Liver Cancer: Prevention is the Best Protection
Liver is no doubt one of the integral organs in our body and performs vital functions including breaking down of toxins and drugs, while helping in absorption of the nutrients. We simply cannot live without it. Cancer of the liver not only impairs its functions but it also means that our body will not be able to tolerate certain medicines, making treatment challenging in advanced stages. There are different types of liver cancers—some start in the liver (primary liver cancer), while others originate in a different site and spread to the liver (secondary liver cancer). In the first world countries, secondary liver cancer is more common while the opposite is true for middle and low-income countries, in Asia and Africa. The Global Cancer Observatory Report for 2020 noted 5,331 new cases of liver cancer in Pakistan, with 5,109 deaths. Liver cancer is common in Pakistan, linked to the high rates of hepatitis B and C infections. According to a study at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, 61% of liver cancer patients had prior infection with hepatitis B or C and most patients presented at advanced stages with large tumours and poor liver function. In this situation, prevention and early detection becomes the key in saving lives.
The most common risk factor for liver cancer in the world is viral hepatitis. People infected with both Hepatitis B and C have a higher risk of developing chronic hepatitis, cirrhosis and liver cancer. In Pakistan, the challenge against fighting hepatitis includes lack of awareness compounded with lack of screening programmes and treatment facilities. The majority of the people remain unaware of their condition, leading to an ongoing cycle of infection caused by unsafe injection practices, transfusion of un-screened blood, unsafe surgical and dental practices and mother-to-child transmission.
A vaccine is available for hepatitis B, which makes it an important tool in the prevention strategy against liver cancer. Screening of pregnant women for hepatitis B and ensuring that birth dose of vaccination is available for those who test positive can avoid mother to child transmission of the virus. Vaccination of children against hepatitis B, as part of national immunisation programmes, can effectively prevent future infection. Since no such vaccine against hepatitis C exists currently, the best strategy is to avoid the high-risk behaviours described above and by ensuring access to treatment in a timely manner for those infected, since hepatitis C is now a curable infection.
There are certain other risk factors that you should consider avoiding to lower your risk of developing liver cancer. Smoking increases your risk for many different types of cancers, including liver cancer, and hence should be avoided. You should maintain a healthy weight because obesity may lead to a condition known as non alcoholic steatohepatitis (NASH), which may cause cirrhosis and ultimately liver cancer.
Another challenge with liver cancer is establishing an early and timely diagnosis. This is because symptoms often do not appear until the disease has already reached advanced stages. Moreover, there are no widely recommended screening tests for liver cancer for people at average risk. For people at high risk of liver cancer, with cirrhosis or chronic hepatitis B infection, experts recommend screening with alpha-fetoprotein (AFP) blood tests and ultrasound every six months.
Treatment of liver cancer depends on the stage of cancer and may include surgery, liver transplant, ablation, embolization, radiation therapy and chemotherapy. If diagnosed at stage 0, the five-year survival rate is estimated between 70-90%, at stage 1 this becomes 50-70%, and in late stages, it drops drastically to only a few months. Therefore, prevention and early detection can play a critical role in saving lives.
At the Shaukat Khanum Memorial Cancer Hospital and Research Centres in Lahore and Peshawar, every new patient is evaluated by a multi-disciplinary team of doctors for an optimal treatment plan. The team includes surgical oncologists, radiation oncologists, medical oncologists, gastroenterologists and interventional radiologists. As committed in our mission statement, we also offer palliative care to manage symptoms and pain in our cancer patients, which is especially beneficial for liver cancer patients who are, unfortunately, in advanced stages of the disease.
This October, let us commit to avoid high-risk behaviour and play our role in preventing liver cancer. If we act together, we can avoid suffering and save lives.
By Dr. Muhammad Zeeshan Siddique (Consultant Gastroenterologist, SKMCH&RC, Lahore).