Liver cancer: A deadly disease

Today, we look at liver cancer, currently the most deadly cancer among Thais aged between 40-70 years and affecting more men than women. World statistics show that its most common form, hepatocellular carcinoma or HCC, is the fifth most diagnosed cancer.

Because liver cancer develops rapidly and its symptoms only start to show at the later stages, a high number of patients die from the disease every year, pushing it into second place in the number of deaths from cancer,

In Thailand, it is estimated that 60 per cent of liver cancer cases are secondary to chronic hepatitis B. Current statistics show that some five per cent of the population is affected with hepatitis B and those who are in the chronic stage of the disease are 20 times more likely to develop liver cancer.

Hepatitis C is also a cause of liver cancer and accounts for about 10 to 20 per cent of cases diagnosed in Thais. People who received a blood transfusion before 1989, with a history of injecting narcotics through a syringe, and those who have been tattooed with unclean needles are all susceptible to hepatitis C infection.

Cirrhosis caused by alcoholism and fatty liver is another major cause of liver cancer.

At present, screening for liver cancer can be conducted by a combination of an Alpha-fetoprotein blood test (AFP) and diagnosis by a CT scan or MRI. If a patient is found to have high AFP and the results of imaging diagnosis indicate liver cancer, this is considered a valid indicator and a biopsy is not necessary.

There are several treatment options for liver cancer, the first being surgery which can bring about a permanent cure. This is a very viable option if the liver of the patient is still functioning well, if the tumour is no bigger than 5 centimetres, and if the cancer has not spread to any nearby veins or other organs.

Liver transplantation is the best approach for those who have both liver cancer and cirrhosis, because transplantation can cure both diseases at once. However, this option can be effective only if the cancer is small and has not spread to surrounding organs. If the cancer is large, there is a high possibility of the recurrence of the disease after the transplantation. In Thailand, liver transplantation is not popular because the surgery has to be conducted in hospitals equipped with specialist surgeons and experienced medical teams and is a very costly procedure. Compounding this problem is a severe shortage of liver donors.

Radio Frequency Ablation uses heat energy to destroy the liver cancer cells and is suitable for patients with a relatively small cancer of under 3cm and if the cancer is located away from the aorta.

Percutaneous ethanol injection is perhaps the most popular option, primarily because it is not costly and produces very few side effects, yet is very effective. However, this approach is only an option if the cancer is small.

A fifth option is TACE (Transarterial chemo embolization) and involves the administration of chemotherapy directly to the liver tumour via a catheter to block the flow of blood to the cancer. This option is good for those who cannot go through surgery or who have a large cancer that cannot be treated by the previously mentioned options. TACE is also good for those whose liver still functions relatively well because this option deteriorates the function of the liver, especially in those whose liver cannot function properly as a result of cirrhosis.

In conclusion, there are many options for the treatment of liver cancer, depending on the stage of the disease, the size of the cancer, and the function of the liver and doctors and patients should work together to achieve the optimal result. However, as with all disease, prevention is better than cure. Screening and vaccination are highly recommended, as is low or zero alcohol consumption. Those with a chronic infection of hepatitis, whether it is virus B or C, should seek out proper treatment. A regular abdomen ultrasound can help to find cirrhosis or the early stages of liver cancer before it is too late.

 

ASSOC PROF TEERHA PIRATVISUTH AND DR NATHAVUT SIRIMONTAPORN are specialists in liver disease and gastroenterology at Samitivej Sukhumvit Hospital. For more information, call the Liver and Digestive Institute at (02) 711 8822-4.