HOW DO I PREVENT LIVER CANCER?
What is the Liver?
The Liver is the Metabolic factory of your body and it has 2 main function. The Synthetic function of the liver manages functions such as hormone production, platelet regulation, clotting factors and blood sugar regulation. The Excretory function on the other hand disposes waste such as Bile. The symptoms of Liver Disease depends on the main diagnosis. It is very common for Liver patients to have more than 1 problem.
The main ways to prevent Liver Cancer is to prevent Liver Cirrhosis and effectively manage Hepatitis B through surveillance.
Stages of Liver Damage
It is important to understand that Liver Damage occurs in Stages. Healthy Liver gets damaged in stages of Fatty-Fibrosis-Cirrhosis and all Liver Cirrhosis will eventually develop Liver Cancer called Hepatocellular Carcinoma (HCC). Liver Cirrhosis itself can no longer be reversed. The only exception to the this is Hepatitis B that can develop Hepatocellular Carcinoma (HCC) even in a normal liver.
Liver Damages are Compounding
Almost all my patients these days have Fatty Liver, due to Lifestyle such as Poor Diet, Lack of Exercise and some with Excess Alcohol Consumption. Additionally Hepatitis B is still prevalent in Asia and Diabetes is on the rise. The combination of Fatty Liver + Alcohol + Hepatitis B + Diabetes are all compounding and will ultimately lead to the development of liver cirrhosis. The more diseases you have, the faster you develop Liver Cirrhosis.
Hepatitis B – Incurable but Treatable
Some of us with visual impairment requiring glasses have incurable vision problem, but it can be easily treated using Glasses allowing to function normally. Likewise Hepatitis B cannot be cured, the virus will always remain in our Liver because its cccDNA attaches to human cells. Antiviral medications such as Tenofovir or Entecavir effectively suppresses the virus and delays development of Liver Cirrhosis. All patients with Hepatitis B require regular follow-up with a Gastroenterologist or Hepatologist every 6 months for blood tests, tumor marker (AFP) and Ultrasound of the Liver. Ultrasound is especially important to pick-up Hepatocellular Carcinoma (HCC) because people with Hepatitis B can develop HCC even in normal liver.
How do we assess your Liver ?
Generally all assessment of Liver requires Blood Test and Imaging. Blood tests usually are done in phases. In terms of Imaging, Ultrasound is the preferred screening test because it is cheap and readily available.
Abnormal Liver Function Test
First we will check for viruses Hepatitis B and C. Most of us will check for Hepatitis A as well because patient might benefit from vaccine. Hepatitis D only affects those with pre-existing Hepatitis B and Hepatitis E is more common in places like Bangladesh. For those who have their AST/ALT more than 100 or raised ALP, I tend to perform second line investigations for diseases such as Autoimmune Hepatitis (AIH) and Primary Biliary Cholangitis (PBC) because these diseases can be treated easily, and tend to be missed unless it checked.
Ultrasound vs Fibroscan vs CT Scan vs MRI
Ultrasound
Ultrasound is very cheap and readily available even in most Private Clinics. It is a cheap and quick test to scan if anything is grossly abnormal with your liver. However Ultrasound is operator dependent, meaning the diagnosis is dependent on the skill of the person performing the test.
CT Scan 5 phase
Any abnormalities in the Ultrasound is often confirmed using CT scans, usually performed in 5 phases which is required to diagnosed Hepatocellular Carcinoma (HCC) because it can assess the Liver, Blood Vessels and the surrounding structure.
A CT scan is usually done in protocols such as Abdomen-Pelvis or Thorax-Abdomen-Pelvis and therefore able to pick up a wide variety of diagnosis.
MRI Liver with or without Primovist Contrast
MRI Liver is not very commonly performed because it is expensive and not readily available. However it is often very useful for patients with suspected Liver Cancers that is not conclusive on the CT scan.
Magnetic Resonance Cholangio-Pancreatography (MRCP)
MRCP is a type of MRI examination that does not use contrast. It is very useful to visualize the Bile Ducts and Biliary Tree to detect drainage/excretory blockages in the bile ducts. It is quite often performed after a CT scan to diagnose blockages in the drainage of Bile such as stones in the Bile duct (Choledocholithiasis) or Infections in the Bile Duct (Cholangitis).
Fibroscan
Fibroscan is a type of test called Liver Elastography useful that works by estimating in patients with Fatty Liver to quantify the degree of Liver Fat Content (CAP Score) and Liver Stiffness in patients with Liver Diseases such as Fatty Liver, Hepatitis B and C. It is quick and pain free and only requires patients to be fasted for 3 hours. However while it does provide a score, it is unable to visualize any conditions and won’t be able to give a diagnosis.
How to Care for my Liver
Patients with Hepatitis B can get treatments to effectively suppress their virus whereas patients with Hepatitis C can be cured with modern medications. Patients with Diabetes should make an effort to reverse their disease where possible or get it under control. Click here to see my recommendations on simple healthy lifestyle changes.
Supplements
I generally do not recommend any supplements as none presently in the market have been proven to improve liver conditions except in rare circumstances.
Do I need to see a Specialist?
I am a trained Gastroenterologist & Hepatologist who specializes in managing patients with Liver Conditions. If you are have a Liver Problem or concerned about your Liver Health, please contact us to discuss your health condition today.
What to do next?
See our Fibroscan packages or contact us to discuss your health concerns.
