It is something that everyone knows that drinking hurts the liver, but what more people know is alcoholic liver disease (ALD). Clinically, ALD is a chronic liver disease caused by long-term heavy alcohol consumption, which usually manifests as fatty liver at the beginning, and then can develop into alcoholic hepatitis, alcoholic liver fibrosis and alcoholic cirrhosis, and epidemiological surveys have found that the prevalence of alcoholic liver disease among adults in China is 4%-6%. When it comes to alcoholic liver disease, many people do not care, thinking that it is not cancer anyway, it does not matter. However, as a responsible oncologist, I must remind those long-term alcoholics that maybe your recent examination is only alcoholic liver disease, but if you don’t pay attention to it and quit drinking, then in the near future, there is a high possibility that you will get liver cancer. Why does alcohol hurt the liver? 4. The consumption of coenzyme I (NAD) during ethanol metabolism increases the reduced coenzyme I (NADH), resulting in a weakened NAD-dependent biochemical reaction and an increased NADH-dependent biochemical reaction, and this disturbance of intrahepatic metabolism may be one of the causes of fatty liver; 5. Patients with high blood alcohol concentration, intrahepatic vasoconstriction, reduced blood flow, hemodynamic disorders, reduced oxygen supply and increased oxygen consumption for alcohol metabolism further aggravate hypoxemia and lead to deterioration of liver function. Who are more likely to get liver cancer when drinking alcohol? 1. Patients with chronic viral hepatitis In clinical work, we often encounter some long-term alcohol drinkers who are actually hepatitis B (HBV) or hepatitis C (HCV) patients. These patients obviously have chronic viral hepatitis, but they feel no physical discomfort and still drink a lot, without knowing that alcohol can cause cancer synergistically with hepatitis B or C. It was found that the combined hepatocarcinogenic effect of HBV and alcohol, in addition to chronic inflammation leading to uncontrolled hepatocyte proliferation, mutation and transformation, is also associated with increased production of procarcinogens produced by the P450 system and a lack of antitumor promoters and retinoids. This suggests that alcohol and HBV interact to accelerate the development of cirrhosis and hepatocellular carcinoma in alcoholics. Chronic hepatitis C and HCV marker-positive alcoholic cirrhosis have a high risk of cancer, mainly because the course of alcoholic liver disease can be altered by the coexistence of HCV, and the natural course of chronic hepatitis C can also be altered by long-term alcohol abuse, and the coexistence of both increases the risk of liver cancer. The viral load (HBV-DNA or HCV-RNA levels) is significantly higher in patients with alcohol combined with hepatitis, suggesting that alcohol suppresses the body’s immune response against the virus, thereby enhancing its pathogenic and carcinogenic effects. Currently, the relationship between viral hepatitis combined with alcohol consumption and liver cancer is attracting more and more attention from the medical community at home and abroad, and several studies at home and abroad have shown that alcohol consumption and chronic viral hepatitis (HBV and HCV) have synergistic effects, and patients under these dual influences may develop liver cancer at an earlier stage, and the histological grading of liver cancer is often highly differentiated. The risk of liver cancer is highest in patients who drink alcohol, followed by HCV, and lowest in non-viral hepatitis. Studies have found that patients with type 2 diabetes are more likely to develop liver cancer if they have been drinking alcohol for a long time, and conversely, patients with liver cancer combined with alcohol consumption are also more likely to develop type 2 diabetes. The increased blood sugar level of diabetic patients will stimulate the increase of hemoglobin release, which will lead to the increase of iron release due to oxidative stress between hemoglobin and free radicals. Iron is a pro-oxidant, which increases oxidative stress in the case of abnormal glucose tolerance and eventually leads to the occurrence of liver fibrosis, as discussed in the previous article. Smokers Tobacco contains carcinogenic substances such as polycyclic aromatic hydrocarbons, nitrosamines, nicotine and cocaine, smoking can lead to the occurrence of lung cancer and other cancers, which has been generally agreed in the medical community. Studies have found that the carcinogenic substances in tobacco can directly damage the liver, and the risk of liver cancer in smokers is 1-2 times higher than that in nonsmokers; the risk of liver cancer in smokers who started smoking before the age of 20 is 2-3 times higher than that in smokers who started smoking after the age of 20; the earlier the age of smoking, the greater the risk of liver cancer in the future. Since both smoking and alcohol consumption are risk factors for liver cancer, long-term alcohol consumption by smokers will significantly increase the incidence of liver cancer. How much alcohol will cause liver cancer? Generally speaking, alcoholic hepatitis can occur after repeatedly drinking large amounts of alcohol for a short period of time, and alcoholic cirrhosis can develop after drinking an average of 80g of alcohol per day for more than 10 years, and if the patient continues to drink, it is very likely to develop into liver cancer. If the patient has a combination of smoking, diabetes and chronic viral hepatitis, the course of cirrhosis or liver cancer will be even shorter.