Liver Cancer Advances

Transcript

00:00 --> 00:02Support for Yale Cancer Answers
00:02 --> 00:04comes from AstraZeneca, dedicated
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00:14 --> 00:16Welcome to Yale Cancer Answers with
00:16 --> 00:18your host doctor Anees Chagpar.
00:18 --> 00:20Yale Cancer Answers features the
00:20 --> 00:22latest information on cancer care by
00:22 --> 00:23welcoming oncologists and specialists
00:23 --> 00:26who are on the forefront of the
00:26 --> 00:28battle to fight cancer. This week,
00:28 --> 00:30it's a conversation about liver
00:30 --> 00:31cancer with Doctor Mario Strazzabosco,
00:31 --> 00:33Doctor Strazzabosco is a
00:33 --> 00:35professor of medicine and clinical
00:35 --> 00:37program leader of the liver Cancer
00:37 --> 00:40program at the Yale School of Medicine,
00:40 --> 00:42where Doctor Chagpar is a
00:42 --> 00:43professor of surgical oncology.
00:45 --> 00:47Mario, maybe we can start
00:47 --> 00:49off by you telling us a
00:49 --> 00:52little bit about liver cancers.
00:52 --> 00:54So often people have different
00:54 --> 00:55kinds of liver cancers.
00:55 --> 00:57Sometimes cancers have started
00:57 --> 01:00somewhere else and go to the liver and
01:00 --> 01:03sometimes cancers start in the liver.
01:03 --> 01:05Can you give us a
01:05 --> 01:08framework of how to think about
01:08 --> 01:10liver cancers?
01:10 --> 01:13We distinguish cancers that start in the liver and
01:13 --> 01:15we call them primary liver cancer,
01:15 --> 01:19from cancer that goes into the liver with
01:19 --> 01:23the primary cancer somewhere else.
01:23 --> 01:25Those are called secondary liver
01:25 --> 01:29cancer and in essence they are
01:29 --> 01:31metastasis from a primary tumor.
01:31 --> 01:34Today the topic will be
01:34 --> 01:38cancer that happens
01:38 --> 01:41in the liver as a primary site.
01:42 --> 01:45And those are less common than the
01:45 --> 01:47cancers that spread to the liver
01:47 --> 01:49from other sites, is that right?
01:50 --> 01:52That is right they are
01:52 --> 01:53definitely less common,
01:53 --> 01:56but it is true that
01:56 --> 01:58primary liver cancer is actually one
01:58 --> 02:01of the few cancers that are still
02:01 --> 02:03increasing in terms of incidence
02:03 --> 02:06and also in terms of mortality.
02:06 --> 02:08So tell us a little bit
02:08 --> 02:10more about primary liver cancers.
02:10 --> 02:12Are there different types
02:12 --> 02:13of primary liver cancer?
02:14 --> 02:17Yes, there are several types.
02:17 --> 02:21The two main types are
02:21 --> 02:24hepatocellular carcinoma,
02:24 --> 02:27which is the cancer
02:27 --> 02:31that starts from the liver cells.
02:32 --> 02:36It is the most common of them and the
02:36 --> 02:38other is called cholangiocarcinoma
02:38 --> 02:42and that starts from the bile ducts
02:42 --> 02:44inside or outside of the liver.
02:44 --> 02:46And this is less common.
02:46 --> 02:49You mentioned that the
02:49 --> 02:53incidences was increasing. What are
02:53 --> 02:57the risk factors for getting liver cancer?
02:58 --> 03:02This is a very important question.
03:02 --> 03:06So liver cancer is increasing as a result of
03:06 --> 03:09several worldwide epidemiological trends.
03:09 --> 03:14The main risk factor is one, having liver disease.
