What You Need to Know About Hepatitis B and Liver Cancer
Worldwide, chronic infection with hepatitis causes 80% of all primary liver cancers and more than 500,000 people die each year from this lethal cancer. Currently, primary liver cancer has a 5-year survival rate of only 10%.
The good news is that there is an effective vaccine against the hepatitis B. In fact, the hepatitis B vaccine was named the first “anti-cancer vaccine” by the U.S. Food and Drug Administration because the prevention of chronic hepatitis B infections results in the prevention of primary liver cancer due to hepatitis B (the vaccine, however, does not protect against liver cancer due to chronic hepatitis C infections).
Additionally, there are effective therapies to control and manage chronic hepatitis B infections to help prevent the progression to liver cancer as well.
What is primary liver cancer?
There are two types of cancers found in the liver: (1) Primary liver cancer which originates from the liver (also known as hepatocellular carcinoma or HCC), and (2) Secondary liver cancer which originates in other parts of the body and spreads to the liver.
Worldwide, primary liver cancer is the 3rd leading cause of cancer deaths and the primary cause of cancer deaths among men in China. In the U.S., it is the 3rd leading cause of cancer deaths among Asian Americans and the 8th leading cause of cancer deaths among Caucasians.
What is the link between hepatitis B and liver cancer?
The most common risk factor for liver cancer is chronic infection with the hepatitis B virus (HBV). Individuals chronically infected with HBV are 100 times more likely to develop liver cancer than uninfected people because the virus directly and repeatedly attacks the liver, which over time can lead to progressive liver damage and liver cancer.
What are the risk factors for liver cancer?
The risk for developing liver cancer among those who are chronically infected with HBV increases as a person gets older or if they have been diagnosed with cirrhosis. Although liver cancer most often occurs in the presence of cirrhosis, this is not always the case. Primary liver cancer can occur even in the absence of cirrhosis, which is why regular liver cancer screening is so important.
Additional factors that increase the risk of liver cancer include a family history of liver cancer, persistence of high HBV DNA levels, co-infection with HIV or HCV, and lifestyle choices such as excessive alcohol use and smoking. Studies have also shown that obesity and diabetes may be important risk factors for liver cancer. Liver cancer is more common among men than women regardless of race or ethnicity.
What are the symptoms of liver cancer?
Liver cancer is a silent killer because the majority of patients appear to be perfectly healthy and have no early signs or symptoms. Both small and large tumors may be undetected due to the shielded location of the liver underneath the ribs which does not register pain.
Pain is uncommon until the tumor is quite large. Later stages of liver cancer, when the tumor is very large or when it impairs the functions of the liver, can produce more obvious symptoms such as abdominal pain, weight loss, lack of appetite, weakness and fatigue, and finally the development of jaundice (yellowing eyes and skin) and abdominal swelling. People who experience any of these symptoms should see their doctor immediately for further evaluation.
Who should be screened for liver cancer?
Since liver cancer develops quietly, usually without symptoms, patients with chronic HBV should be screened for liver cancer as part of their routine medical management. For those with chronic hepatitis B, primary liver cancer can develop with or without cirrhosis, so regular screening is essential. Early detection of liver cancer results in more treatment options, which substantially improves the chances of survival after initial diagnosis.
What is liver cancer screening?
Liver cancer screening can be done as part of your regular doctor’s visit and generally consists of a simple blood test for alpha-fetoprotein (AFP) levels every 6 months and an ultrasound of the liver once or twice a year. Either test alone can miss the diagnosis. Some doctors prefer MRI or CT scans to ultrasounds. Once a patient develops cirrhosis, or has a family history of liver cancer, more frequent screening is generally recommended.
How is liver cancer treated?
Treatment of primary liver cancer is particularly challenging when compared with other types of cancer because in addition to the cancer itself, many patients have livers that have been damaged by chronic hepatitis B infections. For each individual patient, the potential benefits of the various treatment options must be balanced with the risk of liver failure and how it affects the patient’s quality of life. Current treatment options include surgery, chemotherapy, and one approved oral drug. A liver transplant is the only treatment option for those with liver cancer tumors that cannot be surgically or medically removed.