KARACHI, Dec 10: Liver diseases experts said at a symposium on Friday that screening people for hepatitis B and C infections could be a reasonable way of reducing or at least managing the incidence of liver cancer often described as a silent killer. They recognised hepatitis B and hepatitis C as major factors responsible worldwide for increasing the risk of hepatocellular cancer (HCC) in the public.

They urged the government, health practitioners working both in the public and the private sectors and the media to step up efforts to increase awareness of liver cancer in the masses and cancer patients.

The symposium on liver cancer was organised by the Sindh Institute of Urology and Transplantation in collaboration with the Pakistan Society for the Study of Liver Diseases (PSSLD) at the SIUT premises.

“Liver cancer is a silent killer as a majority of its patients appear to be perfectly healthy with no early signs or symptoms. Pain is uncommon until the tumour is quite large and some large tumours do not even cause pain or other symptoms,” a health expert told Dawn.

All over the world, the chronic infection with hepatitis causes 80 per cent of all primary liver cancers, which originates in the liver (also known as HCC), and more than 500,000 people die each year of this cancer. Primary liver cancer is the 3rd leading cause of cancer deaths, it is learnt.

Treatment options for liver cancer patients include surgery, chemotherapy, and an approved oral drug, while a liver transplant is also an option for those with liver cancer tumours that cannot be surgically or medically removed.

Prof Adib Rizvi, director of SIUT, stressed the need for proper care of liver patients to prevent complications including cirrhosis (scarring of liver) and liver cancer.

He said that worldwide about 1.8 million people were living with cirrhosis, while in Pakistan there were about 108,000 such patients, six per cent of which were at the risk of developing HCC.

The distance between doctors and patients, for various reasons, was one of the factors causing a delay in the detection of liver cancer patients and subsequently many of them died without medical therapies and interventions, he said.

He said that liver transplant could be a best gift to patients, but that process needed the will of the entire nation and stakeholders, organ transplant law, massive awareness and training of personnel concerned, pooling of resources and elimination of fast growing commercialism in the field.

Prof Saeed Hamid said that liver diseases were a big problem for Pakistani society.

“Liver cancer is a preventable cancer, provided individuals are vaccinated against hepatitis B and treated at an earlier stage if they are infected with hepatitis C,” he said.

According to him, there is a need to spread the message that if individuals undergo screening for hepatitis B and hepatitis C and also for liver cancer at later stage than “the silent killer” can be identified and managed at a very early stage.

Prof Waseem Jafri, president of the PSSLD, said that hepatitis B carriers who became infected early in their childhood had a high risk of developing liver cancer whether they have cirrhosis or not, while on the other hand, most of the liver cancer cases in the country were due to hepatitis C.

However, according to him, much cannot be done on the preventive side against hepatitis C as the virus transmits from person to person in different ways.

“We have not been able to discipline our barbers, so-called dental surgeons, healers and people engaged in the sub-standard blood transfusion business,” he said.

During the question answer session, he said that the state could be made responsible for the preventive measures and for containment of hepatitis B and hepatitis C and for the facilitation of free of cost vaccination against viral diseases, particularly for the people at risk.“But before that we as a society and stakeholders should also create viable grounds so that individuals by themselves too start taking an interest in their health and approach timely to the relevant facilitators.”

Dr Abdaal Waseem said that liver cancer if detected early was treatable. Small cancers may be treated with surgical removal, radiofrequency ablation and chemoembolisation, while in non-operable cases some drugs were also available to prolong life. He said that there were effective therapies to control and manage chronic hepatitis B infections to help prevent its progression to liver cancer.

“Once the patient develops cirrhosis, more frequent screening is generally recommended,” he added.

Dr Ashfaq Ahmed said that ultrasound of liver and the conventional CT scan were regularly obtained in the diagnostic evaluation of primary liver cancer.

He advised that patients of cirrhosis of liver should be screened for liver cancer by blood test and ultrasound every six months.

Dr Zaigham Abbas highlighted the importance of liver in the body and said that this is the largest organ in the digestive system.

“It filters out any germs in the blood, produces building proteins, and maintains blood sugar, carbohydrates, vitamins and iron and biles to adjust fats, while on the other hand, it also detoxifies poisons and eliminates waste products,” he informed the audience.