03:14 --> 03:17Two having hepatits c, three having
03:17 --> 03:20hepatitis B, four, having an excessive
03:20 --> 03:23consumption of alcohol, five, having
03:23 --> 03:27what we call metabolic syndrome,
03:27 --> 03:30which is the result of being obese
03:30 --> 03:34or overweight or having diabetes,
03:34 --> 03:38or having other cardiovascular risk factors.
03:38 --> 03:40In addition to that,
03:40 --> 03:42there is a 6th epidemiological
03:42 --> 03:44trend which is very important,
03:44 --> 03:48which is the poor access to care in certain countries.
03:55 --> 03:58These are the main factors that
03:58 --> 04:00contribute to increasing the
04:00 --> 04:03incidence of primary liver cancer,
04:03 --> 04:05and particularly of hepatocellular carcinoma.
04:05 --> 04:08Of course, the combination of these factors
04:08 --> 04:12changes according to the geographical area.
04:20 --> 04:24It used to be that in the US,
04:24 --> 04:27the incidence of HCC was lower
04:27 --> 04:29for example, than Asia, Africa,
04:29 --> 04:31or other places.
04:31 --> 04:34But now with migration and other factors,
04:34 --> 04:37it tends to become more equal in terms
04:37 --> 04:40of distribution of risk factors and
04:40 --> 04:43also the risk factors are changing,
04:43 --> 04:46so we used to have a very big
04:46 --> 04:48impact of hepatitis C.
04:48 --> 04:50Now with the new treatments
04:52 --> 04:55we see a rise in the
04:55 --> 04:56hepatocellular cancer
04:56 --> 04:59which is a consequence of the metabolic
04:59 --> 05:01risk factor such as diabetes,
05:02 --> 05:06so the incidence in the US vs Asia
05:06 --> 05:09has increased.
05:09 --> 05:12You mentioned that was due to in part to migration i.e.
05:12 --> 05:15people from Asia moving to the US which
05:15 --> 05:18might imply some genetic factors.
05:18 --> 05:20So is there a genetic underpinning
05:20 --> 05:24to some of these cancers as well?
05:24 --> 05:27I think this is more exposure
05:27 --> 05:28to viral hepatitis.
05:28 --> 05:32For example, one of the main factors
05:32 --> 05:34in hepatitis B
05:34 --> 05:37which is a direct oncogenic virus
05:37 --> 05:41and it used to be lower here and higher
05:41 --> 05:43for example, in the Mediterranean
05:43 --> 05:45countries and in Asia.
05:45 --> 05:48And changes in the
05:48 --> 05:51worldwide population may change that.
05:51 --> 05:53But one peculiar thing in the
05:53 --> 05:56US is actually the increase
05:56 --> 05:59of metabolic risk factors.
05:59 --> 06:01Cancer associated with obesity
06:02 --> 06:05and diabetes and one important thing
06:05 --> 06:08to understand in terms of liver cancer
06:08 --> 06:11is that whereas we try to focus on
06:11 --> 06:14one risk factor as a matter of fact,
06:14 --> 06:16patients with liver cancer,
06:16 --> 06:18have several risk factors. It is not unusual
06:18 --> 06:20to find a patient that is
06:20 --> 06:22overweight, maybe is diabetic,
06:22 --> 06:25which goes with being overweight and
06:25 --> 06:28he didn't know he had hepatitis C
06:28 --> 06:31so lived a normal life with
06:32 --> 06:35drinking more than his liver could stand,
06:35 --> 06:37and so here we are and maybe
06:37 --> 06:39even he was smoking.
06:39 --> 06:42So just a regular guy that had
06:42 --> 06:45accrued four risk factors for liver cancer.
06:45 --> 06:48So this is very important to understand
06:48 --> 06:50when they add to each
06:50 --> 06:53other the increasing the risk factor
06:53 --> 06:53is exponential.
06:53 --> 06:56I want to pick up on the viral
06:56 --> 06:59hepatitities which increase the risk
06:59 --> 07:01of developing hepatocellular cancer.
