Liver cancer, or why the diagnosis is random
The peculiarity of liver cancer is that in the early stages it is almost asymptomatic and the diagnosis is often made by chance during the examination due to other problems. Liver cancer is a rare but dangerous disease. What is the difficulty in diagnosing and treating liver cancer? About this for readers Medpulse tells MD, professor Yuri Patyutko.
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– How often is this disease?
– Primary liver cancer in Russia and in Central Europe is not so common – about 5 cases per 100 thousand people. He is not even included in the “top ten” malignant tumors. Nevertheless, the diagnosis of this disease is a serious problem. The most important thing is to detect liver cancer at an early stage. There is such a concept – “5-year survival”: if the patient after 5 years survives the tumor, he gets a real chance to live for a long time. So: if the size of the liver tumor, when we remove it, is up to 5 cm, then the 5-year survival rate is 70-80%.
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– And what is the difficulty in diagnosing liver cancer?
“The tragedy of this disease is that in the early stages it is almost asymptomatic, and the diagnosis of liver cancer is most often made by accident, during the examination due to other problems. Our center is designed to ensure that any person who has a suspicion of liver problems can undergo a qualified examination here. We want to organize such centers in 7-10 regions of Russia. Another important point is the compilation of the All-Russian Cancer Register. Of course, there are statistics now, but it cannot be said that all patients have been taken into account.
– You said that in Europe, liver cancer is not very common. And in other regions?
– A different picture in Southeast Asia: in China, Japan, Vietnam. There are many cases of hepatitis. Hepatitis can pass into cirrhosis over the years, and then into cancer.
– Is it possible to say that in 2010-2012 there were more cases of primary liver cancer in Russia?
– Not yet. But, according to our virological colleagues, there is a clear increase in the number of cases of viral hepatitis B and C. all over the world. This is due to population migration, increasing contacts, and expanding treatment methods – because hepatitis is transmitted through blood, plasma, and blood transfusions. Hepatitis can be contracted by the dentist through sexual contact. If the number of hepatitis patients is growing, then sooner or later the number of cases of primary liver cancer will increase. And we must be prepared for this.
The best treatment for liver cancer is surgery
– So, if a person has no hepatitis, he is not at risk of liver cancer?
– Unfortunately, this is not the case. Among all the patients we operated on in recent years, only 50% suffered from hepatitis.
– What else provokes liver cancer? Genetic predisposition, ecology, nutrition?
– There is no such data yet, although scientists around the world are studying the problem.
– Do people who abuse alcohol are at risk?
– Alcohol does not cause liver cancer in itself, but if a person suffering from hepatitis drinks, this is a big risk. Everyone who has hepatitis B and C markers should have an ultrasound scan every year. For example, in China and Japan there are social programs for the compulsory medical examination of people with hepatitis, and there are the largest number of operations in the early stages. If such a system is established in our country, this will be a big step forward.
– If you are diagnosed with liver cancer, what treatment will the patient have?
– Surgical treatment of liver cancer is the most effective. If there is no concomitant cirrhosis, up to 70% of the liver can be removed – this organ is very well restored. Also, liver transplantation is common in the world, which is rarely done in Russia. Liver transplantation is a very promising method, and our country needs state transplant programs. Most often, an entire liver transplant is done – from a late donor. But you can take half. For example, they do a related transplantation – they take half of the liver from the parent and transplant it to the child.
– And if for some reason an operation for liver transplantation is impossible?
– There are other treatments for liver cancer. For example, thermoablation: a thin electrode is inserted into the tumor and, in simple terms, it is “burned”. Chemotherapy is also carried out. Today there are new fairly effective drugs. They are used independently – in the treatment of inoperable cancer and after surgery. Now there is a large international study comparing the results of a purely surgical treatment of liver cancer and combined – in combination with drugs. It is important to work as a team!
– In addition to the need for early diagnosis, what else do you consider the most important for the fight against liver cancer?
– Training of specialists. Unfortunately, there are few who want to work in this area. Over the past 5 years I have not had a single graduate student! Operations on the liver are technologically very complex and lengthy. Great psychological stress. Complications are possible at every moment.