By Janet Coulter, MSN, MS, RN, CCM, FCM

October is National Liver Cancer Awareness Month, a time dedicated to raising awareness about liver cancer, its causes, and the importance of early detection and prevention. This campaign provides an opportunity to provide education to the public and healthcare providers about this often-overlooked disease. 

Liver cancer, also known as hepatocellular carcinoma (HCC), is a serious and life-threatening condition. It is the sixth most common cancer worldwide and the second leading cause of cancer-related deaths. Approximately three hundred million people worldwide are living with hepatitis B and hepatitis C, and that puts them at higher risk for developing liver cancer. 

Liver cancer is a leading cause of cancer deaths in the United States among all races, ethnicities, and genders. Approximately 40,00 American adults die each year from liver cancer. Despite its prevalence, liver cancer does not receive the same level of attention as other forms of cancer, making awareness efforts crucial. 

The National Cancer Institute estimates that 41,630 new cases of liver cancer and intrahepatic bile duct cancer will occur in the United States this year. Approximately 29,840 people are expected to die from these cancers. The five-year relative survival rate is 21.7%. 

One of the most significant challenges with liver cancer is that it often goes undetected until it reaches an advanced stage. Symptoms of liver cancer are not always apparent in the early stages, and when they do appear, they can be vague and easily attributed to other less severe conditions. Common symptoms include fatigue, unexplained weight loss, loss of appetite, nausea, and abdominal pain. As the disease progresses, more specific signs, such as jaundice can appear. Liver cancer has several risk factors, many of which are related to lifestyle and underlying health conditions. Chronic infection with hepatitis B or hepatitis C is the leading cause of liver cancer. These viruses can lead to long-term liver damage and cirrhosis, significantly increasing the risk of developing cancer. Other risk factors include excessive alcohol consumption, obesity, type 2 diabetes, and non-alcoholic fatty liver disease (NAFLD, now known as metabolic dysfunction-associated steatotic liver disease - MASLD).  

One of the key messages of this campaign is the importance of regular monitoring for individuals at high risk for liver cancer. Those with chronic hepatitis B or C, a history of heavy alcohol use, or other risk factors should undergo regular liver screenings, such as ultrasounds and blood tests, to detect cancer at an early stage when it is more treatable. Additionally, liver cancer patients are encouraged to seek care from specialized centers with expertise in liver disease, as these centers are more likely to provide the most advanced treatment options. 

National Liver Cancer Awareness Month also serves as a reminder of the importance of research in the fight against liver cancer. Research is essential for developing new and better treatments, improving early detection methods, and ultimately finding a cure. By raising awareness and advocating for more research funding, there can be significant strides in reducing the burden of liver cancer. 

Case Management Interventions 

As case managers, we should be aware of the signs and symptoms of liver cancer as early detection is critical for effective treatment. In addition, addressing risk factors through public health initiatives, such as vaccination programs for hepatitis B, education on safe practices to prevent hepatitis C transmission, and campaigns promoting healthy lifestyle choices, is vital in reducing the incidence of liver cancer. Through partnerships and collaborations with key stakeholders, Federally Qualified Health Centers, health departments, and local health organizations, free liver screenings for at-risk adults are already available or will be available in twenty states this year. 

The American Liver Foundation is promoting Think Liver Think Life™, a national public health campaign which aims to ensure every American understands their risk for liver disease, receives the appropriate screening and care coordination and feels well-informed and supported throughout their liver journey. An on-line quiz has been developed which can help identify individuals at risk for developing liver cancer. This quiz also includes questions to discuss with a health care provider and provides information on common lab work to check liver function. The quiz can be accessed at  https://thinkliverthinklife.org/liver-health-quiz

Conclusion 

Case managers play a vital role in raising awareness about liver cancer, emphasizing the importance of early detection and prevention, and providing support for those affected by the disease. It is essential that we actively share information about liver cancer, promote regular screenings for individuals at risk, and highlight the importance of early detection. By focusing on education, advocacy, and research, we can work towards a future where liver cancer is better understood, detected at earlier stages, and treated more effectively. 

References 

American Liver Foundation. (2024). Think Liver Think Life™. https://thinkliverthinklife.org 

American Liver Foundation. (2024). Liver health quiz. https://thinkliverthinklife.org/liver-health-quiz 

American Liver Foundation. (2023). Liver cancer. https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/liver-cancer/ 

American Cancer Society. (2023). Cancer Facts & Figures 2023. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2023.html 

National Cancer Institute. (2023). Cancer stat facts: Liver and intrahepatic bile duct cancer. https://seer.cancer.gov/statfacts/html/livibd.html 

World Health Organization. (2021). Hepatitis C. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c 

World Health Organization. (2020). Hepatitis B. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b 

Download CMSA's Case Management Adherence and Transitions of Care Guide(CMAG-TOC): Hepatic Encephalopathy - FREE - click here: https://cmsa.org/hepatic-encephalopathy-cmag/

Bio: Janet S. Coulter, MSN, MS, RN, CCM, FCM is a Fellow of Case Management and a board-certified transplant case manager with a large health plan. She is currently President of the Case Management Society of America National Board of Directors. She has held positions as a nurse educator, administrator, team leader, and Director of Case Management. Janet holds a Master of Science in Nursing from West Virginia University and a Master of Science in Adult Education from Marshall University. Janet has been a recipient of the CMSA National Award of Service Excellence and Southern Ohio Valley CMSA Case Management Leadership award.

The views and opinions expressed are those of the author and do not necessarily reflect those of CMSA.