07:01 --> 07:04So hepatitis B and hepatitis C,
07:04 --> 07:06interestingly, as we're living
07:06 --> 07:09through Covid right now, another
07:09 --> 07:13viral disease for which we have a vaccine,
07:13 --> 07:16it's important to understand that
07:16 --> 07:20there are vaccines for hepatitis B&C.
07:20 --> 07:23Have those vaccines had any
07:23 --> 07:26impact on reducing the rates
07:26 --> 07:28of hepatocellular cancer?
07:28 --> 07:30We have vaccination available
07:30 --> 07:34for hepatitis A&B. Hepatitis A is not
07:34 --> 07:37associated with liver cancer, it is the
07:37 --> 07:40hepatitis that is actually acquired
07:40 --> 07:43through eating shellfish,
07:43 --> 07:48or seafood. Hepatitis B,
07:48 --> 07:51we have a vaccine which is extremely
07:51 --> 07:55efficient and we have data showing that,
07:55 --> 07:58for example, in some country in Africa
07:58 --> 08:01where they had a very high incidence
08:01 --> 08:05of a hepatocellular cancer because of the
08:05 --> 08:08maternal fetal transmission of hepatitis B,
08:08 --> 08:12they implemented a mass
08:12 --> 08:13vaccination program there.
08:13 --> 08:17And the incidence of liver cancer dropped
08:17 --> 08:18dramatically, so yes,
08:18 --> 08:22it is there and we can decrease the
08:22 --> 08:25incidence with vaccination and in fact
08:25 --> 08:29most people in the younger generation
08:29 --> 08:31are vaccinated for it.
08:33 --> 08:36Unfortunately we never made it with
08:36 --> 08:39trying to find a vaccine for hepatitis C because of
08:39 --> 08:42this high variability of the virus.
08:42 --> 08:45But we were lucky because
08:45 --> 08:47we were able to devise
08:47 --> 08:50pharmacological treatment and so now
08:50 --> 08:54we have very effective ways to eradicate
08:54 --> 08:57the virus using small molecule compounds.
08:57 --> 09:00And that is important information.
09:00 --> 09:03And overall I think one message
09:03 --> 09:06that it would be very important
09:06 --> 09:09to get through to the public, is that
09:09 --> 09:11most formal liver disease and therefore
09:11 --> 09:14also liver cancer are preventable.
09:14 --> 09:18And also treatable in terms of liver disease.
09:18 --> 09:20So you can
09:20 --> 09:23prevent risky behavior for viral
09:23 --> 09:26hepatitis, you can use vaccination.
09:26 --> 09:28You can treat the virus
09:29 --> 09:33if you realize you are
09:33 --> 09:35infected before having a cirrhosis.
09:35 --> 09:41Avoid, of course,
09:41 --> 09:43excessive use of alcohol.
09:43 --> 09:46You can act on the lifestyle if you
09:46 --> 09:50have diabetes. If you are
09:50 --> 09:52obese,
09:52 --> 09:54you can lose weight.
09:54 --> 09:56You can increase your exercise.
09:56 --> 09:59You can control those factors and so
09:59 --> 10:02all of them are actually preventable,
10:02 --> 10:04acting both at a personal level
10:04 --> 10:07and public health action.
10:08 --> 10:11Let's pick up on on that.
10:11 --> 10:14You mentioned a
10:14 --> 10:16number of preventative measures,
10:16 --> 10:19so if somebody gets vaccinated
10:19 --> 10:21against hepatitis B, for example,
10:21 --> 10:24and never contracts hepatitis B,
10:24 --> 10:26it's understandable then that
10:26 --> 10:29they've eliminated that risk factor,
10:29 --> 10:31but if they get hepatitis
10:31 --> 10:34C and are treated for it,
10:34 --> 10:38does that eradicate the risk of
10:38 --> 10:39developing hepatocellular carcinoma?
10:39 --> 10:43Or is the fact that they already had
10:43 --> 10:47hepatitis C even though it was treated,
10:48 --> 10:50does that still increase their risk?
