase your vitamin D levels
Vitamin D increases the absorption of calcium and regulates the amount of calcium in the blood. It is essential for bone health and strength as without it calcium is not absorbed effectively by the body. The most prominent source of vitamin D is from exposure to sunlight. To ensure you are getting enough sunlight to produce vitamin D, it is recommended that approximately 15% of your body (namely the face, arms and hands) is exposed to sunlight for roughly 6-8 minutes 4-6 times a week. Older people need this exposure more times a week, and darker skinned people require longer exposure times. It is highly recommended that you continue to use sunscreen and avoid sun exposure when it is at its strongest (between 10am-2pm during the summer months) as the risk of cancerous effects outweigh the benefits of vitamin D production.
Vitamin D is found in some foods (fatty fish, liver, eggs) however adequate levels of vitamin D are unlikely to be sustained through diet alone.

3. Get active!
Regular exercise maintains and increases bone strength by increasing bone mass and slowing age-related bone mass loss. Additionally, exercise increases muscle strength which helps support joints and prevent falls. Gains in bone strength are quickly lost once you stop exercising so it is important that you exercise regularly and for the long term. For the biggest benefits, the exercise needs to be regular, fairly intense and offer a variety. Most people should aim for 30-40 minutes of exercise 4-6 times a week with a mixture of weight-bearing exercises and resistance exercises.
Weight-bearing exercise (i.e. any exercise carried out whilst on your feet) helps strengthen your bones as they bear weight and experience certain amounts of strain as gravity exerts its force. Good examples of weight bearing exercise include walking, jogging, tennis or golf. Higher impact exercises include aerobics and running.
Resistance exercises (lifting weights with arms or legs) increases bone mass and strength in response to muscles repeatedly contracting when lifting a heavy weight. Increasing the resistance, the number of repetitions or changing the exercise pattern helps increase bone mass.

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