Yale-New Haven Hospital Physicians Predict Liver Cancer Epidemic

[naviga:img width="1" height="1" src="262308_files/image001.gif" vspace="5"]To many in Fairfield County, the initials HCC may mean nothing more than a community college in Bridgeport. On a global scale, however, HCC, or hepatocellular carcinoma, is the world’s most common form of internal cancer, affecting almost half a million people each year.

Especially prevalent in parts of Asia and Africa, hepatocellular carcinoma is a primary liver cancer, arising from hepatocytes, the major cell type of the liver.

Although the disease is still rare in the United States, physicians at Yale-New Haven Hospital (YNHH) have reason to believe that there will be a dramatic rise in cases within the next ten to 20 years due to the increase in patients with chronic hepatitis C.

“We will see an HCC epidemic in our country in the near future,” said Dr Guadalupe Garcia-Tsao, an attending hepatologist at YNHH. “The predominant factors that predispose HCC are different in the United States, where it is mostly associated with hepatitis C infection, than in Africa and Asia where the disease is most prevalent and is mostly associated with hepatitis B infection,” added Dr Garcia-Tsao, who is a professor of internal medicine at the Yale School of Medicine.

While the cause of the liver cancer is unknown, contributing factors include viral hepatitis, especially hepatitis B and hepatitis C, hemochromatosis (a disorder of iron metabolism), and toxins, specifically aflatoxins found in foods in parts of Africa and Asia. With the exception of people with hepatitis B, it is uncommon to find HCC in the absence of cirrhosis. Thus, the current increase in the number of people living with cirrhosis is a major factor in the predicted epidemic.

“It is estimated that HCC appears once cirrhosis has been present for about ten years. In the United States, the current hepatitis C ‘epidemic’ has led to an increase in the incidence of cirrhosis and it is therefore anticipated that the amount of HCC cases will greatly increase in the next decade or so,” explained Dr Garcia-Tsao.

Symptoms of HCC include abdominal pain or tenderness (particularly in the right-upper quadrant), an enlarged abdomen, bloating, decreased appetite, nausea, unexplained weight loss, and unexplained fevers. Many patients with HCC do not develop symptoms until the advanced stages of the tumor.

“With the approaching threat upon us, regularly scheduled screenings of patients with hepatitis C and cirrhosis could reduce the amount of cases of full-blown hepatocellular carcinoma,” said Jeffrey Pollak, MD, co-section chief of vascular radiology at Yale-New Haven Hospital, who believes that by early detection, the rate of casualties from HCC could be greatly reduced.

Only between ten and 20 percent of hepatocellular carcinomas can be surgically removed in their entirety, since HCC is usually diagnosed at a late stage in patients with advanced cirrhosis. HCC can be cured by surgery only if the tumor is small and the remaining liver will be sufficient to maintain adequate function. In some cases, liver transplantation may also be an option. For large tumors or smaller inoperable ones, interventional radiologists can often offer embolization and/or local tumor ablation (destruction). Embolization consists of blocking the liver arteries and chemotherapy drugs are generally used as part of the blocking agents (chemoembolization). Local tumor ablation may be accomplished by placing a needle into the tumor and either injecting 100 percent alcohol or using radio frequency waves to deliver heat at the needle tip to injure the tumor cells. Intravenous chemotherapy and radiation therapy generally are not very effective for HCC. These procedures may relieve symptoms and prolong life, but are not often curative.

“There is a critical need for further research on hepatitis C and the factors that contribute to the development of HCC if we are to combat this outbreak,” said Dr Garcia-Tsao, who concluded that identification of the steps that lead from chronic hepatitis C infection to cancer would help in developing means of early detection and possible prevention.[naviga:img width="1" height="1" src="262308_files/image001.gif" vspace="5"]