By Eduardo Gonzales, MD What makes Filipinos prone to liver cancer? How deadly is this cancer? —[email protected]   Liver cancer, which refers to cancer that originates in the liver, is truly more common in the Philippines than in most other countries. Worldwide, it is only the eighth most common cancer and in first world countries such as the US, it is rare, but in the Philippines, it is the third most predominant cancer, the second most prevalent cancer in males and ninth most prevalent in females. In 2014, liver cancer claimed the lives of 20 Filipinos a day; a number that is projected to double by 2030. Underlying causes of liver cancer among Filipinos Liver cancer is common in the Philippines not because we are constitutionally prone to the disease but because certain predisposing factors for the disease afflict many of us. Foremost of these is chronic hepatitis B. Between 10 to 12 percent of all Filipinos, (i.e., more than eight million), have chronic hepatitis B, making it a major public health problem in our country. Hepatitis B is caused by a virus that is mainly transmitted by the parenteral route (i.e., use of contaminated needle for injection and transfusion of infected blood) and sexual intercourse, but the virus likewise spreads through contact with body fluids like saliva, tears, breast milk, and urine. It can also be transmitted by an infected mother to her baby during delivery. Generally, hepatitis B is a mild, self-limiting infection. In about 10 percent of cases, however, the body’s defenses are unable to eliminate the virus and chronic hepatitis B ensues. Over time, chronic hepatitis B gives rise to cirrhosis or severe scarring of the liver. Cirrhosis of the liver, on the other hand, is the most important predisposing factor to liver cancer. About 80 percent of all liver cancers arise from liver cirrhosis. Thus, any condition that predisposes to cirrhosis indirectly causes liver cancer. Incidentally, the other form of hepatitis that causes cirrhosis is chronic hepatitis C, but this is not a very significant cause of cirrhosis among Filipinos. Another growing concern of late among our people is fatty liver, which can also give rise to cirrhosis. Fatty liver refers to the accumulation of fats in the organ. The condition is usually seen among heavy alcoholics, but it is also prevalent in people with diabetes, high cholesterol, and triglycerides, and are overweight or obese—three conditions that are now afflicting Filipinos in epidemic proportions. Another risk factor for liver cancer that adds to the high incidence of the malignancy among Filipinos is aflatoxin. Aflatoxin is a toxin that damages the liver and may cause liver cancer. It is produced by certain species of molds that grow in foodstuffs such as peanuts, corn, rice, dried fruits, spices, crude vegetable oils, cocoa beans, and copra, as well as milk and milk products from cattle that have consumed contaminated feed. The high temperature and relative humidity that prevails in the Philippines, and the often improper storing, processing, and handling of foodstuff are the reasons the aflatoxin content of the above mentioned food products are frequently above the acceptable level. Liver cancer is highly fatal but preventable Liver cancer has a poor prognosis or outlook because it is often diagnosed very late in its course. It develops silently usually presenting no symptoms until the tumor is already at least 10 cm in size, at which time cancer cells have likely spread to other tissues and organs. Without treatment, most liver cancer patients die within a year of diagnosis. The five-year survival rate for the disease if no treatment is undertaken is less than five percent, but even with treatment, it is still a low 35 percent. Liver cancer is highly fatal but it is preventable because its major risk factors are already known. Measures that can significantly reduce one’s risk for cancer of the liver include vaccination for hepatitis B, avoidance of alcohol,  proper storage of foodstuff, maintenance of a desirable body weight, exercise, and a healthy diet.   Email inquiries on health matters to: [email protected]