LIVER CANCER & HEPATITIS IN NIGERIA

Liver cancer is the second leading cancer death in Nigeria and it is associated with viral hepatitis, which is virtually unknown to the general public, including some fractions of health-care providers. Complications of viral hepatitis infections such as cirrhosis of the liver, liver cancer and liver failure associated with liver cancer affect mostly people at their prime of life. Epidemiological study reveals that 1 in every 8 persons in Nigeria is living with viral Hepatitis and about 22 million Nigerians are estimated to be infected with either HBV or HCV. 90-95% of Mother to Child Transmission of viral hepatitis ends in chronic hepatitis and in the absence of treatment, 15 – 40% of persons living with viral hepatitis will develop liver cirrhosis and/or liver cancer.

Economically, treatment of hepatitis is expensive usually in millions of naira, 60% and 33% of liver cancer cases in developing countries are caused by Hepatitis B and Hepatitis C respectively.

Over the years there have been series of information dissemination through different avenues to the people on the importance of vaccination especially polio but little emphasis has been focused on cancer prevention through vaccination. And despite the resources available, preventable diseases such as cervical and liver cancer still constitute health risks and deaths among the people. This is so due to insufficient of proper channel of information or outright misinformation.

At Project PINK BLUE, we are using the World Immunization Week (WIW) to educate Nigerians on the need to vaccinate themselves against Hepatitis, thereby reducing their risk of liver cancer.  Please click here to learn more about WIW.

LIVER CANCER

What is liver cancer?

Cancer can start any place in the body. Liver cancer starts in the liver. It starts when cells in the liver grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should.

Cancer cells can spread to other parts of the body. Cancer cells in the liver can sometimes travel to the bone and grow there. When cancer cells do this, it’s called metastasis (pronounced meh-TAS-tuh-sis). To doctors, the cancer cells in the new place look just like the ones from the liver.

Cancer is always named for the place where it starts. So when liver cancer spreads to the bone (or any other place), it’s still called liver cancer. It’s not called bone cancer unless it starts from cells in the bone.

The liver

The liver makes bile to help the body use food. It also cleans the blood and helps blood clot.

Are there different kinds of liver cancer?

There are many types of liver cancer. Some are very rare. Your doctor can tell you more about the type you have.

The most common kind is called hepatocellular carcinoma (heh-PA-toh-SEL-yoo-ler CAR-sih-O-muh). Sometimes it’s called HCC for short. It starts in the cells that make up the liver.

Some rare types of liver cancer are:

  • Angiosarcoma (pronounced AN-jee-o-sar-KO-muh)
  • Hemangiosarcoma (pronounced hee-MAN-jee-oh-sar-KOH-muh)

These start in the cells lining the blood vessels of the liver. They often grow quickly.

Secondary liver cancer

Most of the time when cancer is found in the liver it didn’t start there. It really spread there from somewhere else in the body. Because the cancer has spread from where it started, it’s called a secondary liver cancer. So, cancer that started in the lung and spreads to the liver is called lung cancer with spread to the liver, not liver cancer. This cancer would be treated like lung cancer, not liver cancer.

How does the doctor know I have liver cancer?

Tests that may be done

Liver cancer often doesn’t cause signs and symptoms until it has spread.

Some symptoms of liver cancer are unplanned weight loss, don’t feel like eating, feeling full after a small meal, belly pain and swelling, and itchy, yellow skin. The doctor will ask you questions about your health and do a physical exam.

If signs are pointing to liver cancer, more tests may be done. Here are some of the tests you may need:

Ultrasound: For this test, a small wand is moved around on your skin. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture on a computer screen. This test is often the first test used to look at the liver.

CT or CAT scan: Uses x-rays to make detailed pictures of your body. CT scans can show the size, shape, and place of any tumors in the liver or near it.

MRI: Uses radio waves and strong magnets instead of x-rays to make detailed pictures. MRI scans can help know if tumors in the liver are cancer. They can also be used to look at blood vessels in and around the liver. They can help find out if liver cancer has spread.

Lab tests: Blood tests can check a protein called AFP (alpha-fetoprotein). AFP is often very high in people with liver cancer. Other blood tests can also help find out how well the liver is working.

Liver biopsy

In a biopsy (BY-op-see), the doctor takes out a small piece of tissue where the cancer seems to be. The tissue is checked for cancer cells.

There are many types of biopsies. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.

Sometimes MRI or CT scans clearly show liver cancer and a biopsy isn’t needed.

