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| Edited By: |Source: |Updated: Nov 19, 2013, 11:17 PM IST
Cancer of the liver is painful, hard to detect, and virtually incurable. Labonita Ghosh finds out why its tentacles have spread and what can be done about it.
Naina Khanuja was diagnosed with liver cancer on May 20, 2007. By June 10, she had passed away, after suffering acute pain, memory loss and eventually slipping into a coma. “We admitted her into hospital at the beginning of May because she had a bad attack of jaundice,” says her son Lt Col Rajan Khanuja. “But the doctors had no idea it was liver cancer till the end of the month.”
Naina, 70, had been in hospital from almost six months before that, for pneumonia, a gall stone operation and a broken shoulder, but no one thought of checking for cancer. “When it was finally detected, it was too late to save her,” says Lt Col Khanuja.
Difficult to detect and cure
Khanuja’s case could be a textbook example of how liver cancer plays out. According to doctors, it is hard to detect, proceeds very rapidly, and either results in quick death or a poor quality of life. Also — depending on the stage — it rejects traditional methods of treatment, such as chemotherapy. Although pharma companies are testing a new drug, sorafenib, with some success, it is still a long way from increasing the life expectancy of a patient, which currently averages six months to two years.
“Liver cancer is riskier than other types because it is hard to detect in the initial stages, since there are no symptoms,” says Dr Jagannath, surgical oncologist with Lilavati Hospital. “Half the liver may be affected before you can find cancer.” Treatment is difficult too, says Dr Purvish Parikh, head of the department of medical oncology at Tata Memorial Cancer Hospital; only 10 per cent of all liver cancers can be cured by surgery, if detected on time. “As a cleansing agent for the body, the liver throws out all impurities, including chemotherapy drugs,” adds Dr Parikh, making it non-responsive to this procedure. This same function also makes the liver more vulnerable to cancer as well. “Detoxification in the body takes place either in the kidney or the liver,” says YK Sapru, who heads the Mumbai chapter of the Cancer Patients Aid Association. “These two organs are exposed to the dirtiest things, and likely to get sick the quickest.”
Striking younger and wider
It is also beginning to strike younger — people in the 20-40 age group, besides those in their 50s and 60s. The reason, says Dr Vimal Someshwar, an interventional radiologist at Lilavati Hospital, has to do with the causes: hepatitis B and C infections, cirrhosis of the liver from excessive alcoholism, or any other debilitating ailment and aflatoxins (a virus fround in mouldy grains or meals, like rice and peanuts). “If a teenager has been exposed to the hepatitis B virus, through blood transfusions or contact with infected materials, it might make him vulnerable to liver cancer in a decade or so,” adds Dr Someshwar.
Like Suraj Rathod, 21, who was given a few months to live. By the time he was admitted to hospital, the tumour in his liver was 16cm long. His father, Ramesh, says, “I had such dreams for Suraj.” The boy eventually died after a year and a half. “I just wanted a few more months with him,” a devastated Ramesh says.
“There is a zero survival rate in liver cancer,” says Sapru of CPAA. “Those who have advanced oesophageal cancer can hope to live for 1-2 years; those with lung cancer, six months to a year. But with liver cancer, it’s a couple of months at best.” In Mumbai, says a Tata Memorial finding, about 5 people for every 1 lakh get liver cancer, as opposed to other types of cancer, which affect an average of 120 persons. It is eighth on the list for men, and not among the top 10 for women, doctors say. But the incidence is increasing almost as fast the disease progresses. Dr Someshwar says he expects a 20-25 per cent increase in the next three years. According to Dr Jagannath the number will more than treble in the next five years; he expects at least 20-30 cases a month, up from four-five right now.
Treatment options
There are two types of liver cancer: the primary originates in the liver itself, while the secondary usually ‘metastasises’ or spreads from cancer in other parts of the body. Support group Dream Foundation Cancer Care says about 50 per cent of other cancers — stomach, colon, pancreas, oesophagus, breast and lung — eventually spread to the liver.
The new drug may change that, as might new “multi-modal” treatment, says Dr Anand Koppikar, who helped set up the state’s first liver cancer care unit in Pune. The hepatitis B vaccine has been seen to eradicate almost 90 per cent probability of liver cancer in many southeast Asian countries. “It could work in India if only people are made more aware,” says Dr Koppikar, referring to a campaign as aggressively conducted as the polio drive.
Other methods are radiofrequency ablation (inserting an electrode into the tumour and killing the cells with radiation) for liver cancer that is not amenable to surgery; chemoembolisation (using chemotherapy drugs to cut off blood supply to the tumour and killing it) and Yttrium-90, a more complicated, and very expensive, radiation procedure of destroying the tumour. All of this might give patients a reason to hold out against what doctors dub one of the most virulent forms of cancer.
Deadly cancer
