Obesity coupled with alcohol consumption is turning out to be a deadly cocktail, literally, with city doctors observing a steep rise in the number of liver cancer cases among overweight people who can’t give up drinking. The habit of drinking among overweight diabetics is more worrisome as they have an eight–fold higher chance of getting liver cancer, doctors say.

Over the past few years, alcohol has added to the list of factors causing liver cancer, say doctors. "Liver cancer is emerging as one of the fastest spreading cancers in India. Hepatitis B and C virus infection used to be the most common causes for liver disease in India that led to liver cancer later. But over the past few years, alcohol has also added to the list. In every 10 cases of liver cancer, excessive alcohol consumption is the cause in three to five cases," said Dr Harshal Rajekar, liver, pancreatic and transplant surgeon with Ruby Hall Clinic. He noted that liver cirrhosis caused commonly due to excessive alcohol consumption was the commonest risk factor leading to liver cancer.

Doctors describe consumption of more than 80 gm alcohol (in tippler’s parlance, around 3 large pegs of whiskey assuming an average alcohol concentration of 40 gm per 100 ml) daily as "danger dose", particularly among those who have been drinking regularly for five years. Each gram of alcohol adds seven calories that add up to cause fatty liver, inflammation and scarring of the liver.

Doctors point out how alcohol also causes pancreatitis which in turn further accentuates the harmful effects of alcohol. Alcohol also aggravates liver damage due to hepatitis C virus, and antiviral treatment cannot be given to patients who continue to drink.

"Although it is currently one of the most common worldwide causes of cancer death, a major impact on the incidence of hepatocellular carcinoma (liver cancer) could be achieved through current vaccination strategies for hepatitis B virus (HBV) infection, screening and treatment for hepatitis C virus (HCV) infections, and from the reduction of alcoholic liver disease," said liver physician and gastroenterologist Sheetal Dhadphale.

Liver cancer accounted for nearly 7% of all cancer related deaths in India in 2011 and is the fourth commonest cause of cancer death. The treatment is cost–intensive and doctors advocate a healthy lifestyle.

• Vaccination against hepatitis B and screening of blood donations for hepatitis B and C are effective measures for primary prevention of hepatitis B and C liver disease and also liver cancer. * Patients with hepatitis C need to be identified and treated to reduce the risk of future liver cancer. Thus screening for hepatitis C during routine health check–ups may prove useful.
• Patients who have already developed liver disease should undergo regular screening to help in early detection of liver cancer, when it is possible to cure it.
• A healthy diet and exercise are ways of reducing obesity and fatty liver, and reduces the chances of future liver disease.
• Alcohol consumption should be moderated (30 ml four to five times a week) and educated. Excess alcohol is bad for the liver and increases the risk of liver cancer.

Diabetics suffering from liver disease usually suffer from type 2 diabetes, which is associated with obesity and insulin resistance. Those who are overweight and consume alcohol are more likely to have fatty liver that leads to steatohepatitis (inflammation and fat in the liver). There is a much higher incidence of cryptogenic cirrhosis in those who are overweight and those with type 2 diabetes. Patients with liver cancer with coexisting diabetes have a shorter survival time and a higher risk for tumor recurrence after curative treatments. The exact mechanisms of these are not known at present, but it is advisable for such patients to lose weight and abstain from alcohol, say doctors.