Liver cancer is the 7th most common cancer in Korea. According to the national cancer registration statistics released at the end of last year, there were 15,605 new cases of liver cancer in Korea in 2019, the second most following thyroid cancer, lung cancer, stomach cancer, colorectal cancer, breast cancer, and prostate cancer. The crude incidence rate, which represents the incidence rate per 100,000 people, was 30.4 cases, and the proportion of the total cancer incidence was 6.1%. In terms of gender, it was more common in males, with a ratio of 2.9:1.
The relative survival rate of liver cancer over the past five years (2015-2019) was 37.7%, the lowest among major cancers, along with lung cancer (34.7%). 2 out of 3 liver cancer patients will die within 5 years. This is only half of the overall cancer survival rate of 70.7%. What is even more remarkable is that liver cancer ranks first in the death rate for cancer in those in their 40s and 50s who are economically active.
Yoon Young-cheol (Photo) Professor of Hepatobiliary and Pancreatic Surgery, Incheon St. Mary’s Hospital, Catholic University of Korea In other words, prevention and early treatment are possible.” “If you have hepatitis B, hepatitis C, or alcoholic liver disease, it can be cured by early detection through regular check-ups, and they can also be cured of metabolic diseases such as diabetes or obesity at the same time. “If you do get sick, you can reduce the chance of cancer with proper exercise and weight control.”
Every year, February 2nd is Liver Cancer Day. It was established by the Korean Liver Cancer Society in 2017 to inform the risk of liver cancer and the importance of liver cancer screening. It contains the meaning of receiving ‘2’ and ‘2’ tests a year to diagnose liver cancer at an early stage and receive appropriate treatment. The two tests are liver ultrasound and serum alpha-fetoprotein (blood test).
A healthy liver is located in the upper right abdomen and is protected by the ribs. It weighs 1200~1500g, which is regarding 2% of the body weight, and is dark red in the shape of an elongated triangle and is the largest organ in our body.
The liver is called the ‘energy management center’ of the body. It plays an important role in maintaining the basic functions of our body and protecting life from external harmful substances. Foods absorbed in the intestine are properly transformed and stored into various nutrients such as carbohydrates, proteins, fats, and vitamins. It is also transported to cells throughout the body.
In addition, the liver produces bile acids so that a large amount of proteins, enzymes, and vitamins required by our body can be synthesized in the intestine, and albumin, which prevents body edema, and prothrombin, which is involved in blood clotting. It is the role of the liver to make gamma globulin and help our body’s immune function smoothly through sterilization of blood.
However, the liver is a ‘silent organ’. Even if 70-80% is destroyed by virus, alcohol, fat, or drugs, it does not send a danger signal. Korea, where hepatitis B patients and alcohol consumption are high, is at risk of liver disease. This is the reason why Koreans should pay special attention to liver health.
Liver cancer refers to a malignant tumor that occurs in the liver. These include hepatocellular carcinoma, cholangiocarcinoma, metastatic liver cancer, and angiosarcoma. In general, hepatocellular carcinoma refers to the most common hepatocellular carcinoma.
The major risk factors for liver cancer are hepatitis B virus (72%), hepatitis C virus (12%), and alcohol (9%). In addition, drugs, obesity, autoimmunity, etc. can also be the cause (hepatocellular carcinoma treatment guidelines 2018). In particular, hepatitis B virus infection is known to increase the risk of liver cancer regarding 100 times, and hepatitis C virus infected people are known to increase 10 times. In addition, the longer the period of hepatitis, the higher the risk of liver cancer.
The presence or absence of cirrhosis also has a significant influence on the incidence of liver cancer. In 80% of patients with liver cancer, cirrhosis precedes it, and there is also a study showing that the incidence of liver cancer increases by more than 1,000 times if the patient has cirrhosis. Destroyed and hardened hepatocytes in cirrhosis patients greatly increase the probability of developing liver cancer due to immune responses and carcinogenic mechanisms caused by various factors.