10:58 --> 11:00Number one, there's a lot of
11:00 --> 11:03people that have hepatitis C
11:03 --> 11:05and don't know it, particularly
11:05 --> 11:08in the so called baby Boomer.
11:08 --> 11:15#2 this drug that I was mentioning,
11:15 --> 11:19DAA, direct active antivirus,
11:19 --> 11:21are extremely
11:23 --> 11:25good and can eradicate
11:25 --> 11:27the virus in most cases.
11:27 --> 11:29Then the question becomes
11:29 --> 11:32at what stage did you apply that treatment?
11:32 --> 11:34Did you have just a minor
11:37 --> 11:40chronic hepatitis or were
11:40 --> 11:43you already progressed to have
11:43 --> 11:46more fibrosis and cirrhosis.
11:46 --> 11:49And the risk decreases in
11:49 --> 11:51a different way whether you
11:51 --> 11:53treated hepatitis before becoming
11:53 --> 11:56cirrhotic or when you were already
11:56 --> 11:59cirrhotic?
11:59 --> 12:01In this second instance,
12:01 --> 12:04the decrease in the risk is less important.
12:06 --> 12:08The thing that we learned after treating
12:08 --> 12:11many patients and erradicating
12:11 --> 12:14the virus is that the risk of
12:14 --> 12:17having liver cancer was decreasing,
12:17 --> 12:19but was not zero.
12:19 --> 12:22So there is still a substantial risk,
12:22 --> 12:25even if it is, let's say halved.
12:29 --> 12:31And there is a big controversy in the literature,
12:31 --> 12:34but I won't go into that,
12:34 --> 12:38but I think that one of the problems is,
12:38 --> 12:41the timing in the Natural History
12:41 --> 12:44of disease in which you apply the
12:44 --> 12:47treatment and just to go back to
12:47 --> 12:50the beginning of this conversation,
12:50 --> 12:52we said most patients
12:52 --> 12:53with liver cancer
12:53 --> 12:56have more than one risk factor.
12:56 --> 12:59So if I only eliminate the
12:59 --> 13:00virus and eradicate it,
13:00 --> 13:03I decrease a very important risk factor.
13:03 --> 13:06But I don't zero the risk factor
13:06 --> 13:08because the patient
13:08 --> 13:11may be diabetic, the patient may be overweight,
13:11 --> 13:13but the patient may be drinking
13:13 --> 13:15or go back to drink because
13:15 --> 13:18now he doesn't have the virus.
13:18 --> 13:18So again,
13:18 --> 13:20one of the important messages
13:25 --> 13:29is that liver cancer is a very
13:29 --> 13:30comprehensive approach.
13:30 --> 13:33Eliminating the virus is just step one.
13:33 --> 13:34We're going to pick
13:34 --> 13:38up on how we deal with all of the other
13:38 --> 13:40lifestyle factors right after we take
13:40 --> 13:44a quick break it for a medical minute.
13:44 --> 13:46Please stay tuned to learn more
13:46 --> 13:48about advances in liver cancer with
13:48 --> 13:51my guest doctor, Mario Strazzabosco.
13:51 --> 13:53Support for Yale Cancer Answers
13:53 --> 13:55comes from AstraZeneca, working to
13:55 --> 13:58eliminate cancer as a cause of death.
13:58 --> 14:01Learn more at astrazeneca-us.com.
14:01 --> 14:03This is a medical minute
14:03 --> 14:04about smoking cessation.
14:04 --> 14:06There are many obstacles to
14:06 --> 14:08face when quitting smoking,
14:08 --> 14:11as smoking involves the potent drug nicotine.
14:11 --> 14:14But it's a very important lifestyle change,
14:14 --> 14:15especially for patients
14:15 --> 14:16undergoing cancer treatment.
