GASTROINTESTINAL CANCER PART-15
Welcome to the 15th part of educational series on GastroIntestinal Cancers. We learned in part 14 about treatment of pancreas cancer including surgery as the mainstay of treatment, with adjuvant chemotherapy and sometimes radiotherapy. However, most of these are diagnosed late and are treated with mainly medical management.
Question: Dear Dr. Chiragbhai, what are the risk factors for our next subsite hepatic cancer?
Answer: Hepatocellular cancer is a common cancer worldwide, with a very high incidence in Asia. Risk factors include:
- Hepatitis B
- Hepatitis C
- Cirrhosis – secondary to hepatitis and other causes
- Autoimmune hepatitis
- Genetic disorders like hemochromatosis, primary biliary cirrhosis etc
- Aflatoxin exposure in food
In Asia and Africa, Hepatitis B is the most common cause, whereas in north America, Hepatitis C is more common as cause of Hepatocellular Carcinoma-HCC. Effective immunization against Hepatitis B reduces rate of chronic hep B infection and hence HCC.
All health care workers, including doctors, nurses etc must take vaccine against hepatitis B. It is now part of childhood vaccination plan at most places in India as well. In Hong Kong, this strategy has shown significant reduction in incidence of HCC.
Que: If patients with cirrhosis or those with hepatitis B or C are especially at high risk for developing HCC, is there a screening tool?
Ans: Yes there is. It is not recommended for normal population, but it is worth considering in patients who have any of the above mentioned risk factors. A large randomized controlled trial involving over 18000 patients has shown improvement in survival with screening in patients with above noted risk factors.
This includes abdominal sonography and AFP level evey 6 months. It is shown to detect HCC cases early, thereby allowing surgical resection and increased survival.
Que: Why is this cancer generally detected late?
Ans: HCC mostly presents in very advanced stages, because of nonspecific symptoms like loss of appetite, upper abdominal pain, weight loss, jaundice. Sometimes it presents with paraneoplastic syndrome like hypercholesterolemia, hypercalcemia, erythrocytosis, hypoglycemia.
Diagnosis is made using Triphasic helical CT or MRI, with help of AFP. Classic signs on CT are diagnostic enough for tumors more than 2 cm. Biopsy is required when imaging and AFP are not showing classical findings. Biopsy is also required for non surgical management such as chemotherapy.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA),
Diplomate American Board of Oncology and Hematology.
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad. 079 26754001 www.shyamhemoncclinic.com