Grading liver cancer

The cancer cells in the biopsy sample will be graded. This helps doctors predict how fast the cancer is likely to grow and spread. Cancer cells are graded based on how much they look like normal cells. Grades 1, 2, and 3 are used. Cells that look very different from normal cells are given a higher grade (3) and tend to grow faster. Ask the doctor to explain the grade of your cancer. The grade helps the doctor decide which treatment is best for you.

How serious is my cancer?

If you have liver cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was “stage 1” or “stage 2.” Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the growth or spread of the cancer through the liver. It also tells if the cancer has spread to other organs of your body that are close by or farther away.

Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the liver. Be sure to ask the doctor about the cancer stage and what it means for you.

What kind of treatment will I need?

There are many ways to treat liver cancer, but the main types of treatment are surgery, tumor ablation, radiation, targeted therapy, and chemotherapy. Many times more than one kind of treatment is used.

The treatment plan that’s best for you will depend on:

  • The stage and grade of the cancer
  • The chance that a type of treatment will cure the cancer or help in some way
  • Your age
  • Other health problems you have
  • Your feelings about the treatment and the side effects that come with it

Surgery for liver cancer

Surgery (SUR-jur-ee) is the only way to try to cure liver cancer. Surgery can be done to take out the part of the liver with the tumor or to do a liver transplant. Talk to the doctor about the kind of surgery planned and what you can expect.

Side effects of surgery

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat liver cancer should be able to help you with any problems that come up.

Tumor ablation for liver cancer

Tumor ablation (a-BLAY-shun) destroys the tumor without taking it out. There are a number of ways to do this, such as heating the tumor with radio waves or microwaves, freezing the tumor, or killing the tumor by putting alcohol in it. Talk to the doctor about the planned treatment and what you can expect.

Radiation treatments

Radiation (pronounced RAY-dee-A-shun) uses high-energy rays (like x-rays) to kill cancer cells. There are different kinds of radiation. It can be aimed at the liver from a machine outside the body. This is called external beam radiation.

Radiation treatment can also be done by using a needle to put small radioactive beads into a large blood vessel in the liver (called the hepatic artery). This is called radioembolization (RAY-dee-oh-EM-boh-lih-ZAY-shun).

Side effects of radiation treatments

If your doctor suggests radiation treatment, talk about what side effects might happen. Side effects depend on the type of radiation that’s used. The most common side effects of radiation are:

  • Skin changes where the radiation is given
  • Feeling very tired (fatigue, which is pronounced fuh-TEEG)

Most side effects get better after treatment ends. Some might last longer. Talk to your doctor about what you can expect.

Targeted therapy for liver cancer

Targeted therapy drugs are newer treatments that may be used for certain types of liver cancer. These drugs affect mainly cancer cells and not normal cells in the body. They may work even if other treatment doesn’t. They come as pills that you take at home. These drugs have different side effects than chemo and they are often not as bad.

Chemo

Chemo (pronounced KEY-mo) is the short word for chemotherapy (pronounced KEY-mo-THAIR-uh-pee) – the use of drugs to fight cancer. The drugs may be given into a vein. These drugs go into the blood and spread through the body. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Chemo may be used to treat liver cancer, but it doesn’t work as well as other treatments for liver cancer.

Side effects of chemo

Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends.

There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help.

What about other treatments that I hear about?

When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor

  • Why do you think I have cancer?
  • What tests will I need to have?
  • Do you know the stage of the cancer?
  • What treatment do you think is best for me?
  • What side effects could I have from these treatments?
  • What should I do to be ready for treatment?
  • Is there anything I can do to help the treatment work better?
  • What do I need to do next?

What will happen after treatment?

You’ll be glad when treatment is over. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. Your doctor will ask about any symptoms that you might have and you will have exams, blood tests, and maybe other tests done to see if the cancer has come back.

Your visits may be every 3 to 6 months for the first 2 years, then every 6 to 12 months. Then, the longer you’re cancer-free, the less often the visits are needed. After 5 years, they may be done once a year.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health.

You can’t change the fact that you have cancer. What you can change is how you live the rest of your life – making healthy choices and feeling as good as you can.

REFERENCES

Bosman F. Carneiro F, Hruban R, Theise ND, eds (2010). WHO Classification of Tumours of the Digestive System, 4th ed. Lyon: IARC

McGlynn KA, London WT (2011). The global epidemiology of hepatocellular carcinoma: present and future. Clin Liver Dis, 15: 223-243, vii –x. http://dx.doi.org/10.1016/j.cld.2011.03.006 PMID:21689610.

American Cancer Society (2016) Liver Cancer. Access: March, 17th 2017, Source: https://www.cancer.org/cancer/liver-cancer.html