LIVER
CANCER - for Program Managers and Coalition
Members
Liver cancer kills
500,000 people around the world each
year, and the hepatitis B virus (HBV)
is the cause of most of these cancers,
making it the second-most prevalent
cause of cancer after tobacco smoke.
To prevent infections by HBV, children
in LMCs should be vaccinated at birth
- something that is done regularly
in high-income countries but is still
relatively rare in others, particularly
the poorest and hardest hit by the
virus. A three-dose series of the vaccine
costs less than $2 through Unicef and
can be subsidized by the Global Alliance
for Vaccines and Immunization. (source: UICC)
Hepatocellular
carcinoma (HCC) is the 3rd leading
cause of death by cancer worldwide
and 80% of these deaths occur in low
resource countries. The main risk factors,
namely, the combinations between hepatitis
viral infections and various environmental
factors, are, in theory, preventable.
It is time to consider developing a
global effort aimed at significantly
reducing the burden of this cancer
within the next generation, taking
into account that this cancer is particularly
difficult to treat. This will require
a much improved understanding of the
geographic, pathological, virological
and molecular diversity of the disease,
as well as the identification of reliable
biomarkers for risk assessment, early
detection and monitoring of the disease.
Developing such
an effort is the main objective of
the International
Liver Cancer Study (ILCS), a network
of clinicians, epidemiologists and
molecular biologists coordinated by
the International Agency for Research
on Cancer (IARC).
Chronic liver disease
and cancer
Hepatitis B and
hepatitis C viruses can result in chronic
liver disease and liver cancer. Hepatitis
C virus is also associated with a particular
type of arthritis, as well as a disease
of the blood vessels (vasculitis),
cryoglobulinemia (a blood disorder)
and peripheral neuropathy (disease
resulting in pain, numbness, and altered
sensations). (Source: CDC)
Having
hepatitis or cirrhosis can increase
the risk of developing liver cancer.
Anything that increases
the chance of getting a disease is
called a risk factor. Having a risk
factor does not mean that you will
get cancer; not having risk factors
doesn't mean that you will not get
cancer. People who think they may be
at risk should discuss this with their
doctor. Risk factors for liver cancer
include :
Having
hepatitis B or hepatitis C; having
both hepatitis B and hepatitis
C increases the risk even more.
Having a close
relative with both hepatitis and
liver cancer.
Having cirrhosis,
which can be caused by:
Hepatitis (especially
hepatitis C).
Drinking large
amounts of alcohol for many years
or being an alcoholic.
Eating foods
tainted with aflatoxin (poison from
a fungus than can grow on foods,
such as grains and nuts, that have
not been stored properly).
Tests are used
to screen for different types of cancer
Some screening
tests are used because they have been
shown to be helpful both in finding
cancers early and in decreasing the
chance of dying from these cancers.
Other tests are used because they have
been shown to find cancer in some people;
however, it has not been proven in
clinical trials that use of these tests
will decrease the risk of dying from
cancer.
Scientists study
screening tests to find those with
the fewest risks and most benefits.
Cancer screening trials also are meant
to show whether early detection (finding
cancer before it causes symptoms) decreases
a person's chance of dying from the
disease. For some types of cancer,
the chance of recovery is better if
the disease is found and treated at
an early stage. Clinical trials that
study cancer screening methods are
taking place in many parts of the country.
Information about ongoing clinical
trials is available from the NCI Web
site.
There is
no standard or routine screening
test for liver cancer
Although there
are no standard or routine screening
tests for liver cancer, the following
tests are being used or studied to
screen for it:
Ultrasound
Ultrasound is a
procedure in which high-energy sound
waves (ultrasound) are bounced off
the liver and make echoes. The echoes
form a picture of the liver called
a sonogram. The picture can be printed
to be looked at later.
CT scan
CT scan is a procedure
that makes a series of detailed pictures
of the liver, taken from different
angles. The pictures are made by a
computer linked to an x-ray machine.
A dye may be injected into a vein or
swallowed to help the liver show up
more clearly. This procedure is also
called CAT scan or computed tomography.
Tumor
markers
Tumor markers,
also called biomarkers, are substances
made by the tumor that may be found
in the blood, other body fluids, or
tissues. A high level of a specific
tumor marker may mean that a certain
type of cancer is present in the body.
Alpha-fetoprotein
(AFP) is the most widely used tumor
marker for detecting liver cancer.
However, other cancers and certain
conditions, including pregnancy, hepatitis,
and other types of cancer, may also
increase AFP levels. Specific tumor
markers that may lead to early detection
of liver cancer are being studied.
(source: NCI)
What
do we know about diet and liver cancer?
The
Panel concludes (Chapter
7.8 pages 277-280) To download the
liver chapter as a pdf click
here
The evidence is convincing that aflatoxins,
which contaminate mostly cereals (grains)
and pulses (legumes), usually as a
result of long storage in hot, wet
conditions, are a cause of liver cancer.
Alcoholic drinks
are probably a cause of liver cancer.
There is limited
evidence suggesting that fruits are
protective, and that body fatness is
a cause of this cancer.
