Taken from an interview on the Happy&Healthy show, during the Health Talk FM.102 segment, every Saturday from 09.00 - 10.00 AM, about liver cancer.

Taken from an interview on the Happy&Healthy show, during the Health Talk FM.102 segment, every Saturday from 09.00 - 10.00 AM, about liver cancer.

Liver cancer: What is it, and is it more common in women or men?

Liver cancer can be divided into two types:

Primary liver cancer: This is cancer that originates in the liver tissue or bile ducts in the liver.

Secondary liver cancer: This is cancer that has spread from other areas, such as lung cancer or breast cancer that has metastasized to the liver.

Primary liver cancer is the 5th most common cancer worldwide. In Thailand, according to data from the National Cancer Institute, it is the number one cancer in men and ranks second in women. Mostly it occurs as primary rather than secondary, but secondary cases do occur. Regardless of the type of cancer or its stage, if it is in stage 4, there is often a considerable spread to the liver, such as secondary liver cancer.

Causes of Liver Cancer

The causes depend on the region, such as Asia or specifically Thailand. Most cases are due to hepatitis B virus infection, which becomes chronic, and the main cause is mother-to-child transmission. This accounts for 60% of liver cancer cases in Thai people. Thai statistics indicate that approximately 6,000,000 people are infected with the hepatitis B virus. The result of infection with hepatitis B is chronic inflammation of the liver tissue that leads to liver scarring, hardening, and ultimately liver cancer.

In medical terms, a "carrier" means that the virus is present at a low level, but there are no symptoms of the disease, yet there is a chance of transmitting from mother to child. However, most hepatitis B virus carriers in Thailand have the virus in their bodies, but it's in the dormant phase of the disease, leading to the misunderstanding that carriers don't get sick. But if one day the body's defenses weaken, the hidden virus in the liver cells may increase in number, leading to the disease.

The primary ways to prevent this include vaccination against hepatitis B and screening in high-risk patients. Lastly, if the disease is detected, antiviral medication against hepatitis B can help reduce the chances of developing liver cancer.

The text explains various aspects related to hepatitis B and C viruses in Thailand and their relationship to liver cancer. It also details the vaccination strategies and other risks like alcohol consumption and obesity that might contribute to liver disease. Here's the translation:

For the hepatitis B vaccination in Thailand, newborns are vaccinated, achieving 100% coverage. If immunity does not develop after several years, a booster shot is not necessary every year. Only a single booster shot is usually enough, except in the case of patients with low immunity, such as those receiving steroids, cancer patients, or patients infected with HIV with a low white blood cell count (CD4). In these cases, the immunity might decrease, requiring more attention.

Besides hepatitis B, there is also hepatitis C, which is more common in Western regions but is found in about 10-20% of people in Thailand. Those at risk include intravenous drug users, those with unclean tattoo needles, and unprotected sexual intercourse among men who have sex with men. Current treatments for hepatitis C are quite effective, curing 95-98% within three months. However, hepatitis B is harder to eliminate from the body because the virus can hide in the DNA, making eradication difficult.

Another common cause is regular alcohol consumption, leading to chronic inflammation of the liver, hardening, and eventually liver cancer. Two other factors include fatty liver disease, becoming more common with obesity, and exposure to aflatoxins in food, such as in dried chilies or contaminated beans, which can also increase the risk of liver cancer.

So, to answer your question specifically, regarding the hepatitis B vaccine in Thailand, booster shots are not generally required every year. A single booster shot is usually sufficient unless specific conditions lower the body's immunity.

Liver cancer is similar to general cancer, where in the initial or mostly treatable stage, there are no symptoms. And in patients with symptoms, the majority who come for treatment may already be past the stage where complete cure is possible. It is recommended to screen using ultrasound combined with blood tests, such as in patients with cirrhosis, regardless of the cause, they should be screened for liver cancer every 6-12 months. For men aged 40 who are infected with Hepatitis B virus, they should be screened for liver cancer every 6 months. For women, screening starts at age 50, but family history must be considered. If the family has a history, screening should start earlier than usual. If in a later stage, symptoms may include right abdominal pain, loss of appetite, weight loss, jaundice, swollen legs. The stages of liver cancer are 4, namely:

Stage 1 (Early): Small cancerous lump, and only one lump.

Stage 2 (Intermediate): Proliferation of the lump into the liver's blood vessels, and/or several small lumps.

Stage 3 (Advanced): Large cancerous lump, and/or spread to adjacent liver tissue, and/or into large veins in the abdomen, and/or spreading to nearby gallbladder.

