I heard that liver cancer is scary… Don’t worry less if you get this test twice a year [건강 팁]

Won-Mook Choi, Professor of Gastroenterology, Asan Medical Center, Seoul

About 15,000 new diagnoses per year… 7th most common cancer

Hepatitis B is decreasing as a result of the vaccine… Hepatitis C is increasing

High risk group for liver cancer when diagnosed with hepatitis B and C and cirrhosis

Hepatocellular carcinoma (hereafter called liver cancer) is the seventh most common cancer in Korea. The number of newly diagnosed patients in 2021 reached 15,131. The cancer death rate per 100,000 people is second only to cancer of the biliary tract. Among economically active men in their 40s and 50s, cancer carries the stigma with the highest mortality rate. The liver only sends a signal when it is damaged to the point where it cannot carry it. If inflammation or ulcers occur in the stomach, you may notice symptoms such as stomach ache and indigestion, but even if inflammation occurs in the liver, there may be no obvious symptoms. This is because once there is a certain level of fat, swelling or inflammation, no warning is sent. When the body rises and jaundice occurs, it is likely that more than 70% of liver function is already lost.

Chronic viral hepatitis, such as hepatitis B (60%) and hepatitis C (10%), accounts for about 70% of the causes of liver cancer in Korea. 15% are alcoholic liver diseases, and recently, metabolic liver diseases are increasing rapidly. Not all patients with chronic hepatitis develop liver cancer. However, the probability of developing liver cancer is much higher than healthy people. Avoiding chronic hepatitis is the best way to prevent liver cancer.

Newborns must receive hepatitis B vaccine. Even if you were vaccinated as a child, antibodies may not be detected as an adult. If antibody production has been previously confirmed, re-vaccination is not required, but if antibody production is unknown, the vaccine must be re-vaccinated. As vaccination is implemented nationally, the number of hepatitis B carriers is gradually decreasing. On the other hand, the number of hepatitis C carriers is increasing. Hepatitis C is more common in the West than in the East. It is transmitted mostly through blood, such as through piercings, tattoos, drugs, and injections. There is currently no vaccine to prevent hepatitis C, so it is important that you are exposed to the hepatitis virus.

As a result of CT examination of patients with liver cancer, cancer is observed (red circle). Photo courtesy of Seoul Asan Medical Center

With advances in cancer treatment technology, the 5-year survival rate for liver cancer has increased to 39.3%. However, treatment outcomes are still low compared to other types of cancer. Liver cancer mostly occurs as a result of chronic liver disease, and even if liver cancer is treated, chronic liver disease is not cured and the recurrence rate is high. When the liver is severely damaged due to cirrhosis, treatment options are limited and the effectiveness of treatment is inevitably reduced. Therefore, high-risk groups over 40 who have been diagnosed with hepatitis B or C or liver cirrhosis must undergo a liver ultrasound and a blood test (serum alpha-fetoprotein test) every six months through the national screening program cancer. If liver cirrhosis or fatty liver is severe and liver cancer is difficult to detect using ultrasound imaging alone, computed tomography (CT) or magnetic resonance imaging (MRI) is required. You can also take antiviral medication as prescribed by a specialist. At this time, hepatitis C can be completely cured by giving antiviral drugs. Even patients with hepatitis can reduce their risk of developing liver cancer if they undergo regular check-ups and have good lifestyle habits.

As the drinking culture spreads socially, the number of patients with cirrhosis and liver cancer caused by alcoholic liver disease is also increasing. In particular, for patients with viral hepatitis, abstinence from drinking is essential because frequent drinking can damage the liver at a rapid rate and increase the risk of developing liver cancer.

Surgical treatment for liver cancer is mainly divided into liver resection and liver transplantation. Liver resection is only possible in about 30% of liver cancer patients. The prerequisites must be met: the cancer has not progressed and the remaining liver function is sufficient. Recently, active efforts have been made to improve patient quality of life and surgical outcomes through minimal incisions using laparoscopy or robotics. Liver cancer itself is detected early, but if liver function is poor, it is difficult to remove it through surgery, so a liver transplant is performed. Even for patients with severe liver cirrhosis, a liver transplant may be the only treatment.

For small liver cancers, local treatments such as radiofrequency therapy (RFA) and extracorporeal radiation therapy are performed. If there are several liver cancers at the same time or if surgical treatment is difficult, hepatic arterial chemical embolization (TACE) or radioembolization (TARE) can be considered. This is a treatment that injects anticancer drugs or high-dose radioactive microspheres into the hepatic artery, which provides nutrients and oxygen to the liver cancer tissue. If the liver cancer has spread outside the liver or is very advanced, consider chemotherapy. Even if liver cancer is completely treated, there is a chance that cancer will develop again in the liver with remaining disease. Therefore, regular follow-up is important after liver cancer treatment. The risk of recurrence can be reduced by providing appropriate antiviral treatment along with management of the chronic liver disease.

Choi Won-mook, professor of gastroenterology at Asan Medical Center in Seoul. Photo courtesy of Seoul Asan Medical Center