Liver Cancer

It is the highest incidence in men and hepatocellular carcinoma (HCC) Is the majority of primary liver cancer cases.

Globally, each year over 750,000 people are diagnosed with HCC, most often in late stages of the disease.

Chronic HBV infection is the leading cause of HCC in Thailand and other Eastern Asian countries

In the US and some countries in Europe the incidence and number of deaths from liver cancer has been on the increase in recent years.

In the US, this increase is faster than any other cancer, having doubled since the mid-1980s, which in part is due to the rising prevalence of fatty foods and obesity, a factor that is increasing the risk globally.

• Hepatitis B and C virus                

• Fatty foods and obesity

• Alcohol                                         

• Aflatoxin (a carcinogenic mould found in contaminated food, especially rice)

HCC often doesn’t show symptoms until the advanced stages of the disease, but some people may experience:

• Abdominal pain or tenderness

• Easy bruising or bleeding

• Enlarged abdomen

• Unexplained weight loss

• Jaundice

Surveillance programmes are associated with improved survival.

People at high-risk of developing liver cancer may undergo ultrasound examinations, which can be sensitive enough to detect small masses on the liver, or blood tests for protein levels (AFP).

If liver cancer is suspected, other methods of diagnosis are:

• Abdominal CT scan

• Abdominal MRI scan

• Liver biopsy

There are limited treatments available for people across all stages of liver cancer, and even less if diagnosed at the advanced stage.

In fact less than 50% of people diagnosed with advanced HCC will survive more than a year after diagnosis.

Treatments currently available across different stages of the disease include:

• Surgery to remove masses                                           

• Radiation

• Liver transplant                            

• Transarterial chemoembolization

• Chemotherapy                                 

• Tyrosine kinase inhibitors

Immune checkpoint inhibitors, which target the PD-L1 and PD-1 proteins

Future perspectives for people with HCC Despite the high prevalence of HCC,people with the disease still have few options and a low survival rate.

References

1. WHO: Globocan 2018 – Liver cancer factsheet. [Internet; cited 2019 Dec 6] Available from:

2. Llovet J, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016;2:16018.

3. Dimitroulis D et al. From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world. World J Gastroenterol. 2017;23(29):5282-5294.

4. Yang JD, et al. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nature Reviews . 2019; 16:589-604

5. Tanaka M, et al. Hepatitis B and C Virus Infection and Hepatocellular Carcinoma in China: A Review of Epidemiology and Control Measures. J Epidemiol. 2011;21(6):401-416.

6. Islami F, et al. Disparities in liver cancer occurrence in the United States by race / ethnicity and state. Ca CancerJ Clin. 2017;67:273–289.

7. Pimpin L, et al. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies.J Hepatol. 2018;69:718–735.

8. WHO – Obesity and overweight. [Internet; cited 2019 July 24] Available from:

9. Medline. [Internet; cited 2019 July 24]. Available from:

10. Giannini G, et al. Prognosis of untreated hepatocellular carcinoma. Hepatology. 2015;61(1):184-190.

11. Medscape. [Internet; cited 2019 July 24]. Available from:

12. Marrero K, Kulik L, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by theAmerican Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723-750.

13. Wu Q, Qin S. Features and treatment options of Chinese hepatocellular Carcinoma. Chin Clin Oncol. 2013;2(4):38.

14. Okusaka T, Ikeda M. Immunotherapy for hepatocellular carcinoma: current status and future perspectives.

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