14:16 --> 14:18Quitting smoking has been shown to
14:18 --> 14:20positively impact response to treatments,
14:20 --> 14:23decrease the likelihood that patients
14:23 --> 14:25will develop second malignancies,
14:25 --> 14:27and increase rates of survival.
14:27 --> 14:28Tobacco treatment programs are
14:28 --> 14:30currently being offered at federally
14:30 --> 14:32designated Comprehensive cancer centers
14:32 --> 14:34and operate on the principles
14:34 --> 14:36of the US Public Health Service
14:36 --> 14:38clinical practice guidelines.
14:38 --> 14:40All treatment components are evidence
14:40 --> 14:43based and therefore all patients are
14:43 --> 14:45treated with FDA approved first line
14:45 --> 14:47medications for smoking cessation as
14:47 --> 14:50well as smoking cessation counseling
14:50 --> 14:52that stresses appropriate coping skills.
14:52 --> 14:55More information is available at
14:55 --> 14:57yalecancercenter.org you're listening
14:57 --> 14:58to Connecticut Public Radio.
14:58 --> 14:59Welcome back to Yale Cancer Answers.
15:01 --> 15:05This is doctor Anees Chagpar and
15:05 --> 15:07I'm joined tonight by my guest
15:07 --> 15:09doctor Mario Strazzabosco.
15:09 --> 15:12We're discussing the care of patients
15:12 --> 15:14with liver cancer and right before
15:14 --> 15:17the break Mario you were telling us
15:17 --> 15:20about this plethora of factors that
15:20 --> 15:23increase people's risk of
15:23 --> 15:25liver cancer and the fact that
15:25 --> 15:29while we do have interventions for
15:29 --> 15:31hepatitis there frequently are other
15:31 --> 15:34factors that are are involved.
15:34 --> 15:37You mentioned a few that I'm
15:37 --> 15:40going to lump together,
15:40 --> 15:42which are metabolic syndrome.
15:42 --> 15:44So obesity and diabetes,
15:44 --> 15:47as well as alcohol which
15:47 --> 15:50can lead to fatty liver.
15:50 --> 15:53So can you tell us a little
15:53 --> 15:56bit more about fatty liver,
15:56 --> 15:59and whether that impacts the development
15:59 --> 16:02of liver cancer and whether
16:02 --> 16:05there's any quote safe amount
16:05 --> 16:08of alcohol that we can consume?
16:14 --> 16:17What we call fatty liver is
16:17 --> 16:19a very common condition which
16:19 --> 16:21is identified by an increased
16:21 --> 16:25deposition of fat in the liver cells.
16:25 --> 16:30Fatty liver can be the result of several
16:30 --> 16:36problems, but most likely it's due to
16:36 --> 16:38the effect of obesity,
16:38 --> 16:42the affect of diabetes, hyperlipidemia,
16:42 --> 16:46and what we call metabolic syndrome,
16:46 --> 16:49which is a complex of
16:49 --> 16:51changes that are increasing
16:51 --> 16:54the risk of cardiac disease.
16:54 --> 16:58This is how we recognize this
16:58 --> 17:02at the beginning and we used to think that fatty
17:02 --> 17:06liver was a relatively benign condition,
17:06 --> 17:08but now we
17:08 --> 17:10understand that some patients
17:10 --> 17:12with fatty liver
17:12 --> 17:16will develop an
17:18 --> 17:19inflammatory condition of the liver
17:19 --> 17:23that is not any more benign but can
17:23 --> 17:26lead to chronic liver disease like
17:26 --> 17:28cirrhosis and can be associated with
17:28 --> 17:31the development of liver cancer.
17:31 --> 17:35Clearly the amount of people that are
17:35 --> 17:41affected by this condition is very high, so
17:41 --> 17:43the question is how do we
17:43 --> 17:44follow those patients?
17:44 --> 17:47What do we do?
17:51 --> 17:55It would be important to try to prevent it,
17:55 --> 17:58and so how do you prevent it?
