Asia Pacific forum on liver cancer held in Cebu

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THE ASIA Pacific Association for the Study of the Liver (APASL) will be holding its third convention in Cebu City on Nov. 21-23 to tackle the growing menace of hepatocellular carcinoma or liver cancer worldwide. The Cebu conference is being hosted by the Hepatology Society of the Philippines (HSP).

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The HSP will be collaborating with the Philippine Society of Gastroenterology and the Philippine Society of Digestive Endoscopy to gather medical practitioners interested in getting a deeper knowledge and appreciation of liver cancer, its causes, detection, cures, modern imaging techniques and tricks on interventional hepatology.

Liver cancer (hepatocellular carcinoma) is the fifth most common cancer in men and the seventh in women and afflicts 600,000 people worldwide each year, with approximately 20,000 new cases in the United States, according to the New England Journal of Medicine.

In the Philippines, it is the third most common form of cancer in men and sixth most common in women. Hepatitis B is hyper-endemic in the Philippines which is why chronic Hepa B is the most common cause of liver cirrhosis and liver cancer.

Approximately 85 percent of these cases occur in developing countries especially in regions where infection of hepatitis B virus (HBV) is endemic namely in Southeast Asia and the sub Saharan Africa. Liver cancer occurs before the age of 40 and reaches its peak for those 70 years old and up, the journal stated.

Liver cancer is more prevalent in men than women. Liver cancer related to hepatitis C virus (HCV) has become the fastest rising cause of cancer-related death in the US, tripling in the past two decades with a survival chance of below 12 percent.

Major risk factors include infection with hepatitis B and hepatitis C viruses, alcoholic liver disease and non-alcoholic fatty liver disease (or obesity). The less common causes are heredity, antitrypsin deficiency, autoimmune hepatitis, porphyrias and Wilson’s disease.

Most of the risk factors lead to the formation and progression of cirrhosis, which is present in 80 to 90 percent of those with liver cancer.

Worldwide, chronic HBV infection accounts for half of all cases of liver cancer and all of childhood cases. In Asia and Africa, where HBV is transmitted from mother to newborn, up to 90 percent of infected persons have a chronic course with frequent integration of HBV into host DNA, the journal explained.

Although HBV can cause hepatocellular carcinoma in the absence of cirrhosis, majority (or 79 to 80 percent) of persons with HBV-related liver cancer have cirrhosis.

The risk of liver cancer among persons with chronic HBV infection increases if they are male or elderly, have been infected for a long time, have a family history of live cancer, have been exposed to mycotoxin aflatoxin, have used alcohol or tobacco, are co-infected with HCV or hepatitis delta virus, have high levels of HBV replication or are infected with HBV genotype C.

The estimated risk of liver cancer is 15 to 20 times higher among persons infected with HCV, the journal said.

Curiously, in several studies in Western countries, 30 to 40 percent of liver cancer patients did not have chronic HCV or HBV infection suggesting the presence of other causes like fatty liver disease (obesity) and metabolic syndrome (diabetes type 2 or lifestyle diabetes).

The journal said that several case control and cohort studies have shown that in Japan and southern Europe, coffee drinking has been associated with reduced risk of liver cancer; reduced insulin levels and reduced type 2 diabetes.

Efforts to reduce HBV through vaccination of infants and mothers in Taiwan 20 years ago have led to declining incidence of liver cancer among children ages 6 to 10 of by 65 to 75 percent, the journal noted.

The journal said that although several curative and palliative approaches to treatment of liver cancer have been developed, these would all depend on cancer stage, resources available and the level of practitioner expertise.

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