Liver cancer: The importance of surveillance and digital diagnostics

Aptly named the ‘silent killer’, liver cancer is the sixth most common cancer globally and carries a poor prognosis for those who are diagnosed with the disease at a later stage.[1,2] Thanks to a pioneering breakthrough in diagnostics, hope is in sight for patients around the world.

Liver cancer is now the third leading cause of cancer death1 and the number of deaths due to liver cancer is estimated to rise in the future.1 In fact, more than 900,000 people are diagnosed with the most common form of liver cancer, hepatocellular cancer (HCC), annually.1 Unfortunately, the majority of diagnoses occur in the late stages of disease, resulting in an overall survival rate of less than 16% after five years.3 Frustratingly, we know that many cases are preventable, so why is this cancer on the rise?1,4,5

Lifestyle factors play a major role

This is partly due to unhealthy diets and obesity being on the rise in many countries. 6,7 Key risk factors include: 2,8

  • Hepatitis B and C virus

  • Alcohol

  • Aflatoxin

  • Non-alcoholic steatohepatitis

Signs and symptoms to look out for

Unfortunately, HCC often doesn’t show symptoms until the advanced stages of the disease, but some people may experience symptoms such as: 2,9

  • Abdominal pain/enlarged abdomen

  • Easy bleeding or bruising

  • Unexplained weight loss

  • Jaundice

Early diagnosis offers the best chance for cure

While recent developments in screening and new treatments are making advances in the prevention, diagnosis and treatment of HCC, clinicians still face challenges in diagnosing the disease early enough:

  • Approximately 20 to 43% of liver cancer patients are diagnosed at an early stage.2, 10,11

  • Of HCC patients, which are diagnosed with late-stage disease, less than 16% survive a period of 5 years.5

  • Of the patients diagnosed at an early stage, more than 70%  may be alive after five years.5

Therefore, diagnosing HCC as early as possible is essential to improving patient outcomes.

The goal of HCC surveillance is to reduce HCC-related mortality by promoting very-early tumor detection and facilitating curative treatments. In a recent publication, Dr. Amit Singal, Medical Director of the Liver Tumor Program and Clinical Chief of Pathology at UT Southwestern Medical Center in Dallas, USA, observed a consistent association between HCC surveillance and improved clinical outcomes, including overall survival, across contemporary cohort studies [...] current data suggest HCC surveillance is of high value and should be promoted in patients with cirrhosis, particularly given the low proportion of surveillance-detected HCC cases across studies.12

Thanks to digitalisation, pioneering technologies are transforming the way that diseases can be detected, which in turn enable physicians to better predict a disease's prognosis and be more informed about treatment options for their patients at the outset. The good news is that these innovations in science and digital diagnostics may lead to a new era in screening for HCC. New digital algorithms are currently being developed to help physicians determine a patient’s likelihood of requiring further testing to aid in the diagnosis of early stage HCC. 13,14

Currently, people at high-risk of developing liver cancer may undergo ultrasound examinations, which can detect early stage HCC with a sensitivity of 45%.15Combining ultrasound and blood tests for protein levels can increase early stage detection by 18%.15 Furthermore, additional blood tests combined with a patient’s age and gender, in an algorithm, may indicate if a patient should undergo further HCC diagnostic testing.13,14

Algorithm to aid HCC diagnoses

Like many other forms of digital diagnostics, this algorithm is a beacon of hope for those suffering the effects of HCC now and into the future by improving patient outcomes and potentially easing a burden on healthcare systems. This Liver Cancer Awareness Month, those at risk of developing liver cancer are urged to act on any symptoms at the earliest stage to detect cases as soon as possible.

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References

  1. WHO: Globocan 2020 – Liver cancer factsheet. [Internet; cited 2022 October 4] Available from: http://gco.iarc.fr/today/data/factsheets/cancers/11-Liver-fact-sheet.pdf

  2. Llovet J, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016;2:16018.

  3. Tsuchiya, Nobuhiro et al World J Gastroenterol. 2015 Oct 7; 21(37): 10573–10583.

  4. Moon, et al.Clin Gastroenterol Hepatol . 2020 Nov;18(12): 2650-2666.

  5. Asrani et al. Journal of Hepatology 2019. Jan;70(1):151-171.

  6. Islami F, et al. Disparities in liver cancer occurrence in the United States by race / ethnicity and state. Ca Cancer J Clin. 2017;67:273–289.

  7. Pimpin L, et al. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018;69:718–735

  8. Medline. [Internet; cited 2022 october 4]. Available from: https://medlineplus.gov/ency/article/000280.htm.

  9. El‐Serag, H. B. (2002), Hepatocellular carcinoma and hepatitis C in the United States. Hepatology, 36: S74-S83.doi:10.1002/hep.1840360710.

  10. cancer.net [Internet; cited 2022 October 4]. Available from: https://www.cancer.net/cancer-types/liver-cancer/statistics

  11. CCO. [Internet; cited 2022 october 4]. Available from: https://cco.amegroups.com/article/view/2865

  12. Singal et al. (2022) HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: A meta-analysis. J Hepatol 2022 Jul;77(1):128-139. doi: 10.1016/j.jhep.2022.01.023

  13. Henry Chan et al. JGH Open: An open access journal of gastroenterology and hepatology 6 (2022) 292–300

  14. Philip J Johnson et al. Cancer Epidemiol Biomarkers Prev. 2014 Jan;23(1):144-53

  15. Tzartzena, K..,et al.. Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis. Gastroenterology. 2018 May;154(6):1706-1718.e1.

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