17:58 --> 18:02There is data that shows if you lose
18:02 --> 18:0510% of your body weight the risk decreases.
18:05 --> 18:08This 10% of your body weight
18:08 --> 18:10should be lost in your
18:10 --> 18:13abdominal fat because this
18:13 --> 18:17is a fact that is more
18:17 --> 18:19associated with this complication.
18:24 --> 18:28An increase in physical activity is going to play a role.
18:28 --> 18:31We see that with patients that
18:31 --> 18:33have this predisposition,
18:33 --> 18:36a low carbohydrate diet is preferred.
18:36 --> 18:40They should avoid sodas and so on.
18:40 --> 18:44I do understand this is
18:44 --> 18:49a change in lifestyles which
18:49 --> 18:52are very very difficult to achieve.
18:52 --> 18:56But addressing this metabolic factor is
18:56 --> 19:01really part of the constellation of medical
19:01 --> 19:04action that we need to take.
19:10 --> 19:15I mean it seems like this really,
19:15 --> 19:17that constellation to
19:17 --> 19:20exercise more, lose weight, eat right,
19:20 --> 19:23that's really a constellation for good
19:23 --> 19:27health in general, and it has so many
19:27 --> 19:29really important health benefits.
19:29 --> 19:31But one question that people
19:31 --> 19:34may be wondering about is,
19:34 --> 19:37if I've been overweight
19:37 --> 19:41all my life and we know that there is
19:41 --> 19:44an uptick now
19:44 --> 19:46even in childhood obesity.
19:46 --> 19:49So if somebody has been overweight, obese,
19:49 --> 19:52they then lose a bunch of weight,
19:52 --> 19:55is the damage to their liver already
19:55 --> 19:58done such that you're
19:58 --> 20:00having a relatively small impact on
20:00 --> 20:03reducing hepatocellular carcinoma?
20:03 --> 20:05Or is this really reversible?
20:11 --> 20:15If you eliminate the
20:15 --> 20:17damaging condition to the liver,
20:17 --> 20:20you can to a certain extent
20:20 --> 20:23reverse the chronic damage.
20:23 --> 20:25We learned this when we started
20:25 --> 20:27to treat patients with hepatitis B and antivirals.
20:29 --> 20:33They were very effective in suppressing
20:33 --> 20:36the virus and that patient
20:36 --> 20:38went from a complete cirrhosis
20:38 --> 20:39to an incomplete cirrhosis.
20:39 --> 20:42So yes, there is a remodeling of your
20:42 --> 20:44liver and this is not
20:44 --> 20:46complete in how much it happens.
20:46 --> 20:49It depends how far you went,
20:49 --> 20:51but there is to a certain extent
20:51 --> 20:53a remodeling or the liver and
20:53 --> 20:55we saw that happening in patients
20:55 --> 20:58that stopped drinking alcohol.
20:58 --> 21:00All of them have an improvement.
21:00 --> 21:02And we saw that with patients
21:02 --> 21:04treated for hepatitis.
21:04 --> 21:08Now to what extent this is going to impact
21:08 --> 21:09the natural
21:09 --> 21:11history of metabolic liver
21:11 --> 21:13disease is less certain,
21:13 --> 21:16but it's very likely that we can,
21:16 --> 21:18for example, if you
21:18 --> 21:20decrease your body weight,
21:20 --> 21:21your risk decreases.
21:21 --> 21:23Now the trick is that when
21:23 --> 21:25you decrease your body weight,
21:25 --> 21:28you don't need to get it back,
21:28 --> 21:31So it's very easy to decrease 10%
21:31 --> 21:32of your body weight,
21:32 --> 21:36but what it counts is 2 years after.
21:36 --> 21:38Did you maintain that 10%
21:38 --> 21:41decrease because that is what
21:41 --> 21:44counts in terms of
21:44 --> 21:46risk reduction.
21:46 --> 21:47So you want to
21:47 --> 21:49make sustainable lifestyle changes now.
