Primary liver accounts for three per cent of Bermuda cancers. Obesity is one factor that will increase the risk. *Photo supplied
Primary liver accounts for three per cent of Bermuda cancers. Obesity is one factor that will increase the risk. *Photo supplied

Each year in the month of January, Bermuda recognizes Cervical Health Awareness Month.

In addition to promoting regular pelvic checks and cervical screening, local health professionals advocate that young males and females (beginning at ages 11 to 12) be immunized against the human papillomavirus (HPV) known to cause cervical cancer. If you are not already aware, research shows that approximately 70 per cent of cervical cancers are caused by HPV.  

Primary liver cancer is another disease with a strong association with viral illnesses — specifically chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV).  Worldwide, HBV causes about 80 per cent of all liver cancers, with the highest incidences occurring in sub-Saharan Africa and Southeast Asia. However, in the USA, HCV is responsible for the majority of diagnosed cases. These viruses are highly contagious and may be transmitted in a variety of ways — blood or body fluids containing blood, shared needles, unprotected sex and a pregnant female carrier to her baby during delivery. 

You cannot develop viral hepatitis from casual contact such as hugging, kissing, sharing food or drink, or from coughing and sneezing. Prior to 1992, some individuals contracted HCV from blood transfusions or organ transplants, but since then all donated blood and organs are tested for this virus so transmission via these procedures would be extremely rare. 

Other risk factors associated with developing liver cancer include heavy alcohol use, exposure to toxic chemicals, smoking, obesity and genetic causes.  Any of these factors can lead to cirrhosis, a disease in which damaged liver cells are replaced by scar tissue. Men are more likely to develop liver cancer than women, and this may be related to greater participation in some of the above mentioned high-risk behaviours.

About the liver:

The liver is both the largest internal organ in the body and the largest gland. Located in the upper abdominal cavity underneath the right lung, the organ is divided into four lobes and is shaped like a pyramid. It is larger in males than in females, and weighs approximately 1.2 to 1.6kg (2 ½ to 3 ½ lbs.) The liver has many vital functions including the production of bile, which is needed for metabolism and absorption of nutrients from the intestine, production of clotting factors, production of triglycerides, breakdown of red blood cells and the removal of toxic wastes from the body.

Infection:

Infection with viral hepatitis may go undetected for many years. During the acute stage, some persons may have no symptoms at all. Others develop flu like symptoms eg: fatigue, mild fever, headache, muscle aches and pains, nausea, loss of appetite, diarrhoea or constipation which then clear on their own. Yellowing of the skin or eyes (jaundice) may also occur. Approximately 10 per cent  of adults and most children under five years. infected with HBV will become carriers and likewise 80 per cent of those infected with HCV. A blood test is the only way to confirm the presence of these viruses.

Development of a Vaccine:

According to the Centre for Disease Control (CDC), before the availability of the HBV vaccine in 1982, an estimated 200,000 to 300,000 adults and 20,000 children in the USA were infected annually. During the period 1990-2002 the incidence of acute HBV declined 67 per cent from 8.5 per 100,000 to 2.8 per 100,000 population. This significant reduction is attributed not just to the vaccination of infants and high risk individuals such as health care workers, but also to the fact that many states have mandated the vaccination of students at primary and middle school levels. Current Bermuda Department of Health recommendations are consistent with those of the CDC and the American Academy of Pediatrics, which recommend that infants commence the HBV vaccine at 6 months and complete the three doses by age 18 months.

To date there is no vaccination available for HCV although quite a few are under development. Several approved drug treatments exist for HBV but there is still no complete cure. Recent results of drug therapies tested on HCV patients have shown more promise.

Developing Cancer:

In 2013, the American Cancer Society estimates about 30,000 persons will be diagnosed with primary liver and bile duct cancer. In Bermuda, liver cancer accounts for just over 3 per cent of all cancer diagnoses. Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Metastatic liver cancer occurs when cancer in another organ such as the breast, colon or lung has spread and is treated differently. As with viral hepatitis, most people with primary liver cancer have no symptoms in the early stages. When symptoms are present they can include general malaise, poor appetite, loss of weight without trying, abdominal pain, jaundice and an enlarged liver. Persons at high risk eg those being treated for cirrhosis or with liver cancer in their family may benefit by being screened. Liver cancer may be detected by a blood test for a protein called AFP (alpha-fetoprotein), biopsy, ultrasound or other imagining tests – CT scan, MRI etc.  Treatment options include surgery to remove the tumour, chemotherapy, and radiation. A liver transplant may be an option for those with small tumours which cannot be totally removed. Every situation however is unique and must take into consideration the patient’s age, general state of health and personal preferences. 

Given that the majority of liver cancers are caused by HBV, a vaccine-preventable disease, it is important that children are protected early in life. Healthy lifestyle choices can also play a crucial role in the prevention of HBV or HCV infection during adolescence and adulthood.

For more information on World Cancer Day or programmes offered by Bermuda Cancer and Health Centre please visit our website www.chc.bm or call 236-1001.