Source: Second
Expert Report: Food, Nutrition,
Physical Activity, and the Prevention
of Cancer: a Global Perspective. World
Cancer Research Fund / American
Institute for Cancer Research (WCRF/AICR),
Washington DC: AICR, 2007. 537
Pages. Note: PDF file of the complete
report is 12 MB in size. More about
this report can be found on the
“diet” link [or some other name
later] of this website. To download
the entire report (pdf 12MB) please
click here.
• To download a summary of the report
(16 pages, pdf 1.2MB) please
click here • To download the report’s summary
in other languages than English (WCRF
website), please
click here
Resources
MedlinePlus
- Liver Cancer Link
MedlinePlus will direct you to information
to help answer health questions. MedlinePlus
brings together authoritative information
from NLM, the National Institutes of
Health (NIH), and other government
agencies and health-related organizations.
MedlinePlus also has extensive information
about drugs, an illustrated medical
encyclopedia, interactive patient tutorials,
and latest health news. To visit MedlinePlus
online for Liver Cancer with an extensive,
constantly updated resource list please
click here
US
GOVERNMENT AND GENERAL RESOURCES
The
National Cancer Institute (NCI)
is a component of the National Institutes
of Health (NIH), one of eight agencies
that compose the Public Health Service
(PHS) in the Department of Health and
Human Services (DHHS).
The National Cancer
Institute coordinates the National
Cancer Program, which conducts and
supports research, training, health
information dissemination, and other
programs with respect to the cause,
diagnosis, prevention, and treatment
of cancer, rehabilitation from cancer,
and the continuing care of cancer patients
and the families of cancer patients.
NCI publishes a
wealth of information about cancer
on the Web. To make it easier for you
we have provided direct breast cancer
links from NCI below.
“What
You Need To Know About™ Liver Cancer” NCI’s
booklet helps you to learn liver
cancer symptoms, diagnosis, treatment,
and questions to ask your health
care provider. To read the publication,
constantly updated, online on the
NCI website, please
click here
NCI’s booklet
“What You Need To Know About™
Liver Cancer” helps you
to learn about liver symptoms, diagnosis,
treatment, and questions to ask your
health care provider. NCI 2006, 51
pages (pdf 2MB). To download the
pdf file please
click here
American
Cancer Society (ACS)
is the nationwide community-based voluntary
health organization dedicated to eliminating
cancer as a major health problem by
preventing cancer, saving lives, and
diminishing suffering from cancer,
through research, education, advocacy,
and service. For liver cancer from
ACS please
click here
For a list of
the complete list of Guidelines,
from the American Cancer Society
(ACS), that are
updated constantly, please
click here
The American
Liver Foundation
was created in 1976 by the American
Association for the Study of Liver
Disease (AASLD). This organization
of scientists and healthcare professionals
was concerned with the rising incidence
of liver disease and the lack of awareness
among both the general public and the
medical community. The mission, the
programs and the services provided
by ALF complement the great work of
AASLD.
Flyers and brochures
ASCO
Answers: Liver Cancer ASCO
Answers is a series of fact sheets
that provides an introduction to a
specific type of cancer. Each fact
sheet is a PDF that includes an overview
of what the cancer is, an illustration
of where the cancer starts, how it
is treated, terms to know, and questions
to ask the doctor.
American Society of Clinical Oncology
(ASCO) 2008. 2 pages (pdf 292K). To
download the pdfplease
click here
Developing
a Health Education Program to Address
Liver Cancer in a Community Impacted
by Environmental Contamination
Melanie J. Rodriguez, MPH, (no date)
Public Center for Environmental Health,
San Antonio Metropolitan Health District,
San Antonio, Texas. 1 page (pdf 168K).
To download the pdf please
click here
Hepatitis
B Vaccine - What you need to know
CDC 2007, 2 pages, black and white,
easy to photocopy. (pdf 48K).
To download the pdf please
click here
Quality
Assurance & Improvement
The Pacific
Island Health Officers Association
(PIHOA) is dedicated to the health
and well-being of the Pacific Island
populations.
The links and documents
on their website have been selected
from a very large body of available
materials about quality assurance (QA)
and accreditation in health care, with
the intention of including those that
are especially useful for PIHOA members
and their associates who are interested
in building QA systems which fit with
their local needs. The materials have
been grouped into several sections. To
get to the PIHOA quality assurance
site please
click here
On-line tools
Siteman
Cancer Center:Cancer
- your disease risk This
interactive tool estimates your risk
of cancer and provides personalized tips
for prevention. Anyone can use it, but
it's most accurate for people age 40
and over who have never had any type
of cancer. Please
click here
Visuals
Online from the National Cancer Institute
NCI Visuals Online
contains images from the collections
of the Office of Communications and
Education and Office of Media Relations,
National Cancer Institute. Contents
include general biomedical and science-related
images, cancer-specific scientific
and patient care-related images, and
portraits of directors and staff of
the National Cancer Institute.
Use of Images
Except where noted
on the image details page, Visuals
Online images are in the public domain
and may be used, linked, or reproduced
without permission. If you use an image,
you should credit the listed source
and/or author. Please
click here
Journal
Articles
Liver
cancer in low and middle income
countries Prevention should target vaccination,
contaminated needles, and aflatoxins
Editorial, BMJ 2003;326:994-995 ( 10
May ) to read the full text online please
click here
