Liver cancer is the fifth most common cancer and third leading cause of death from cancer in the world. According to the World Health Organization (WHO), more than 830,000 people died of liver cancer in 2020 and more than 900,000 new cases of liver cancer were detected. Liver cancer is more prevalent in Southeast Asia, China and Africa.
Types of liver cancer
There are two types, 1. Primary liver cancer: An uncontrolled growth of various liver cells that transform into cancer cells, such as hepatocellular carcinoma, cholangiocarcinoma and sarcoma. 2. Metastasis liver cancer (Secondary liver cancer): Cancer of other parts of the body can spread through the blood or directly to the liver. Notable among them are colon, rectum, gallbladder, pancreas, stomach, breast, lung and malignant melanoma. Metastatic cancers are 30 times more common than primary cancers in the liver.
Liver cancer in children:
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The most common liver tumor in children is called Hepatoblastoma. Usually in the first 3 years of age and boys are more susceptible.
Causes of liver cancer:
1. Liver cirrhosis or long-term hepatitis for any reason can lead to liver cancer.
2. Chronic hepatitis and liver cirrhosis due to hepatitis B and C can lead to liver cancer. More than 80 percent of liver cancers are caused by hepatitis B and C. Hepatitis B causes about 54 percent of liver cancers and Hepatitis C causes about 31 percent of liver cancers. Two out of three liver cancer deaths are due to Hepatitis B & Hepatitis C
3. Fatty liver, NFLD, Nash cirrhosis leads to liver cancer.
4. Alcoholic hepatitis: Excessive and uncontrolled alcohol consumption causes hepatitis, liver cirrhosis and liver cancer. Nash and alcoholic hepatitis cause about 15% of liver cancers.
5. Excess hormone intake: Prolonged use of male hormones, anabolic steroids, birth control pills can lead to liver cancer from liver cell adenoma.
6. Arsenic and vinyl chloride: Prolonged exposure to arsenic in water and exposure to vinyl chloride (which is used to make some plastics) can lead to liver cancer.
7. Aflatoxin: Found in nuts, corn, betel nut and seeds. It is a toxin produced by a fungus, which causes liver cancer.
The trend of liver cancer in Bangladesh:
The total population of Bangladesh is about 166 million. The prevalence of Hepatitis B in Bangladesh is about 5.5 percent and Hepatitis C is about 1 percent. It is estimated that about 10 million people are infected with Hepatitis B and C viruses. About 25-40 percent of people with hepatitis B are at risk of developing liver cancer at some stage. About 20 percent of people with hepatitis C are at risk of cirrhosis of the liver, and about 20 percent of people with the disease may have liver cancer. A large portion of the total population of Bangladesh is prone to liver cancer caused by Hepatitis B and C viruses.
There are no statistics on liver cancer caused by complications of NASH, Alcoholic liver disease and other diseases. Also, there are no statistics on metastatic liver cancer.
According to a 2018 report by the World Health Organization, 3,112 people died of liver cancer in Bangladesh in 2018, which is 0.4 percent of all deaths in Bangladesh in that year.
Symptoms of liver cancer:
There are usually no symptoms in the early stages. In most cases it grows without symptoms. Symptoms include: loss of appetite, fatigue, weight loss, upper abdominal pain, nausea, jaundice, watery feet and abdomen.
Treatment of liver cancer:
The treatment procedure is to be followed by following a specific protocol considering the location, stage and function of the liver cancer and the overall condition of the patient.
1. Liver resection: Part of the liver with cancer is surgically removed. After liver resection, the rest of the liver grows, which becomes full within 6 to 8 weeks. Different types of liver resection are performed. Liver resection is performed considering the location of the cancer, its extent, and the condition of the rest of the liver. It is important to note that the rest of the liver will be able to continue its activities after the liver resection.
2. Liver transplant: This is a fast advancing and complex medical procedure. The cancerous liver is completely removed and a part or whole liver of donor is implanted at the site. Liver transplant to be done according to a specific criterion considering many aspects of the donor and the recipient. It is only done in cases of primary cancer. The chance of 5 yr. surviving after liver transplant is around 80 percent.
3. Liver cancer ablation: In those cases of liver tumors (cancers), liver resection or liver transplants are not possible, the cancers are destroyed in different ways. Each of these methods has to follow a specific application policy.
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Prevention of liver cancer
1. Prevention of hepatitis B and C.
2. Hepatitis B and C are transmitted from one person to another through blood and body fluids (semen, tears, saliva, etc.). It is important to be aware of the followings:
A) Make sure that hepatitis ‘B’ and ‘C’ virus is free before blood transfusion.
B) Be sure to use a disposable syringe and needle.
C) Use your own toothbrush, razor, scissors etc.
D) Safe sex practices.
E) Hepatitis B and C patients should never be considered as blood and organ donors.
F) Piercing the nose and ears, using the same needle when piercing.
G) Use of sterile instruments for all types of surgery and dental treatment.
H) Do not use the same razor / blade in the saloon
3. Hepatitis B infection from mother to newborn is one of the main causes of hepatitis B transmission. It is important to get tested for hepatitis B in every pregnant woman. It is vital to treat positive mothers and give the newborn the vaccine (birth dose) and immunoglobulin as needed within 24 hours of birth. It is important that every child is vaccinated against hepatitis B. Adults and those who are in risk should also be vaccinated. There is no vaccine for hepatitis C. All preventative measures are needed. Prevention of Hepatitis B and C can prevent 80 percent of liver cancers.
4. NASH prevention: NASH is caused by Non Acholic Fatty Liver Disease (NFLD) followed by fatty liver. NASH is growing day by day. Prevention of diabetes, dyslipidemia, overweight, hypothyroidism, fatty liver is important.
5. Alcoholic Hepatitis: Excessive drinking of alcohol should be reduced or stopped. Nash and alcohol-related hepatitis cause about 15 percent of liver cancers.
6. Excess hormone intake: Long-term anabolic hormones and birth control pills should be avoided. It is important not to drink arsenic-contaminated water and take Aflatoxin-free foods.
Early detection of liver cancer:
When liver cancer is diagnosed at an early stage, successful treatment is possible in most cases, which is not possible in diagnosing late & complex conditions. Those diagnosed with liver cirrhosis or chronic hepatitis should be properly followed by doctor (surveillance). It is important to check the abdominal ultrasound and Alfa fetoprotein at least once every 6 months. So that early detection and appropriate treatment of the cancer is possible. Abdominal pain, jaundice, loss of appetite, ascites should be consulted immediately.
Liver cancer is a deadly disease worldwide. The hope is that this cancer is largely preventable. There are effective vaccines to prevent hepatitis ‘B’ and medicines to cure hepatitis C. There are many ways to prevent other causes too. Multi modal management strategy is needed for its management. Early diagnosis and proper treatment are the main way to offer long survival.
Professor Mohammad Ali is Founder, National Liver Foundation of Bangladesh