Should a Person with Liver Cancer Stop Drinking Alcohol?

By Andrea Peirce,

Wednesday, December 23, 2015

Consuming alcohol is dangerous when you have liver cancer or cirrhosis.
Summary

Many people with primary liver cancer wonder if it’s safe to keep drinking alcohol. The fact is that alcohol is toxic to liver cells and consuming alcohol can accelerate liver damage with sometimes fatal consequences in people with this cancer. In addition, treatment options rapidly diminish when drinking continues. Patients who cannot stop consuming alcohol altogether should reach out for help from their hospital’s counselling center.

Highlights
  • Alcohol can act like a poison to liver cells, killing them on contact.
  • Continuing to consume alcohol in the presence of primary liver cancer can cause irreparable damage.
  • Alcohol can accelerate disease and reduce treatment options.

Memorial Sloan Kettering medical oncologist Ghassan Abou-Alfa often hears one particular question from people who come to him for treatment of primary liver cancer: Can I keep drinking alcohol?  

More than half a million people around the world get this cancer each year. Also referred to as hepatocellular carcinoma, it can have a variety of causes including alcohol overuse, chronic hepatitis B or C virus infection, morbid obesity with diabetes, or a metabolic disease such as hemochromatosis.

Whatever the cause, Dr. Abou-Alfa counsels primary liver cancer patients to steer clear of the bottle. “Most patients with primary liver cancer get help — once they hear what alcohol can do or has already done to their liver.”   

The Reality: Stiffer than a Drink

Medical oncologist Ghassan Abou-Alfa counsels patients with liver cancer on making smart lifestyle choices.

Alcohol can act like a poison to liver cells, killing them on contact, reports Dr. Abou-Alfa. In the presence of cancerous cells already frenetically dividing, the addition of this toxin leads to ever-larger parts of the normally soft, blood-rich organ to die and turn waxy and stiff in a phenomenon known as cirrhosis. Sometimes, it’s the cirrhosis that occurs first, and then cancer follows.  

In time, it becomes increasingly difficult for the liver to carry its many tasks: produce bile that help digest fats, store and release glucose (the main type of sugar in your blood), and clear harmful substances from the bloodstream, to name just a few.

Ever more clogged and hardened due to cancer or cirrhosis (or both), the liver eventually becomes overwhelmed. Fluid may start to build up in the abdomen and legs. Jaundice (yellowing of the skin and the whites of the eyes) may develop as bile clogs the bile duct — the tube that drains bile out of the liver and into the intestines. Bile then builds up in the liver and flows back into the bloodstream. Over time, a person may experience confusion, memory problems, and loss of balance.

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Diminishing Treatment Options

Another risk of consuming alcohol for a person who already has liver cancer, says Dr. Abou-Alfa, is that treatment options dwindle. For example, surgery to remove cancerous liver tissue is off the table if too little of the normally functioning parts of the liver remain.

And while some people may be eligible for a liver transplant, doctors usually consider this option only if the amount of cancer in the liver is limited — and the person commits to staying alcohol free. Participation in a clinical trial may not even be a possibility if there’s concern about the liver’s impaired function and ability to process and get rid of the drugs that are being tested.

It's never too late to stop drinking.
Ghassan K. Abou-Alfa
Ghassan K. Abou-Alfa medical oncologist

For people who had cirrhosis before they were diagnosed with liver cancer, continuing to drink can make the cirrhosis even worse. Once advanced cirrhosis sets in, localized therapies such as hepatic artery embolization — designed to block blood flow to the artery that feeds liver cancer cells — may no longer make sense. The same is true for oral drugs like sorafenib, which can block key tumor cell signals and limit the formation of new blood vessels that the cancer relies on to keep growing.

“Basically, once cirrhosis or liver cancer develops, a person’s risk of dying is much higher if he or she continues to drink,” says Dr. Abou-Alfa. “But even if a person has one or both of those diagnoses, stopping drinking has a beneficial effect. It’s never too late to stop drinking.”

MSK patients can reach out to the counselling center for help with alcohol addiction. Patients at other hospitals should talk to their doctors about additional resources available to them.

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Comments

Is the risk the same for triple negative Brest cancer that has metastasized to the liver and is responding to treatment with xeloda?

Dear Eileen, we forwarded your question to Dr. Abou-Alfa and he responded:

"The blog focuses primary on liver cancer with associated liver cirrhosis. The liver functions and condition in the setting you are referring to may vary. I strongly recommend you check with your doctor."

