Tuesday, 25 January, 2022
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Controlling Liver Cancer

Professor Mohammad Ali

Controlling Liver Cancer
Professor Mohammad Ali

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Liver is the largest internal organ of our body. It is made up of its own cells, biliary, vascular and supporting tissues. Each cell/tissue can transform into cancer, called the liver's own cancer (Primary liver Cancer).  As the body's blood is filtered in the liver, malignant tumours (cancers) of any part of the body can spread to the liver, called metastatic or secondary liver cancer. Liver cancer is the third leading cause of cancer death in the world, highest in South-East Asia.

Liver Cancer Burden in Bangladesh:

Liver cancer is the third leading cause of cancer death in Bangladesh, next only to cancers of lung and stomach (DGHS Health Bulletin 2019). Most of them remain undiagnosed or have late diagnosis, especially those from rural Bangladesh. Treatment facilities are also limited and centred at the cities. Multiple causative factors of liver cancer exist in our country.

Causes of Liver cancer:

Liver cirrhosis or long-term hepatitis for any reason is the prime cause of liver cancer. Hepatitis B (HBV) and hepatitis C (HCV) are the most common causes followed by Nonalcoholic Fatty Liver Disease ( NAFLD/NASH). HBV causes about 54%, HCV about 31% and NAFLD/NASH about 15% of liver cancers. Other causes are Alcoholic liver disease, hormones, contraceptive pills, Arsenic, Vinyl chloride andAflatoxin (carcinogens produced by the mold found in the grains/nuts).

Diagnosis: Usually, in most cases it grows without symptoms. Still patients may develop symptoms including loss of appetite, fatigue, weight loss, upper abdominal pain, nausea, jaundice, oedema leg and ascites (fluid in the abdomen).

Investigations are Liver Function Test, Alpha Fetoprotein (AFP) and Viral Markers (HBsAg/Anti HBc Total/Anti HCV), abdominal Ultrasonography, CT scan, MRI, CT Angiogram, CT Volumetry, FNAC / biopsy (if required). If diagnosed at an early stage, successful treatment of liver cancer is possible in most cases. Those diagnosed with liver cirrhosis or chronic hepatitis should follow up with doctors (surveillance) in every 6 month.

Treatment:

The treatment is planned according to the location, stage of cancer, function of the liver and the overall condition of the patient. In case of secondary tumour, primary tumour should be diagnosed and treated first. 

Liver Resection: This is the primary option. The cancerous part of the liver along with a portion of healthy liver is surgically removed. After liver resection, the rest of the liver grows, which becomes full within 6 to 8 weeks.

Liver Transplant: The whole liver, containing cancer and its cirrhotic part, is completely removed. A part of liver from living or deceased donor or whole liver from deceased donor is implanted at its site.

Liver Cancer Ablation: In those cases of Liver cancers, where liver resection or liver transplants are not possible, the cancers are destroyed in different ways such as Radio Frequency Ablation (RFA) by extra heat.

Drugs are used in cases, when other treatment not possible.

Prevention:

1.            Prevention of HBV and HCV can prevent about 80% of liver cancer. Awareness, vaccination and treatment of patients are the fundamentals.

2.            Hepatitis B and C are transmitted from person to person through the blood and body fluids (semen, tears, saliva, etc.), HBV & HCV free blood transfusion, the use of disposable syringe and needle and common toothbrush, razor, scissors and unsafe sex practices. Therefore, use sterile needles for piercing the nose and ears and sterile instruments for surgical and dental procedures. Do not to use the same razor/blade in the saloon. Drug addicts should not share the same needles with others. HBV and HCV affected people should never donate blood or organs.

3.            HBV infection from mother to newborn is the major way of hepatitis B transmission. Every pregnant woman is tested for HBV. Newborn of HBV positive mothers should get the vaccine (birth dose) and immunoglobulin as needed within 24 hours of birth. Every child needs to be vaccinated against HBV. There is no vaccine for HCV, so personal preventive measure is needed.

4.            Non-Alcoholic Fatty Liver Disease (NFLD) leads to Nonalcoholic steatohepatitis (NASH) causing liver cirrhosis and liver cancer. Prevention of diabetes, dyslipidemia, overweight and hypothyroidism is essential to prevent NASH.

5.            Excessive drinking of alcohol to be avoided to prevent alcoholic hepatitis.

6.            Long-term anabolic hormones and birth control pills to be avoided. Not to drink arsenic-contaminated water and avoid Aflatoxin containing foods.

Liver cancer is a deadly disease worldwide and leading cause of cancer death in Bangladesh. But this cancer is largely preventable. Controlling HBV, HCV and NAFLD are the prime concerns. Early diagnosis and proper treatment are the main way to offer long term survival.

 

The writer is the Founder of National Liver Foundation of Bangladesh