As the world continues to mourn the loss of David Bowie, the director of Lazarus, a musical based on his back catalogue, told Dutch radio station NOS.nl that the legend’s creative spirit never wavered.

Ivo Van Hove said Bowie told him weeks before the premiere of the theatre production that he wanted to “make a second one now”.

Bowie, who died at 69 after a battle with what is being reported as liver cancer, likely endured a lot of discomfort during those 18 months.

The liver, the body’s largest internal organ, removes toxins from the blood, produces bile and enzymes to help with digestion, makes proteins that help the blood clot, controls the cholesterol levels in the body, and stores glycogen (sugar) that the body uses for energy.

Men are twice as likely as women to get the disease, according to the B.C. Cancer Agency. Damage to the liver, known as cirrhosis, is a major risk factor. Someone with cirrhosis of the liver is 40 times more likely to develop cancer than a person with a normal liver.

Cirrhosis can develop from alcoholism, exposure to toxins, and viral or parasitic infections.

There are no obvious symptoms in the early stages of liver cancer, but signs in later stages include weight loss, loss of appetite, abdominal pain and swelling, fever, weakness, fatigue, nausea, vomiting, and jaundice, according to the Canadian Cancer Society.

It’s generally not diagnosed until it has progressed to a later stage.

Surgery is the only way to cure primary liver cancer (meaning cancer that originated there and didn’t spread to the liver from other parts of the body). Unfortunately, according to the B.C. Cancer Agency, most often the cancer has already spread through the liver or the liver may already be damaged by cirrhosis.

Primary liver cancers account for less than one percent of all cancers in North America whereas in Africa, Southeast Asia, and China, they may account for up to 50 percent of cancers, the Canadian Liver Foundation reports. The prevalence of people carrying the hepatitis B virus and having liver cirrhosis in those regions might explain the geographic discrepancy. 

The Canadian Liver Foundation recommends that all children as well as adults at high risk of liver cancer should be vaccinated against hepatitis B. Since there is no vaccine against hepatitis C, it is important to prevent the spread of this disease. 

Alcohol consumption should be limited to no more than one to two standard drinks per day. Drinking alcohol every day as well as binge drinking can be harmful to your liver.

“Bowie was still writing on his deathbed, you could say,” Van Hove told the Dutch radio station. “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.”

Bowie attended the premiere of Lazarus in New York on December 7, one of his last public appearances a month before his death.