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Study: Western Liver Cancer Standards Inadequate

LE - Chemotherapy medicine is readied for a liver cancer patient at the National Institutes of Health in Bethesda, Md., March 24, 2009.
LE - Chemotherapy medicine is readied for a liver cancer patient at the National Institutes of Health in Bethesda, Md., March 24, 2009.

Experts are calling for more targeted standards in developing countries to help diagnose and treat risk factors for liver cancer. It's currently the second most deadly form of cancer worldwide.

Liver cancer accounts for some 750,000 deaths a year globally. Experts say only pancreatic cancer accounts for more deaths.

In Western countries, liver cancer typically strikes middle age men over 60, who drink alcohol and smoke cigarettes.

But the patient profile is a bit different in developing countries, including sub-Saharan Africa, Latin America and China. There, it’s not uncommon to see liver cancer in young people.

“It can be four or five decades earlier, so in fact you are losing half of your life when you are in such major trouble," said Pascal Pineau.

Pineau, a cancer geneticist at Pasteur Institute in Paris, says more than 86 percent of liver cancer deaths occur in the developing world, but standards to diagnose and treat the disease follow guidelines based on the older Western patients. The guidelines help doctors determine the best course of treatment.

Pineau was part of a team of French and Peruvian researchers who conducted a study in the Latin American country involving 250 liver cancer patients who underwent surgery.

Their average age was 36, and relatively few had cirrhosis, or hardening of liver tissue, which is common in Western liver cancer patients.

Under the treatment guidelines, Pineau says those patients might have been written off as incurable, despite their young age and the lack of cirrhosis. They would not have been given potentially life-extending treatment, including surgery, for the lethal disease.

Pineau says most patients in developing countries get the most common form of liver cancer (hepatocellular carcinoma) after being infected with hepatitis B for a long period of time.

“You are living in sub-Saharan Africa and you are infected with hepatitis B virus, but you are also eating food contaminated with toxins from microscopic fungi, and then you will develop the liver cancer," he said.

He says many liver cancers worldwide could be avoided through hepatitis B vaccination, but there’s a hitch.

The vaccine, endorsed by the World Health Organization, is a series of four injections that Pineau says is not easy to get for many people living in remote areas.

“I suspect that in some occasions, the vaccination is not done. The immunization is not done," he said.

In addition to increasing the number of people who get vaccinated against hepatitis B, writing in the journal Heliyon, Pineau and colleagues call for changing the treatment guidelines to help young liver cancer patients who for now might be considered incurable.