Thank you for reaching out to us.

Have chronic hep b-what about having food made with wine-as I understand the alcohol is burned off in cooking?

Dear Dorothy we are sorry to hear about your diagnosis. We forwarded your inquiry to Dr. Abou-Alfa, and he responded:

"This should be less of an issue, especially if your liver function is appropriate as it seems."

We encourage you to discuss any specific concerns with your physician. Thank you for reaching out to us.

I would like to take this opportunity to thank Dr. Abou-Alfa for the extraordinary professional medical care which he continues to provide to me as his patient at MSKCC.
Being under his care gives me great comfort because I know he very closely monitors my medical condition. He is an outstanding and expert doctor- a true leader in liver oncology, and a kind and compassionate gentleman.
He also has a talented and dedicated staff- his nurse Natasha Pinhiero and his office assistant Jaime Ryan.

I just wanted to take this opportunity to thank Dr. Abou-Alfa for being such an extraordinary and expertly talented medical professional. It gives me great comfort knowing that he is closely monitoring my condition. He is a true leader in liver oncology and a compassionate gentleman. I know I could not be in better hands.
I would also like to thank his dedicated staff- nurse Natasha Pinheiro and his office assistant Jaime Ryan. They are always helpful and very responsive to my needs and my concerns.
I am very grateful to the entire team!!

Dear Raymond, we are glad to know you felt well-cared for by Dr. Abou-Alfa and nurse Pinheiro, and that you had a good experience with the rest of our staff. We will forward your kind note to them. Thank you for sharing your experience. Wishing you all our best in the new year!

It probably is true that alcohol is bad for liver cancer, but many doctors impose their personal beliefs into the issue. They also make no distinction between moderate red wine with dinner and straight hard liquor.

Dear Elliot, we forwarded your comment to Dr. Ghassan Abou-Alfa and he responded:

"Thank you for input. I would not argue about the value of moderate red wine and its ingredient resveratrol to the heart. By all means please enjoy and stay healthy. The subject matter discussed in this posting on liver cancer relates to a very particular situation where the liver reserve is so limited so that any form of alcoholic drink may further damage the liver. In a situation like this, the heart-related value of red wine unfortunately takes the back seat. Thus the focus on alcohol as an element regardless of the drink."

We hope this information is useful. Thank you for your comment.

My sister has breast cancer and this has spread to liver bones and lung. These are small metasteses. Us it OK for her to have a daily glass if red wine?

Dear Linda, we are sorry to hear about your sister's diagnosis. It's best if she speaks with her physician, who can offer specific advice and recommendations around what's appropriate for her. Thank you for reaching out to us.

"Once advanced cirrhosis sets in, localized therapies such as hepatic artery embolization — designed to block blood flow to the artery that feeds liver cancer cells — may no longer make sense." I can infer from this statement my brother did not have advanced cirrhosis when he had the embolization at MSK. Why, when the cancerous liver tumor is continuing to shrink, is his liver function failing?

Dear Kitty, we are sorry to hear about your brother. His oncologist, who is aware of the specific details of his condition, medical history, and treatment, is the most appropriate person to ask about this. We recommend that you discuss your concerns with your brother's physician at MSK. Thank you for reaching out.

I have had Hep C, for a while now, then I found out, it had turned to Cancer, and has spread to my bile duct. I am on Chemo, but actually, haven't eaten more in my life, which is strange, after I had a stent put in, between the bile duct and liver. I as wondering, how do you know, when your time is getting near, as I fell pretty good. I haven't drunk alcohol for years, ever since I found out I had Hep C

Dear Mitchell, we are sorry to hear about your diagnosis. We cannot tell you exactly when end of life is near or what will happen because people have different symptoms and needs during that time.We recommend you discuss your specific concerns with your physician. You may also find the following patient education materials on our website helpful. This resource will help you understand some of the symptoms people may experience toward the end of life and the options that are available to them: https://www.mskcc.org/cancer-care/patient-education/towards-end-life-wh…. We hope this information is useful. Thank you for reaching out to us.

Is wine just as dangerous as is alcohol is

The subject matter discussed in this blog post on liver cancer relates to a very particular situation where the liver reserve is so limited so that any form of alcohol (regardless of the type of drink) may further damage the liver. Thank you for reaching out to us.

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