Liver cancer


Risk Factors

Viral hepatitis:

Chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are the main causes of liver cancers in this country.

Long-term exposure to:
  • Aflatoxin
    Aflatoxin is a naturally occurring mycotoxin produced by two types of mold: Aspergillus flavus and Aspergillus parasiticus. Aspergillus flavus is common and widespread in nature and is most often found when certain grains are grown under stressful conditions such as drought.
  • Cirrhosis
    In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should. Cirrhosis is due to:
    • Chronic alcoholism, chronic hepatitis B , C and D.
    • Hemochromatosis is an overload of iron in the liver. 20% of patients who get cirrhosis from the overload may develop HCC.
    • Alpha1- antitrypsin deficiency is a rare condition where a necessary enzyme is lacking to break down waste products in the liver and lung. HCC can develop in 40% of patients who get this type of cirrhosis.
  • Miscellaneous irritants to the liver including:
    • Polyvinyl Chloride (PVC) is linked to angiosarcoma.
    • Liver flukes are linked with bile duct cancer in China.
    • Thorotrast is a contrast dye for radiology studies no longer used after being linked to angiosarcoma.
    • Radiation Exposure can lead to liver sarcomas, sometimes as long as 5 decades after the exposure.
    The common thread to liver cancer risk factors is chronic irritation, which causes the liver cells to divide more quickly than they ordinarily would to repair perceived damage. The more often cells divide, the more the chance for a genetically abnormal one to arise, with the gene changes leading to it's becoming cancerous.
Age:

Increasing with age and common in males.

Screening

Patients that are at risk should have regular test done including alfafetoprotein measurements and liver ultrasound examination.

  • Alfafetoprotein (AFP)
    The sensitivity and specificity varies with the level of AFP.
  • Ultrasound
    The sensitivity varies from 71% to 78% while the specificity is about 90%.

Interval for screening is around 6 monthly.

Recommendation

Prevention is the best defense against liver cancer. Efforts to reduce the chances of cirrhosis, which lowers the risk of cancer, are one way of doing this. Early detection and treatment of chronic hepatitis is another. Some of the medications used to treat hepatitis, antiviral drugs, also appear to reduce the incidence of hepatic tumors.

Vaccination against hepatitis B is also advised, especially if you are already infected with hepatitis C. Alcohol abuse and illegal intravenous drugs are also discouraged. People at high risk for liver cancer should have regular screenings for liver cancer to increase the chances of early detection.