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? If so, how much?
More than a half-million people around the world get this cancer each year. Also referred to as hepatocellular carcinoma, primary liver cancer can have a variety of causes including alcohol overuse, chronic hepatitis B or C virus infection, morbid obesity with diabetes that causes non-alcoholic fatty liver disease, or a metabolic disease such as hemochromatosis.
Whatever the cause, Dr. Abou-Alfa counsels primary liver cancer patients to steer clear of the bottle.
The Reality: Stiffer than a Drink
Alcohol can act like a poison to liver cells, killing them on contact, he explains. In the presence of cancerous cells already rapidly dividing, the addition of this toxin causes ever-larger parts of the normally soft, blood-rich organ to die and turn tawny or yellow — a condition 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 perform its many critical tasks. These include producing bile that helps digest fats, storing and releasing energy from food, and clearing harmful substances from the bloodstream.
As the cancer or cirrhosis (or both) worsens, 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 from 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.
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.
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 drugs being tested.
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 that block key tumor signals and limit the formation of new blood vessels that the cancer relies on to grow. Advanced cirrhosis also can remove the possibility of using immunotherapy drugs, which boosts the body’s natural defenses to fight the cancer.
“Basically, once cirrhosis or liver cancer develops, a person’s risk of dying is much higher if he or she continues to drink,” explains 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 counseling center for help with alcohol addiction. “Most patients with primary liver cancer get help — once they hear what alcohol can do or has already done to their liver,” Dr. Abou-Alfa says.
Patients at other hospitals should talk to their doctors about additional resources available to them.