Patients are curious regarding the symptoms of liver cancer, but there are no symptoms in the early stages of liver cancer. By the time the symptoms become clear, in most cases, it has already progressed. As the size of the liver cancer grows, fatigue and weakness gradually occur, or the biliary tract is blocked, causing jaundice, penetrating the liver capsule and invading the nerve, causing pain or even rupture and bleeding and excruciating pain, especially in the right rib area. feel it This is a symptom that occurs when liver cancer has advanced for a long time.
The progression of liver cancer, that is, the stage, is divided into 4 stages according to the size of the tumor, whether the tumor has invaded blood vessels, and whether it has metastasized to other organs. Treatment depends on the stage of liver cancer and the presence or absence of cirrhosis.
The most effective treatment for early liver cancer is liver resection, radiofrequency ablation, and liver transplantation. These three treatments are treatments that can completely eliminate the cancer itself, and the treatment depends on the liver function or the patient’s condition.
When liver cancer is so advanced that liver resection, liver transplantation, or radiofrequency ablation cannot be applied, TACE (Transcatheter arterial chemoembolization) or Radiation therapy and chemotherapy are administered. Yoon Young-cheol, a professor of hepatobiliary and pancreatic surgery at Incheon St. Mary’s Hospital, Catholic University of Korea In some cases, liver resection, radiofrequency ablation, and liver transplantation are used to cure the disease, so we should not give up treatment just because liver cancer has advanced.”
The reason for the high recurrence of liver cancer is that there is a high possibility of another liver cancer occurring in the hardened liver that remains following liver resection or radiofrequency ablation. Therefore, the most complete treatment for liver cancer is liver transplantation, which removes all the hardened liver and puts a new liver in its place. Compared to other treatments, liver transplantation has an overwhelmingly high 5-year survival rate as well as 10-year and 20-year survival rates.
There are two main types of liver transplantation. There are two types of liver transplantation: ‘whole-dead liver transplantation’, in which the whole liver of a brain-dead person is transferred, and ‘living part liver transplantation’, in which a part of the liver of a living (living person) donor is removed and transplanted. It would be nice if brain-dead donations might be received smoothly, but in Korea, brain-dead donations are not yet active, so inevitably, more living body transplants are being carried out.
In living liver transplantation, it is most important to minimize the complications of the liver donor. This is because the donor is a healthy person, not a patient. Recently, laparoscopic surgery, in which only a few holes are drilled in the abdomen, has been applied to relieve the burden of surgery on a liver donor who provides a healthy liver.
Professor Yoon Young-cheol said, “There are many live liver transplants due to liver cancer, but in the long run, we need to gradually increase liver transplantation through brain-dead donation. By actively carrying out liver transplantation for patients with liver cancer or liver disease, we will be able to create a healthier society.”
Regular checkup every 6 months for hepatitis bearers = Prevention of hepatitis B or hepatitis C, the cause of liver cirrhosis, is important to prevent liver cancer. Hepatitis B can be prevented through vaccination. For hepatitis C for which there is no vaccine yet, be careful regarding infection through blood or secretions, such as using a single needle, avoiding inappropriate sexual contact, tattooing or piercing. Never use multiple nail clippers or razors. Fortunately, a treatment for hepatitis C has now been developed. If you have hepatitis C, it is important to actively seek treatment following consulting your doctor. In addition, to prevent alcoholic liver cirrhosis, you should refrain from drinking excessively, and if you have alcoholic liver disease, you should absolutely refrain from drinking.
In Korea, people over the age of 40 who are at high risk of developing liver cancer can undergo tests provided by the National Health Insurance Corporation every six months. The high-risk groups for liver cancer are hepatitis B, hepatitis C, and alcoholic liver cirrhosis. The problem is that they don’t know if they have hepatitis B or hepatitis C. Be sure to check whether you are infected with hepatitis B or hepatitis C through a health check-up. If you are in the high-risk group, the cost of the examination may be free or there may be a 10% co-payment. You can check it by visiting the Health Insurance Corporation website and inquiring regarding the subject of the examination. Reporter Kang Kyung-nam