Liver Cancer

Liver cancer, that recently claimed the life of the ever-smiling senior Maharashtrian politician and ex-CM, has become a hotly researched and discussed topic in hepatology meetings in the last few years. The reason for resurgence in interest in this disease, acronymed HCC (Hepatocellular cancer) stems from the recognition that it is the 5th commonest cancer worldwide, claiming around a million lives annually, but equally from the new understanding of this unique cancer, methods of its detection and specific treatment modalities that are indeed curing many.

Cancer, as we all know and fear, has long been considered to be an universally and always fatal disease. Not any more! Doctors, who once talked of 1-year and 5- year survival rates are now beginning to talk of "cure". And HCC is joining this list after lymphomas, leukemias, colon and breast cancers.

For one, doctors have realized that HCC usually does not occur in "anyone"; it needs a hot bed of a diseased liver or a longstanding liver infection with Hepatitis B or C virus to occur. If patients with these predisposing conditions are checked up frequently, it stands to reason that cancers would be picked up very early and removed.

Dr Okuda, a Japanese hepatologist in the 80s, who periodically screened all his patients of liver cirrhosis with meticulous ultrasound examination, soon started finding small round tumours springing up in the liver. Once picked up early, they could be removed by surgery or burnt with chemicals, producing "cure" in a few.

Taking up on this cue, scientists went a step further in all directions. Better technology, such as triple-phase contrast enhanced CT scanning and MRI led to higher pick-up rates of even smaller tumors. Further, other methods of destroying tumor cells within the liver emerged such as burning it with a radio-frequency probe inserted into the tumor, selective deposition of anti-tumor drugs or radio-isotopes into the lesion through an arterial catheter, and selective drugs.

Not to be left behind, surgeons joined the fight by resecting affected portions of the liver or removing tumorous livers and transplanting healthy ones in their place.

Despite these advances, what then makes liver cancers turn fatal? The commonest cause is if the disease is advanced and has spread already to other parts of the body when detected. Mistaken diagnosis and failed initial therapy come much lower down.

Liver cancer has also taught us that it comes on almost always in diseased livers. The importance of checking and screening for Hepatitis B and C cannot therefore be over emphasized. If found positive, and and the infection timely treated, cancer risk recedes. While infections are on the decline in developed countries, exponentially increasing consumption of alcohol is likely to keep hepatologists in the business of treating HCC in the next few decades to come.

As published in HT City ( Hindustan Times) dated 26th August, 2012