With diabetes, hypertension, obesity and cirrhosis complicating his condition, 72-year-old Manohar Singh from Agra was fortunate to survive liver cancer. Recently, surgeons at a private hospital removed a cricket ball-sized tumour from his liver using keyhole surgery, which allowed them to operate through small incisions rather than a large surgical cut, with limited blood loss.
The case brings into focus the toll of liver cancer in India, with doctors stressing the need to detect liver disease, particularly diabetic or obese, or those suffering with the co-morbidities before serious complications develop in the liver.
Data speaks. According to GLOBOCAN 2022 estimates, 36,953 people died of liver cancer in India that year, making it the eighth leading cause of cancer-related deaths in the country. India recorded an estimated 2.6 liver cancer deaths per 100,000 people, based on the age-standardised mortality rate.
Dr Manoj Gupta, Senior Director and Head of Robotic and Laparoscopic GI Surgery, GI Oncology and Liver Transplant at Yatharth Super Speciality Hospital in Greater Noida who led the surgical team in operating Singh, warned that diabetes and obesity can increase the risk of metabolic dysfunction-associated steatotic liver disease (MASLD), in which fat accumulates in the liver.
In some patients, persistent injury leads to inflammation and fibrosis, or scarring. Advanced fibrosis can progress to cirrhosis, which is a major risk factor for hepatocellular carcinoma, the most common type of primary liver cancer.
“Unlike some other conditions, liver disease may not produce clear warning signs in its early stages. A person can continue working and carrying out daily activities while damage progresses. Fatigue can be one possible symptom, but it is not specific to liver disease and may have many other causes.
“It needs to be evaluated rather than automatically attributed to their routine or lifestyle,” added Dr Siddharth Srivastava, Director Professor in the Department of Gastroenterology at GB Pant Hospital, Delhi.
“Cirrhosis can remain silent until the disease reaches an advanced stage. By the time symptoms become apparent, the liver may already be severely damaged,” he said.
People with long-standing type 2 diabetes, obesity, abnormal liver enzymes or other metabolic risk factors should discuss with their doctors whether an assessment for liver fibrosis is appropriate.
However, diabetes does not mean that a person will inevitably develop cirrhosis or liver cancer. Liver cancer has several causes, including chronic hepatitis B and C infections and alcohol-related liver disease, and risks can overlap.
In fact, the scale of fatty liver disease among people with diabetes is highlighted by a systematic review published in the Indian Journal of Medical Research in 2026. Researchers from AIIMS Bhopal and other institutions analysed 18 studies involving 81,364 adults with type 2 diabetes and estimated that 56.9% had MASLD. The estimate varied widely across studies, reflecting differences in populations and diagnostic methods.
Dr Pramod Garg, Professor Head of Gastroenterology at AIIMS Delhi, said the pattern of liver disease in India was changing. “Hepatitis B and C are declining because of vaccination and better treatment; alcohol-related liver disease and fatty liver are increasing rapidly due to unhealthy lifestyles,” he said. The issue was discussed threadbare at the World Congress of Gastroenterology 2026 held early this month in the national capital.
Dr Shalimar, Professor, Department of Gastroenterology and Human Nutrition Unit, AIIMS New Delhi also maintained, “We are confronting the growing burden of metabolic liver disease. With fatty liver disease affecting around one in three adults and children in India, understanding its links with diabetes, hypertension, obesity and dyslipidaemia is increasingly important.”
For patients already diagnosed with cirrhosis, regular specialist follow-up is important. Eligible patients may need liver cancer surveillance, generally with ultrasound every six months. This is different from recommending cancer screening for everyone with diabetes, said the doctors.
