KOCHI: If you look into the national registry of cancer, you would find that there are very few patients with liver cancer in Kerala, when the reality is that in recent years, the numbers have been steadily increasing. However, there is no data to support this. To remedy this lack, the Kerala Society of Gastroenterology has started a study to figure out the actual numbers, and our initial reports are alarming.
Usually, the majority of patients with liver cancer have pre-existing alcoholic cirrhosis or virus-related cirrhosis.
But our findings have been that a chunk of the patients who come to us neither consume alcohol nor have Hepatitis B or C. These same patients have been found to be either diabetic or obese, two common forms of lifestyle diseases. We have now realised that there is a new killer disease that will grip the Malayali population in the coming years - Liver cancer, which is no longer the sole concern of those with alcoholism or Hepatitis.
Data from our hospital shows that over 300 cases of liver cancer were recorded last year alone. The numbers are similar or even more in other institutions and other government cancer centres. By next year, the study from the Kerala Society of Gastroenterology will give us the precise numbers of those struggling with this disease. With liver cancer, it is important to detect the disease early as there isn’t much we can do once it has progressed beyond a limit.
The treatment options vary depending on early detection, and whether the patient has cirrhosis along with cancer, depending once again on the stage of liver cirrhosis.The first option is a liver transplant. If that isn’t possible, then a curative resection can be done.Then come different ablative therapies - live microwave ablation and radiofrequency ablation, both of these procedures involve destroying the tumour under ultrasound or CT guidance. The next option is TACE (Trans-Arterial Chemo Embolisation), where the tumour blood supply is cut off angiographically, after placing chemotherapeutic drugs into a tumour. This sometimes requires multiple sessions.
TACE reduces the size of a tumour and makes it possible to be surgically removed at a later stage. The last option is TARE (Trans-Arterial Radio Embolisation), where radio-active beads are placed into a tumour angiographically. However, this is a very expensive treatment and resorted to only when there are no other options left. Unfortunately, there are no effective chemotherapy drugs for this disease.
It is saddening to note that some patients with liver cancer were picked up at a very early stage when curative treatments like surgery or transplant were possible. But they chose to go for alternative treatments and came back after a few months when we could not do anything. Prevention is always better than cure, so it is important for patients with cirrhosis of all causes to follow up every 6 months with ultrasound examinations and blood tests. When there is any doubt, an MRI or CT scan is required. With the advent of newer imaging modalities, a biopsy test is rarely done.
If you are an obese patient, you have to reduce your weight with a proper diet and exercise, especially if you are also diabetic. The role of exercise is of the utmost importance as NASH (Non-Alcoholic Steato Hepatitis) and NAFLD (Non-Alcoholic Fatty Liver Disease) are increasing very quickly in the Malayali population. A proper, healthy diet is also very important. With these facts in mind, let us all walk and eat towards a healthier Kerala.
— Dr Roy MukkadaChief consultant gastro enterologist and HODDepartment of Gastro medicine
VPS Lakeshore Hospital(The views expressed by the author are his own)