By Dr. Bappaditya Har, Senior Consultant – Gastrointestinal Oncology, Liver Transplantation and Hepatobiliary Surgery
Narayana RN Tagore Hospital, Mukundapur, Kolkata
October is observed as Liver Cancer Awareness Month a time to remind ourselves that liver cancer is not only a serious disease, but also one where prevention, surveillance and timely treatment can make a substantial difference.
Globally, the World Health Organization (WHO) has reported that approximately 866,000 adult liver cancer cases and over 758,000 death were recorded in 2022. Thus, liver cancer continues to represent one of the top 5 causes of death from cancer worldwide. Nonetheless, there is an important story of hope here as it has been announced by The BMJ that the Lancet Commission on liver cancer has revealed that it could be possible to prevent nearly 60 percent of the cases by controlling major modifiable risk factors. Many of liver cancer cases emerge against background of chronic liver disease. Chronic hepatitis B and hepatitis C infections, cirrhosis, heavy consumption of alcohol and liver metabolic diseases are considered key ones. And now the situation gets even worse since obesity, diabetes and fatty liver disease emerge as important factors responsible for the future burden of liver cancer.
Hepatitis B deserves particular attention because it is preventable through vaccination. Effective treatment is also available for chronic hepatitis B, while hepatitis C can now be cured in the vast majority of patients with modern antiviral therapy. Prevention and treatment of viral hepatitis therefore have an important role in reducing liver-cancer risk.
The silent nature of liver cancer makes surveillance important:
One of the challenges with liver cancer is that it may remain silent until it becomes advanced. Importantly, not everyone needs routine liver-cancer screening, but people at increased risk—particularly those with cirrhosis and selected patients with chronic hepatitis B/C—may require regular surveillance as advised by their hepatologist. For high-risk individuals, appropriate surveillance can help detect tumours at an earlier stage, when potentially curative treatments may still be possible.
Liver cancer is not synonymous with liver transplantation:
As a liver transplant surgeon, I often meet patients who believe that transplantation is the only treatment for liver cancer. This is not true. Treatment depends on the number and size of tumours, their location, liver function, presence of cirrhosis, vascular involvement and whether the disease has spread outside the liver.
Depending on the individual patient, treatment may include:
Surgical liver resection
Liver transplantation
Local ablative treatments, such as radiofrequency or microwave ablation
Radiological therapies, including chemoembolisation and radioembolisation
Systemic treatment, including modern immunotherapy-based treatments for appropriate patients
Where does transplantation fit in?
For carefully selected patients with liver cancer, particularly when the tumour is associated with significant underlying cirrhosis or within established criteria (Milan/California), liver transplantation can treat both the cancer and the diseased liver. In selected patients, locoregional treatments may also be used to control or downstage the tumour while transplantation is being considered.
Prevention remains our strongest weapon:
Vaccination against hepatitis B, testing and treatment for hepatitis B and C, avoiding harmful alcohol consumption, maintaining a healthy weight, controlling diabetes and metabolic risk factors, and seeking medical advice for chronic liver disease can all contribute to reducing the burden of liver cancer.
The message this Liver Cancer Awareness Month is simple:
Liver cancer can sometimes be prevented. When it cannot be prevented, early detection can change the course of the disease. And when cancer does occur, modern medicine offers several treatment options—not just one.
Awareness, surveillance and timely referral to an appropriate liver cancer centre can make the difference between discovering a cancer when it is treatable and discovering it when options have become limited.
