Cirrhosis
Permanent scarring of the liver after years of damage from hepatitis B or C, alcohol or fatty liver disease. It is the soil in which most liver cancers grow, and its severity limits which cancer treatments a patient can withstand.
Around 80-90% of hepatocellular carcinomas arise in cirrhotic livers, at roughly 2-4% per year, which is why patients with cirrhosis are offered six-monthly ultrasound and AFP surveillance. Hepatitis B vaccination and antiviral therapy, hepatitis C cure with direct-acting antivirals and, prospectively, GLP-1 agonists for metabolic liver disease are the main preventive levers. Cirrhosis also complicates treatment: it causes portal hypertension, low platelets and impaired drug clearance, and is graded by Child-Pugh and ALBI for treatment eligibility.
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