21:49 --> 21:52One of the things that you
21:52 --> 21:54mentioned was that you've seen the
21:54 --> 21:57fact that you can reduce risk in
21:57 --> 21:59people who have stopped drinking,
21:59 --> 22:01so abstained from alcohol,
22:01 --> 22:04but some people may be wondering,
22:04 --> 22:08is there any quote safe limit for alcohol?
22:08 --> 22:12So if you used to drink 4 drinks a night,
22:12 --> 22:16is it OK to drink one drink a night?
22:16 --> 22:19Is there any safe level of
22:19 --> 22:22alcohol to which the damage to your
22:22 --> 22:27liver is minimal and the risk of
22:27 --> 22:30hepatocellular carcinoma is minuscule?
22:30 --> 22:33Or is all alcohol going to be
22:33 --> 22:36somewhat toxic to your liver?
22:40 --> 22:42We used to think that there
22:42 --> 22:43was a threshold, and
22:43 --> 22:46this is being kind of revised,
22:46 --> 22:49but it's very well known that a little
22:49 --> 22:51amount of alcohol can actually
22:51 --> 22:54improve your metabolic risk.
22:54 --> 22:55However, how little is enough,
22:55 --> 22:58it doesn't really depend on a fixed dose.
22:58 --> 23:01It depends what your
23:01 --> 23:04genes are and what your history is.
23:04 --> 23:06So if you're drinking alcohol but
23:06 --> 23:09you have hepatitis C, it's zero,
23:09 --> 23:12there's no even smelling it.
23:12 --> 23:15So it's a difficult question to reply.
23:21 --> 23:25In general your advice is
23:25 --> 23:28abstinences is the gold standard.
23:28 --> 23:30It depends on what your
23:30 --> 23:32overall risk profile is.
23:32 --> 23:36But let's say if you drink once in a while,
23:36 --> 23:38that is clearly not a problem,
23:38 --> 23:41But if it's your habit,
23:41 --> 23:46it may become a problem.
23:46 --> 23:47This doesn't say that if
23:47 --> 23:48you go out for dinner,
23:48 --> 23:50you can drink a glass of wine.
23:50 --> 23:52Of course you can,
23:52 --> 23:56even eating a candy is OK.
23:56 --> 24:00But not OK if you have diabetics.
24:00 --> 24:03This brings us to the point
24:03 --> 24:06of surveillance of the liver, right?
24:06 --> 24:09How can we tell how damaged our liver is,
24:09 --> 24:11whether it's from diabetes,
24:11 --> 24:13or whether it's from obesity,
24:13 --> 24:15or whether it's from alcohol,
24:15 --> 24:17or whether it's from hepatitis.
24:17 --> 24:20As you mentioned before the break,
24:20 --> 24:23we may not even know that we have.
24:23 --> 24:25Are there ways of looking
24:25 --> 24:27at the liver?
24:28 --> 24:30Yes, so everything starts
24:30 --> 24:31from understanding whether
24:31 --> 24:34you liver is damaged or not,
24:34 --> 24:37so you may for any reason do
24:37 --> 24:38some laboratories tests that
24:38 --> 24:40include liver function tests.
24:40 --> 24:43You may get an ultrasound or
24:43 --> 24:46you may get tested for hepatits
24:46 --> 24:49C for example if you
24:51 --> 24:54were born a baby boomer,
24:54 --> 24:57so if you had a risky behavior
24:59 --> 25:02anything that may increase risk,
25:04 --> 25:06then a way to understand how
25:06 --> 25:08chronic is your damage,
25:08 --> 25:12you can use a fiber scan so it's like
25:12 --> 25:14a machine that
25:14 --> 25:15looks like an ultrasound,
25:15 --> 25:18but it is not ultasound because this
25:18 --> 25:21measures how elastic is your liver and
25:21 --> 25:23that can give us an estimate whether
25:23 --> 25:26you have significant fibrosis or not.
