Liver Cancer by Dr. Harshal RajekarDr.Harshal Rajekar
Dr. Harshal Rajekar
It is estimated that liver diseases are among the top ten killer diseases in India, causing lakhs of deaths every year. Besides, there are those who suffer from chronic liver problems, needing recurrent hospitalization and prolonged medical attention, which leaves them physically, mentally, emotionally and financially devastated.
On the other hand, there are millions of cases of hepatic diseases, which go unreported or are reported when the matters have gone out of hand. Poverty coupled with lack of education and awareness prevents people from seeking medical advice until it is too late. It is very important for people to realize that one can suffer liver damage without exhibiting obvious symptoms. The most common liver disease presents with jaundice. However, many people with end‐stage liver disease may not have marked jaundice.
In addition, high cost of treatment poses as major obstacle in convincing people about taking treatment.
Liver cancer is a fairly rare form of cancer in the western world but much more common in Africa and parts of Asia. Liver cancer is rapidly fatal and unfortunately, most of the cases are diagnosed at a later stage. Liver cancer accounted for nearly 7% of all cancer related deaths in India according to data published this year, and was the 4th commonest cause of cancer death.
Liver Cancer is a common problem in this part of the country and is usually related to the infection with Hepatitis B Virus and Hepatitis C Virus, alcohol consumption and fatty liver disease related to overweight and diabetes mellitus. Liver Transplantation is the only hope for many patients with liver cancer in the presence of liver cirrhosis and this modality is more widely available than just a decade ago.
Liver cancer is emerging as one of the fastest spreading cancers in India. The good news, however, is that almost 50% see a specialist in a treatable condition as opposed to 10% about two decades ago.
Early detection always helps in better treatment outcome. It is recommended that high-risk category people get screened regularly, and see a liver specialist if cancer is diagnosed. Hepatitis B and C used to be the most common causes for liver disease in India that led to liver cancer later. Since the past few years, alcohol has also added to the list. For diabetics, who are over-weight and consume alcohol, the chances of getting liver cancer increases by eight fold. Diabetics have two-and-a-half times more chances of developing chronic liver disease.
Studies have indicated that some liver related diseases like Hepatitis B and Hepatitis C virus could burgeon into an epidemic much larger in scale than the dreaded HIV. However, these diseases being silent killers with long gestation periods do not attract the attention of the Government or the other influential bodies. The needs of patients with liver related disease have been grossly underestimated and largely ignored. Nearly 1 million people suffer from chronic liver disease because of alcohol. At least one in five Indians is living with some kind of liver problem. At most hospitals, patients with alcoholic liver disease (ALD) comprise a big chunk. Almost 70% of in-patients with liver disease and 15% with liver cancer have ALD. This is congruent to the data worldwide, and says that ALD accounts for 40% deaths from cirrhosis and 30% from liver cancer. The problem, say experts, is only growing because of lack of awareness and few dedicated liver hospitals. With this the incidence of liver cancer is probably going to increase.
The only possible cure for liver cancer is surgery, by which the tumor is surgically removed. Through surgery, either a part of the liver bearing the cancer is removed or the whole liver is removed through liver transplantation. In surgery for liver cancer the part of the liver bearing the cancer is removed, provided the remaining liver is healthy. However, the remaining liver is usually unhealthy or cirrhotic in most cases and hence needs a liver transplant to treat the cancer. Cirrhosis of the liver is the commonest risk factor for development of liver cancer.
Liver disease needs to be managed by specialists like hepatologists and liver surgeons. It is important to diagnose early and accurately and start treatment. There are treatments available for viral hepatitis and liver tumours. In the case of end‐stage liver disease that has developed in the form of cirrhosis or acute liver failure, liver transplantation is offered by way of treatment. Facilities for liver transplantation are available at Inamdar hospital. At Inamdar hospital, facilities for liver surgery other than liver transplant are already in place.. We commonly treat liver cancer, gall bladder cancer and cholangiocarcinoma.
Although it is currently one of the most common worldwide causes of cancer death, a major impact on the incidence of hepatocellular carcinoma (liver cancer) could be achieved through current vaccination strategies for hepatitis B virus (HBV) infection, screening and treatment for hepatitis C virus (HCV) infections, and from the reduction of alcoholic liver disease. However, because the latency period from hepatic damage to hepatocellular carcinoma development is very long, it may be many years until the incidence of hepatocellular carcinoma decreases as a result of these interventions.
Advances in medical science have led to new treatment options for liver cancer patients. Blocking blood supply to the tumour and administering chemotherapy directly to the tumour called trans-arterial chemo embolization; radiation treatment, using radioactive beads through the blood supply to the tumour are useful in prolonging life and palliating many patients from inoperable liver cancer. Radiofrequency ablation is another new modality that is available for patients with liver cancer that cannot undergo surgery. For liver cancer patients, who are declared inoperable due to large multiple tumours, selective internal radiation therapy (SIRT), where the radio-active substance directly reaches the tumour through the artery supplying blood to the liver, may be extremely useful. However, the high cost of treatment is a big deterrent, especially in the developing countries. One dose of the therapy can cost 6-9 lakh rupees.
Much of the lack of awareness comes from the lack of literacy and the lack of access to advanced healthcare. Many doctors, especially general practitioners are unaware that liver cancer can be treated. Until recently, i.e. 10-15 years ago liver cancer was deemed untreatable and liver surgery had a high mortality. Any patient with any tumour in the liver was told that nothing can be done. However with improving healthcare and recent advances in surgery and medicine, liver surgery is no longer insurmountable. Sadly, many doctors still believe liver tumors are untreatable. Because of patients faith in their own doctors and the lack of awareness many cancers remain untreated.
In fact even some secondary cancers in the liver are also amenable to treatment. Secondary cancer is cancer that has spread to the liver from other organs. Many patients do not seek medical help from experts due to lack of awareness.
It is time for this to change.
Dr Harshal Rajekar
MBBS MS MRCS DNB
+91 992 307 8668