National Cancer Institute of Thailand statistical data from 2013-2015 revealed that hepatocellular carcinomas (HCC, or liver cancer) accounted for 34% of cancer cases among men and 13% of cancer cases among women, making it the most common and second most common form of cancer for males and females, respectively. Common age of onset for HCC are between ages 40 to 70. Most of the initial symptoms are nonspecific and the disease can progress quickly. This means that by the time patients are diagnosed the disease is often already at an advanced stage, making treatment ineffective. However, liver cancer that is detected early can be effectively treated, and regular checkups and a healthy lifestyle can help prevent liver cancer from developing at all.
Approximately 60% of liver cancer cases in Thailand are caused by chronic hepatitis B infections. There are currently around 6 million Thais suffering from hepatitis B. Patients with high levels of the hepatitis B virus are at significantly increased risk of developing liver inflammation and cirrhosis, and up to 3-8% more likely to develop liver cancer with each year that passes. If you have been diagnosed with hepatitis B, be sure to attend annual health examinations, as there are effective antiviral drugs available that can reduce the risk of developing cirrhosis and liver cancer. Additionally, hepatitis B can be effectively prevented by administering hepatitis B vaccinations in high-risk populations. Read more
While this is the most common cause of liver cancer in Western countries, it accounts for 10-20% of all liver cancers in Thailand. High risk groups include intravenous drug users, those who received a blood transfusion before 1989, and those who have been tattooed and/or pierced with a shared needle, all of which can increase a person’s risk of the hepatitis C virus entering the body. Chronic hepatitis C infection leads to chronic liver inflammation and fibrosis, which can lead to cirrhosis, detrimentally affect liver function, and increase the risk of hepatocellular carcinoma. If you have been diagnosed with hepatitis C infection be sure to undergo thorough testing. There are highly effective all-oral antiviral drugs available that can potentially cure and reduce the risk of liver cancer. Read more
Other causes of liver cirrhosis include alcoholic cirrhosis from heavy alcohol drinking and non-alcoholic fatty liver disease (NAFLD). People in these risk groups tend to have higher-than-normal levels of liver enzymes (AST & ALT) present due to chronic liver inflammation, fibrosis and cirrhosis. When their liver functions decline, patients may suffer with jaundice, abdominal distension from ascites, brain complications resulting from liver failure and a higher risk of developing liver cancer. Anyone in these risk groups is advised to undergo ultrasound screening for hepatocellular carcinoma every six months.
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are now being diagnosed in ever increasing numbers due to the worrying trend of sedentary lifestyles, decreased physical activity, high calorie diets and obesity, which can all play a key role in cirrhosis of the liver and the onset of liver cancer. Read more
For those suspected of suffering with liver fibrosis or the early stages of cirrhosis, clinical symptoms are often lacking or non-specific. FibroScan is a non-invasive tool for measurement and evaluation of liver stiffness. It helps medical staff to closely monitor patients suffering from chronic hepatitis B and C infections without the need for a liver biopsy. The device therefore helps with the planning of effective and timely treatment, and is also capable of screening for fatty liver disease. Read more
1. Surgery: This is the first consideration for treatment of hepatocellular carcinoma due to the likelihood of curing the disease. However, only those patients with normal functioning livers and cancer size smaller than 5 cm without involvement of nearby blood vessels will be considered because these groups are most likely to benefit from surgery.
2. Liver transplantation: This form of treatment is considered for patients who are also suffering with liver cirrhosis because it can offer treatment for both cancer and cirrhosis at the same time. Nonetheless, this form of treatment is only suited to patients for whom the cancer is small in size and has not yet spread to other nearby organs; the larger the carcinoma size, the greater the risk of recurrence after transplantation. Although liver transplantation is an effective form of treatment, this option remains limited in Thailand due to the small number of liver donors and the cost of surgery.
Samitivej Sukhumvit Hospital is a liver transplant center. Our team, consisting of transplant surgeon, hepatologist and medical staff, is well prepared to offer this treatment. Our hospital meets the required standards necessary to carry out the procedure, making this a viable option for patients who meet the criteria.
3. Radiofrequency ablation (RFA): Utilizing high frequency radio waves transformed into heat energy to destroy cancer cells, this method is effective in treating smaller carcinomas; those measuring less than 3 cm in size and located far enough away from vital blood vessels are the most suitable.
4. Transarterial chemoembolization (TACE) or transarterial radioembolization (TARE): These treatments involve injecting chemotherapy or radionuclide agents directly into the cancer in order to destroy cancer cells. These are followed by embolization of the feeding artery to decrease the blood supply to the cancer. Patients suited for TACE/TARE are those who cannot be treated using the prior mentioned treatments due to the size of the tumor, or those with a carcinoma located in close proximity to another vital organ or for whom surgery is not a safe option. However, patients still require their liver function to be good enough for the procedure, as decreased blood supply to some areas may lead to temporary liver function decompensation.
Both TACE and TARE treatments can significantly help patients survive longer.
5. Systemic chemotherapy: This treatment is considered in cases that have not responded well to any of the aforementioned methods of treatment. Systemic chemotherapy consists of either targeted chemotherapy or immunotherapy. Medical staff will carefully consider these options before making decisions on a case-by-case basis
There are now a range of treatments available for liver cancer, with the most suitable option dependent on the stage of the cancer, the size of the carcinoma and the liver function of the patient. Patients and their doctors will carefully consider each method of treatment before choosing the most effective option. Treatment for hepatocellular carcinoma is currently much more effective than in the past. Patients whose cancer has been detected during its initial stages are now more likely than ever to be completely cured. Therefore, it is of the utmost importance that liver cancer surveillance with abdominal ultrasonography be undertaken regularly in patients who fall into high-risk categories.
For patients without chronic liver disease, adhering to healthy lifestyles and undergoing regular annual exams should be sufficient to prevent liver cancer. This includes reducing exposure to risk factors associated with liver cancer, screening for hepatitis B and C infection, avoiding alcohol, maintaining body weight in a healthy range, and receiving essential vaccinations.
M.D., Faculty of Medicine Mahidol University , 2008