Today, I exchanged text messages with my patient who has had a liver transplant for liver cancer caused by infection with the Hepatitis B virus. It has been more than 5 years since his liver transplant and while it has not all been a walk in the park, he has been more fortunate than his three younger siblings who all succumbed to liver cancer and Hepatitis B. The month of January of each year has been declared “Liver Cancer and Viral Hepatitis Awareness and Prevention Month” by Republic Act 10526 to help bring into focus the story of my patient, which is not uncommon, in our country. His story highlights important aspects of the disease and its prevention and the need to raise awareness about it.
Liver cancer is an important public health problem worldwide and in the Philippines. Liver cancer claims the lives of close to 800,000 persons every year worldwide and more than half of these are caused by infection with either the Hepatitis B or Hepatitis C virus. In the Philippines, it is the fourth leading cause of cancer and the second leading cause of cancer deaths. More than half of all cases of liver cancer in the Philippines are caused by infection with the Hepatitis B virus. Hepatitis B affects 10% and Hepatitis C affects 0.6% of Filipinos.
What is the link between Hepatitis B or C and liver cancer? Infection with the Hepatitis B or C virus leads to inflammation and scarring in the liver. Scarring, the most severe form of which is called cirrhosis, can then lead to the development of liver cancer. Liver cancer caused by Hepatitis B or C virus is treated in the same way as liver cancer from other causes. However, many cases of liver cancer in the Philippines are discovered at a late stage where treatment is either not possible or not effective. Prevention of the development of liver cancer and its complications in Hepatitis B or C infection, therefore, is an important aspect of the care of patients with these infections.
There are several ways that we can prevent liver cancer and its complications in those with Hepatitis B and C infection. For those who are already infected with Hepatitis B or C, early detection of liver cancer through screening and surveillance using liver ultrasound and a blood marker called alpha-fetoprotein performed every 6 months in high-risk patients is recommended. High-risk patients include those who have severe scarring or cirrhosis, those who have had the infection for a long time, and those with a family history of liver cancer. Early detection leads to improved survival in liver cancer patients. Another way to prevent liver cancer and its complications is to treat the Hepatitis B or C infection. Highly effective treatments for Hepatitis B or C infection are available and have become more affordable. For Hepatitis B infection, the long-term use of oral medications called Entecavir or Tenofovir taken once daily can control Hepatitis B infection and prevent the development of liver cancer. For Hepatitis C infection, highly effective antiviral medications such as Sofosbuvir, Ledipasvir. Daclatasvir, and Velpatasvir used in various combinations have been associated with very high cure rates which have been shown to decrease the risk of liver cancer.
Because early detection of liver cancer and early treatment of Hepatitis B or Hepatitis C is effective in preventing liver cancer and its complications, it is important to screen for Hepatitis B and C. Screening for Hepatitis B and Hepatitis C is recommended for those exposed to blood products before 1994, born to infected mothers, with close household contacts with Hepatitis B or C, those who have used intravenous drugs, and those with liver disease. Anyone who desires to be tested should undergo testing and linked to care.
The single most important strategy to prevent liver cancer is to prevent infection with Hepatitis B or C. For Hepatitis B, a highly effective vaccine is available. It is mandatory that all infants should receive the Hepatitis B vaccine within 24 hours of birth as stipulated in Republic Act 10152. Infant Hepatitis B vaccination is provided free by the Department of Health and is included in the Philhealth Newborn Care Package. For Hepatitis C, there is no vaccine available, prevention of infection is directed towards reducing the risk of exposure to the virus in healthcare settings and in high-risk populations, for example, people who inject drugs.
The CLHT, otherwise known as The Medical City Liver Center, may be reached through 89887000 loc. 6506.