Worldwide, chronic infection with
hepatitis causes 80% of all primary liver cancers and more than 500,000 people
die each year from this lethal cancer. Currently, primary liver cancer has a
5-year survival rate of only 10%.
Additionally, there are effective
therapies to control and manage chronic hepatitis B infections to help prevent
the progression to liver cancer as well.
What
is primary liver cancer?
There are two types of cancers found
in the liver: (1) Primary liver cancer which originates from the liver (also
known as hepatocellular carcinoma or HCC), and (2) Secondary liver cancer which
originates in other parts of the body and spreads to the liver. Worldwide, primary liver cancer is
the 3rd leading cause of cancer deaths and the primary cause of cancer deaths
among men
What
is the link between hepatitis B and liver cancer?
The most common risk factor for
liver cancer is chronic infection with the hepatitis B virus (HBV). Individuals
chronically infected with HBV are 100 times more likely to develop liver cancer
than uninfected people because the virus directly and repeatedly attacks the
liver, which over time can lead to progressive liver damage and liver cancer.
Alarmingly, with chronic HBV
infections on the rise in the United States, there is a growing incidence of
primary liver cancer and it has become one of the three fastest growing cancers
in the country. While the overall incidence of cancer has stabilized, and in
many cases decreased, primary liver cancer is an increasing public health
threat and has a five-year survival rate of less than 10% (making it the 2nd
deadliest cancer in the U.S.).
What
are the risk factors for liver cancer?
The risk for developing liver cancer
among those who are chronically infected with HBV increases as a person gets
older or if they have been diagnosed with cirrhosis. Although liver cancer most
often occurs in the presence of cirrhosis, this is not always the case. Primary
liver cancer can occur even in the absence of cirrhosis, which is why regular
liver cancer screening is so important.
Additional factors that increase the
risk of liver cancer include a family history of liver cancer, persistence of
high HBV DNA levels, co-infection with HIV or HCV, and lifestyle choices such
as excessive alcohol use and smoking. Studies have also shown that obesity and
diabetes may be important risk factors for liver cancer. Liver cancer is more
common among men than women regardless of race or ethnicity.
What
are the symptoms of liver cancer?
Liver cancer is a silent killer
because the majority of patients appear to be perfectly healthy and have no
early signs or symptoms. Both small and large tumors may be undetected due to
the shielded location of the liver underneath the ribs which does not register
pain.
Pain is uncommon until the tumor is
quite large. Later stages of liver cancer, when the tumor is very large or when
it impairs the functions of the liver, can produce more obvious symptoms such
as abdominal pain, weight loss, lack of appetite, weakness and fatigue, and
finally the development of jaundice (yellowing eyes and skin) and abdominal
swelling. People who experience any of these symptoms should see their doctor
immediately for further evaluation.
Who
should be screened for liver cancer?
Since liver cancer develops quietly,
usually without symptoms, patients with chronic HBV should be screened for
liver cancer as part of their routine medical management. For those with
chronic hepatitis B, primary liver cancer can develop with or without
cirrhosis, so regular screening is essential. Early detection of liver cancer
results in more treatment options, which substantially improves the chances of
survival after initial diagnosis.
What
is liver cancer screening?
Liver cancer screening can be done
as part of your regular doctor’s visit and generally consists of a simple blood
test for alpha-fetoprotein (AFP) levels every 6 months and an ultrasound of the
liver once or twice a year. Either test alone can miss the diagnosis. Some
doctors prefer MRI or CT scans to ultrasounds. Once a patient develops
cirrhosis, or has a family history of liver cancer, more frequent screening is
generally recommended.
The treatment options are dictated by the stage of Liver Cancer and the overall condition of the patient. The treatment to be given depends mainly on the size, number, and site of tumors in the liver. Before planning the appropriate treatment the functioning of the Liver is checked as also the spread of the cancer within and outside the liver is to be tested. The Various treatment options available are as follows:- Surgery : Surgery is the removal of the tumor and surrounding tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with small tumors (smaller than 5 cm). A surgical oncologist is a doctor who specializes in treating cancer using surgery.
- Hepatectomy : When a portion of the liver is removed, the surgery is called a Hepatectomy. A Hepatectomy can be done only if the cancer is in one part of the liver, and the liver is working well. The remaining section of liver takes over the functions of the entire liver and may regrow to its normal size within a few weeks
- Liver Transplantation :Liver transplant may be the best option for some people with small liver cancers. At this time, liver transplants are reserved for those with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby blood vessels. In most cases, transplant is used for tumors that cannot be totally removed, either because of the location of the tumors or because the liver is too diseased for the patient to withstand removing part of it.
- Chemoembolization:This is a type of chemotherapy treatment in which drugs are injected into the hepatic artery and then the flow of blood through the artery is blocked for a short time so the chemotherapy stays in the tumor longer. Blocking the blood supply to the tumor also kills cancer cells
- Radiation Therapy :Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. External-beam radiation therapy is radiation given from a machine outside the body. External-beam radiation therapy is not often used for HCC.
- Targeted Therapy :Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells. Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor.
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