New Delhi: Liver cancer also known as Hepatocellular cancer (HCC) arises from the normal cells of the liver. It is a deadly disease and globally it ranks third in terms of mortality as per GLOBOCAN (Global Cancer Observatory) 2022 data. In India, the incidence of liver cancer is 38,703 /100,000 cases per year. Over the last few decades, the incidence of liver cancer is increasing in India. Unfortunately, most of the time HCC gets diagnosed in advanced stages resulting in high rates of mortality as per Indian Council of Medical Research (ICMR) data. Cirrhosis of the liver is a precursor for the development of HCC. Common causes of liver cancer are chronic infection with Hepatitis B and Hepatitis C viruses, alcohol consumption, obesity, type 2 diabetes mellitus, hypercholesterolemia.
Dr. Sandip Ganguly, Senior Consultant Medical Oncology, Apollo Multispeciality Hospital, Kolkata, said, “Chronic infection with Hepatitis B is the most common cause of HCC. Prophylactic vaccination for Hepatitis B infection and its inclusion in the universal vaccination program is an essential step to prevent the infection. The cases of HCC are gradually increasing in patients with no antecedent history of Hepatitis infection or consumption of alcohol. It is seen in a spectrum of a disease called nonalcoholic fatty liver disease (NAFLD). NAFLD is characterised by the deposition of fats in the liver cells which cause hepatitis and if not controlled it causes cirrhosis of the liver and HCC. NAFLD is seen in patients with diabetes mellitus, obesity, and hypercholesterolemia. Lifestyle changes like weight loss through dietary modification and exercise aimed at reducing the risk factors play a crucial role in preventing NAFLD.”
Dietary modification is one of the ways to prevent HCC. A diet rich in calories, fats, and sugars causes obesity which in turn may cause HCC. Even high consumption of processed meats, salt-preserved foods, and alcohol consumption are important risk factors. Contrarily, a plant-based diet has been shown to help promote better liver health by preventing NAFLD. A diet rich in fruits and vegetables protects the liver from damage by causing detoxification with the rich antioxidant concentration in them. Similarly, whole grains like brown rice, oats, and wheat provide fibres that support the liver similarly and overall health. Fibre-containing foods like legumes and chickpeas play a pivotal role in stabilising blood sugar levels and thus reducing the risk of NAFLD. Healthy fats from nuts, seeds, avocados, and olive oil provide essential fatty acids and reduce inflammation in the liver
A patient with HCC must be treated under the supervision of a multi-disciplinary team (MDT) consisting of a surgeon, medical oncologist, gastroenterologist, radiation oncologist, and palliative care physician. Treatment decisions are individualised and are based on the extent of the disease, organ functions, patients’ general conditions, and preferences. Barcelona Clinic Liver Cancer (BCLC) staging system is used to determine the extent of disease in a patient with HCC.
Patients whose tumour size is less than 3 cm in size or those who have three tumors with normal organ function (BCLC A) should go for removal of the tumour in the liver or liver transplant if they are eligible. Removal of the tumour can be done by various processes. It includes surgical resection of the tumour, radiofrequency ablation of the tumour, or by ablating it by instilling ethanol injection percutaneously.
BCLC B patients are those whose tumour size is more than that of BCLC A patients with confinement within the liver and with no vessel involvement. They are treated by TACE (Transarterial Chemoembolization). In TACE, chemotherapy is directly administered into the tumour through the blood vessel which supplies the tumour and then embolizing (blocks) the blood vessel. Recent studies have shown that after TACE, giving immunotherapy (durvalumab) and targeted therapy (bevacizumab) results in better and prolonged disease control and is becoming the new standard of therapy.
HCC patients with major vessel involvement and /or spread to other organs with normal organ function are classified as BCLC C patients. They are treated with the intent to control the disease. They can be treated with oral targeted tablets like Sorafenib, Lenvatinib. But recently immunotherapy alone or a combination of immunotherapy and targeted therapy has shown marked and prolonged disease control with a better quality of life compared to the tablets. In one study, immunotherapy (atezolizumab) was combined with bevacizumab, and in another two different types of immunotherapy were combined (durvalumab+ tremelimumab).
Patients with advanced disease and poor organ function are classified as BCLC D patients. Unfortunately giving systemic therapy in any form causes more harm to the patients because of side effects. They should be considered for palliative care which aims at reducing the symptoms due to the disease burden.
Incidence of HCC is gradually increasing and lifestyle modification can play a pivotal role in reducing the risks of HCC. Proper treatment under the guidance of MDT is essential for proper treatment.
Patients with advanced disease and poor organ function are classified as BCLC D patients. Unfortunately giving systemic therapy in any form causes more harm to the patients because of side effects. They should be considered for palliative care which aims at reducing the symptoms due to the disease burden. Health Conditions Health News: Latest News from Health Care, Mental Health, Weight Loss, Disease, Nutrition, Healthcare
