Those days it was equivalent to a death sentence. If someone was diagnosed with liver cancer there was only despair.
Today, however, medicine has advanced in this field and with modern therapies there is hope for people with liver cancer, reiterates Prof. Pierce Chow from Singapore in an exclusive interview with MediScene in Colombo recently.
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| Prof. Pierce Chow.
Pic by Mangala Weerasekera |
Selective internal radiation therapy is one which this Hepato-Pancreato-Biliary (HPB) Specialist picks on, turning the spotlight on the new wonder treatment for liver cancer.
Prof. Chow is not only a Professor at the Duke-NUS Graduate Medical School in Singapore but also Head of HPB Surgery at the Singapore General Hospital. While this eminent surgeon holds many other important appointments as well, he has more than 150 scientific publications and books to his credit.
Detailing selective internal radiation therapy, he says that about 20,000-30,000 very tiny (micro) spheres tipped with yttrium are delivered through a catheter into the artery in the groin of the person suffering from liver cancer by an interventional radiologist, part of a team also comprising a surgeon and a nuclear medicine physician. As the catheter is also threaded through the haepatic artery, the liver’s major blood vessel, the spheres find their way to the tumour site.
The microscopic spheres, each about one-third the diameter of a single hair, target the tumour in the liver and destroy it, explains Prof. Chow, pointing out that the radiation is delivered to that specific site. Conventional therapy, on the other hand, adversely affects not only the tumour but also nearby tissue.
Radiation from a machine is “a very bad idea” for a person with liver cancer as not only the whole liver, which is one of the most important organs in the body, but also the stomach will be affected, says Prof. Chow.
Survival is far superior under this new therapy which is being used by Singapore General Hospital in a big way since 2010.
However, if the liver cancer has spread to other areas, then chemotherapy with the drug sorafenib may be the answer, according to Prof. Chow, who cites the example of the malignancy going into the lungs. “This would help the patient to survive a little bit longer,” he says.
To deal with small tumours about three cm or less and not more than three such tumours in the liver, he recommends radio-frequency ablation, for the outcome increases life expectancy by 10 years for such patients. Radio-frequency waves passed through a probe into the tumour make the temperature rise, causing the destruction of the tumour.
The best, of course, if detected with liver cancer early would be to re-section or surgically remove the affected area. This is major surgery. If, however, a person is unfortunate to be diagnosed with liver cancer when the tumour is inoperable, there are these therapies that give hope. Those days, about 10 years ago, a surgeon would simply say sorry your cancer cannot be removed surgically and there was nothing he could do, he said.
Looking at the causes of primary (starting within the organ itself) liver cancer, Prof. Chow points his finger at viral hepatitis, with Asia having a higher incidence than the west. Hepatitis B is more prevalent in South East Asia, while in some parts of Asia Hepatitis C is also prevalent.
When comparing a person who has had viral hepatitis or is a carrier and one who has not had the disease, they would be very much more vulnerable to liver cancer than the last person, he says, adding that Hepatitis B is a higher risk factor than C.
Secondary liver cancer, however, could come in the wake of a cancer affecting another part of the body and spreading to the liver. In most parts of Asia, primary liver cancer is more prevalent while in the west it is secondary, says Prof. Chow.
Primary liver cancer is much more difficult to cure as viral Hepatitis B has scarred and hardened the liver, causing cirrhosis and this even without the cancer is a significant disease. “Unfortunately the people who have primary liver cancer have two diseases at the same time which makes treatment much more difficult, with cirrhosis reducing the functioning of the liver,” he explains.
Underscoring the fact that prevention of Hepatitis B would be the best, he explains that children may get the disease from their infected parents and the only way out in such a situation is vaccination. Lamentably, if someone’s parents have had viral hepatitis, a person in his ’30s or ’40s may have been a carrier for that long and the possibility of developing liver cancer at a young age would be high.
The other way of getting infected with Hepatitis B is through sexual intercourse, where body fluids from an infected person are passed onto another, he says. Hepatitis C usually spreads through infected blood transfusions.
The symptoms of Hepatitis B are elusive, according to Prof. Chow, and many carriers do not know they have the virus. The best way is to get a blood test done and if you are not a carrier get yourself vaccinated, while also undergoing regular screening for liver cancer, as this is a malignancy which spreads fast and furiously……with life ending in about six months.
But when detected, there is hope. For now Asia has highly specialized liver surgeons and state-of-the-art equipment, he adds. |
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