Liver Cancer and Hepatitis: Common Causes, Diagnosis and Prevention
Before looking into liver cancer in detail, let us first understand the role the liver plays in our body.
We all are aware that the liver is the largest organ in the body and serves to remove toxins and harmful substances from the body, which is an extremely vital function for our overall health.
An average adult liver weighs about 1.5 kg and is located in the upper-right portion of the abdomen. In addition to detoxifying the blood from harmful substances such as alcohol and drugs, the liver also acts as a storage house for sugar glucose, vitamins, and iron and also plays an important role in the digestion of fats, glucose and protein metabolism.
Common liver diseases include hepatitis infection, fatty liver disease, and liver cancer, as well as damage from alcohol, the pain reliever acetaminophen, and some cancer drugs.
In simple words, Hepatitis is inflammation of the liver. It is commonly caused by a viral infection and other lesser known causes include excessive alcohol consumption, side effects of prescription drugs and drug abuse. Hepatitis is known to be either self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer.
Infectious Hepatitis (Viral Hepatitis) is mainly caused due to infection by viruses namely Hepatitis A, B, C, D and E. These 5 types of hepatitis add to some serious burden of illness on the health care system and death and have a potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic is the most common cause of liver cirrhosis and cancer.
Causes of liver cancer:
Parenteral: Transmission by direct contact with infectious body fluids (blood, vaginal secretions, or semen,) such as contaminated blood or blood products, IV drug abuse, and sexual contact with an infected partner.
Acute infection presents with jaundice (yellowing of the skin and eyes), dark urine, pale stool, extreme fatigue, nausea, vomiting and abdominal pain, loss of appetite and unexplained weight loss, whereas, chronic hepatitis develops slowly and remains asymptomatic until the onset of cirrhosis or end-stage liver disease. The risk for chronic infection is greatest among young children and approximately 25% of those who become chronically infected during childhood.
Hepatitis is diagnosed by eliciting a history of previous exposure to the hepatitis virus and lifestyle habits, clinical examination, liver function tests, blood tests to isolate the virus and other serological factors, ultrasound scanning of the liver and Liver Biopsy.
Non Infectious causes of Hepatitis include chronic consumption of alcohol (also known as alcoholic hepatitis), recreational drug abuse and/or overdose of medications and less commonly due to exposure to harmful toxins/poisonous chemicals and in rare cases faulty immune conditions such as autoimmunity. It is mainly treated by discontinuing the consumption of alcohol/drugs, a special diet to correct malnutrition, administration of corticosteroids to reduce inflammation of the liver and severe cases of liver failure are treated with a liver transplant.
Hepatitis and liver cancer
Hepatitis B, C and D start as acute infections and run the risk of progression into more serious forms of chronic hepatitis and cirrhosis of the liver predisposing such individuals to the development of cancer. The risk is even higher if they are heavy drinkers (at least 6 standard drinks a day) and in immunosuppressed individuals.
Liver cancer is considered to be the 5th most common cancer in the world. The estimated number of cases per year in India is approximately close to 22,000 with similar mortality. Unfortunately, hepatitis B is relatively common in India and approximately 70% to 80% of all liver cancers are related to the hepatitis B virus (HBV).
Around 15% were related to hepatitis C virus (HCV), and 5% to both HBV and HCV. This prevalence of liver cancers in India is relatively less in comparison to the worldwide prevalence and is probably because of under-reporting of liver cancers, due to non-surveillance of chronic hepatitis B patients and carriers, and cirrhotic patients, attributing to the majority of cases being diagnosed at a late stage of the disease.
It most commonly occurs in males in the age range of 14 to 60 yrs and most of the cases under the age of 14 years are hepatitis B positive. Approximately 90% of patients are symptomatic at the time of diagnosis with the symptoms lasting five months to almost a year. The most common clinical presentations are anorexia, fever, weakness, abdominal pain, weight loss, ascites with jaundice, fever and gastrointestinal bleeding are common symptoms. Massive hepatomegaly (enlarged liver) is seen in about 50% of patients.
Liver cancer diagnosis and treatment
A liver cancer diagnosis is usually done by liver function tests, ultrasound scanning, serological tests and liver biopsy. Liver cancer prevention is possible at two levels. The first level of prevention is to avoid alcohol abuse and to prevent the occurrence of Hepatitis B or Hepatitis C by universal vaccination of all newborns and the rest of the non-infected population.
Management and liver cancer treatment of patients includes surgical resection and liver transplants in 90% of cases. Those cases that can’t be treated with surgery are treated with Radiofrequency ablation (RFA), trans-arterial radioembolization (TARE) and trans-arterial chemoembolization (TACE). The majority of the patients are treated with palliative and supportive care and life spans are limited. Chemotherapy is administered to a relatively small section of patients.
The fact that a vast majority of liver cancers are due to chronic viral hepatitis underscores the critical importance of hepatitis vaccination, early diagnosis, and treatment to reduce the burden of illness on the health care system. Therefore it is critical that you understand the condition well and prevent it.