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Belgian theatre director Ivo van Hove, who worked with David on his Broadway production, Lazarus, told DutchNews that David told him he had liver cancer, because he needed him to know he would be too sick to attend rehearsals. “He said that because he knew that he may not always be able to be around.” What could have David gone through during this horrible time? Here’s five things to know:

Liver cancer symptoms include weight loss and abdominal swelling

There’s no routine screening for liver cancer, so it’s sometimes hard to spot the disease. But for most people, symptoms include: nausea, weight loss, loss of appetite, fever, upper abdominal pain, enlarged liver or spleen, fatigue, and jaundice (yellowing of skin). David reportedly had six heart attacks over the course of the last 18 months, according to Daily Mail.

Liver cancer is diagnosed through blood tests

It’s unclear what David went through in his medical journey with liver cancer, but the disease is typically diagnosed through a series of blood tests, imaging, and tissue biopsies. This determines the stage of the cancer, and how aggressive the tumor may be — if it’s spread to other parts of the body.

The cancer obstructs liver function

Liver cancer, of course, makes it difficult for the liver to function properly, and that has brutal consequences to the human body. The liver aids in in digesting and detoxification of the human body; without a functioning liver, one cannot survive.

Men over 63 are more likely to develop the disease

David fits the most criteria for liver cancer: men are likelier than women to develop the disease; the average onset age is 63. There is no information on what may have caused David’s cancer (sometimes it’s just genetics), but there are a series of risk factors that play into the illness: smoking, heavy drinking, obesity, both types of diabetes, liver cirrhosis, metabolic illnesses, and exposure to certain chemicals.

But Bowie didn’t let cancer stop him from creating

“Bowie was still writing on his deathbed, you could say,” Ivo told the site. “I saw a man fighting. He fought like a lion and kept working like a lion through it all. I had incredible respect for that.” Just a month before his death, David happily attended the premiere of Lazarus in NYC, on December 7 — one of his last public appearances. Two days before his death, on his birthday, January 8, he released his stunning last album, Blackstar.

HollywoodLifers, our thoughts are with David’s family and loved ones at this tragic time.