25:26 --> 25:29Or you can do an MRI, there are
25:29 --> 25:32several ways to understand if you
25:32 --> 25:34liver disease, and
25:34 --> 25:36then if you have chronic liver
25:36 --> 25:38disease with significant fibrosis,
25:38 --> 25:40the current guidelines are that
25:40 --> 25:42you should be doing an ultrasound,
25:44 --> 25:45every six months.
25:47 --> 25:50And there is very good evidence that
25:50 --> 25:53this can help diagnose liver cancer
25:53 --> 25:57in early stage and therefore in a
25:57 --> 26:00stage when the treatment can be successful.
26:00 --> 26:03There are other patients that may
26:03 --> 26:05need screening, like patients
26:05 --> 26:08mainly from Asia that have hepatitis.
26:11 --> 26:16and are less than 40 years of age.
26:20 --> 26:22Or for example, a patient with hepatitis C that
26:22 --> 26:25has been treated,
26:25 --> 26:28but they have significant fibrosis.
26:33 --> 26:36So the screening is a very important
26:36 --> 26:38component of our strategy, but
26:38 --> 26:43still we see patients coming to the
26:43 --> 26:47clinic with advanced stage cancers.
26:47 --> 26:52Or cancer that is beyond curative options.
26:52 --> 26:55And that is a failure of screening,
26:55 --> 26:57but of course you can have the
26:57 --> 26:59situation in which the patient
26:59 --> 27:02didn't know he had liver disease,
27:02 --> 27:04because a lot of times liver disease
27:04 --> 27:07can be significant but not
27:07 --> 27:09symptomatic.
27:12 --> 27:15So still the amount of patients that come
27:15 --> 27:18with advanced liver disease is too high
27:18 --> 27:21because we do have again
27:21 --> 27:25ways to prevent the cancer, ways to screen
27:25 --> 27:28to get an early diagnosis and it
27:28 --> 27:31is important because we now have
27:31 --> 27:34several ways to approach liver cancer
27:34 --> 27:37and therapeutic approaches
27:37 --> 27:41are increasing every year.
27:41 --> 27:44So it's very important to get diagnosed
27:44 --> 27:47and to go to a center where you have a
27:47 --> 27:50multispecialty program so that all
27:50 --> 27:52aspects of the care can be addressed
27:52 --> 27:54at the highest professional level.
27:55 --> 27:57And it brings back one of the other
27:57 --> 27:59risk factors that you mentioned
27:59 --> 28:02which was access to care people who
28:02 --> 28:04don't have good access to care,
28:04 --> 28:06and I wonder whether you
28:06 --> 28:08mentioned that as a risk factor.
28:08 --> 28:11Because if you don't have access to care,
28:11 --> 28:13you can't get appropriate screening,
28:13 --> 28:14is that right?
28:15 --> 28:17You cannot and appropriate care
28:20 --> 28:23is something that we will be
28:23 --> 28:25investigating next because it's really
28:25 --> 28:28a pity that you have ways to prevent it,
28:28 --> 28:30way ato treat it, but people don't
28:30 --> 28:33even get close to that opportunity.
28:33 --> 28:34It's really saddening.
28:35 --> 28:37Doctor Mario Strazzabosco is a
28:37 --> 28:38professor of medicine and clinical
28:38 --> 28:41program leader of the Liver Cancer
28:41 --> 28:43program at the Yale School of Medicine.
28:43 --> 28:45If you have questions,
28:45 --> 28:46the address is canceranswers@yale.edu
28:46 --> 28:48and past editions of the program
28:48 --> 28:50are available in audio and written
28:50 --> 28:52form at yalecancercenter.org.
28:52 --> 28:54We hope you'll join us next week to
28:54 --> 28:57learn more about the fight against
28:57 --> 29:00cancer here on Connecticut Public Radio.

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May 2, 2021

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

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