Stage 4 (Final): Cancer spreads through the bloodstream, often to other liver lobes and lungs, but may enter other organs such as the brain, and/or bones, or spread to gallbladders far from the liver, such as in the abdominal cavity or pelvic area.

The early and intermediate stages, which are these first two stages, are in the range that can be completely cured. But if in the advanced or final stage, treatment is usually aimed at improving life to live longer, but the chance of complete cure is difficult. Therefore, for prevention, it is recommended to check every 6 months or 1 year. Most general hospital health check-up programs already include this examination, but patients who are not in the risk group may not get screened. The main ones that need to be checked are patients with a history of cirrhosis, Hepatitis B virus infection. These patients must be specifically examined.

The current treatment does not focus on medication. For the group diagnosed with fatty liver, it is recommended that patients lose about 7-10% of their weight, which can help reduce liver inflammation and damage. However, the main guideline recommended by liver associations worldwide is for patients to exercise in conjunction with changing behavior and eating a healthy diet.

Currently, the risk is high, but there are 2 ways to detect fatty liver. In the case where fatty liver is present at 30%, an ultrasound of the liver can detect it. If a more detailed examination is needed, a Fibro Scan can be performed. This test is able to measure the fat in the liver and can also evaluate the extent of liver fibrosis.

Treatment involves a collaborative care approach among internists, surgeons, and radiologists to determine the best option for the patient. If the tumor is small, surgery is the first option, which may offer the patient a chance of complete recovery. However, the size of the tumor or nodule must not exceed 5 centimeters, there must be no cancer spreading to nearby blood vessels, and the liver's function must still be good. If the liver's function is poor, the remaining liver might not be sufficient for survival, or the liver might not function properly.

Normally, the surgeon will evaluate whether surgery is feasible. If the patient has cirrhosis and liver cancer, the best treatment option in this case, if the tumor is not too large and has not spread, and if within the defined criteria, is a liver transplant. This involves removing the old liver that has cancer and replacing it with a new liver that is cancer-free. But currently, this is relatively rare and is only performed in major hospitals or medical schools. The current problem is a shortage of organ donors, so the number of patients in need and the number of available livers are limited. The average cost of a liver transplant is about 1,000,000 THB. Government-funded surgeries cover only civil servants and those with social security, not yet including patients with a gold card. Plans are underway to expand access to treatment more widely. Currently, surgeries can be performed for 100-200 patients per year due to limited resources.

Another method for small tumors, not exceeding 2 centimeters, commonly used is high-frequency electrical waves. The high frequency converts to heat energy to destroy the liver cancer cells, with proven curative results, no different from liver surgery, for tumors no larger than 2 centimeters. This method is more popular abroad because hospital stays and surgeries are quite expensive, and many patients who do not want surgery or are at a higher risk for surgery may choose this method.

However, the choice of treatment method must be assessed individually, as the location of the tumor will affect the treatment. Another stage, when it has already spread, cannot be treated by liver transplantation or electric zapping, so there will be another treatment method called "TACE," which involves directly injecting chemotherapy into the cancer nodule, along with injecting Gelfoam to block the blood vessels feeding the cancer nodule. However, this treatment does not cure cancer but can improve the quality of life and prolong the life of the patient.

Preventing and taking care of liver health for the general public or individuals at higher risk for liver cancer is extremely important. Below are some additional recommendations for self-care:

Dietary Care: Consume nutritious and balanced foods such as vegetables, fruits, and foods low in saturated fats to promote good liver health.

Exercise Regularly: Engage in regular exercise to maintain a healthy weight and prevent fatty liver disease.

Avoiding Toxins: Be cautious with chemicals and drugs that might impact the liver, such as pain relievers, alcohol, or certain prescription medications.

Liver Health Screening: Consider regular liver check-ups to monitor the condition and function of the liver, especially if there are higher risk factors.

Avoiding Infections: Be careful with behaviors that risk infection, such as sharing needles for tattoos, having unprotected sex, or using injectable drugs.

Vaccination: If you have not been vaccinated against Hepatitis B or C, consider these vaccinations to prevent infection.

Alcohol Prevention: Consume alcohol in moderation or avoid it altogether if there are other risk factors.

Taking care of yourself and regularly monitoring liver health can reduce the risk of liver cancer and promote better overall health. Consulting with doctors or health professionals about appropriate liver care based on your health status is a good and beneficial step in the long run.