Dr Naveen Polavarapu is Chief Transplant Hepatologist and Consultant Gastroenterologist at Apollo Hospitals)
Hepatocellular carcinoma (HCC), commonly known as liver cancer, is fastest-growing cancer in the world. HCC usually occurs in cases of chronic liver disease, wherein there is no symptom until the liver is damaged to an advanced stage, which is why liver diseases are known as silent killers.
Liver cancer is the fifth most common cancer globally, with approximately 8,41,000 new cases reported in 2018. It is also the second most common cause of cancer death, with over 7,80,000 deaths in 2018, suggesting that it is deadly cancer that hardly gives us a chance to treat patients. The five-year survival rates of this deadly cancer are dismal at 21 per cent.
As per studies, multiple risk factors have been identified in the development of HCC, and a common characteristic among many of them is an injury to the liver parenchyma, resulting in cirrhosis. Chronic infection with Hepatitis B virus (HBV) or HCV underlies in many of these cases. In an analysis of 7,70,000 cases of HCC occurring worldwide, over 50 per cent of cases was attributed to chronic HBV, and 20 per cent of cases was attributed to chronic HCV infection.
The other common reasons for HCC are fatty liver-related cirrhosis and alcohol-induced cirrhosis. There are over 100 different reasons why the liver can get damaged and lead to cancer.
Liver cancer does not usually cause any symptoms of its own. A few patients might have a lump or mild pain in the upper belly, and feel full early on when they try to eat or lose weight. Others might have symptoms that are caused by the liver disease they had before they got cancer. Those symptoms can worsen or return because of cancer. They include swelling of the belly or legs, the skin or white part of the eyes turning yellow, blood vomitus, black stools, drowsiness, change in sleep pattern, extreme weakness and fatigue.
The diagnosis of HCC, which can be difficult, often requires using one or more imaging modalities. The goal is to detect the tumours when they are ≤2 cm in size so that the entire range of curative treatment options is available. The five-year survival rate for patients whose tumours are detected early and who receive treatment exceeds 70 per cent.
Although the best long-term survival is observed after surgical therapies, most patients are not eligible because of late presentation. Surgical resection is a potentially curative therapy for patients without cirrhosis or those with cirrhosis who lack portal hypertension. Liver transplantation is a potentially curative therapy for select patients who are not candidates for resection.
Most adult patients with cirrhosis and some patients with chronic HBV are at sufficiently high risk for developing HCC, so they should be enrolled in a screening and surveillance programme. Screening aims to detect the disease at a very early stage. Surveillance of at-risk patients with imaging results in detecting HCC at an earlier stage, which positively affects outcomes.
