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Hepatocellular carcinoma kills more people in Texas than in any other state: How we can fight back

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More Texans die from hepatocellular carcinoma, the most common type of liver cancer, than people in any other state, but we can fight back.

Texas has more people than any other state who die each year from hepatocellular carcinoma (HCC), which is the most common type of cancer that starts in the liver. The rates of people being diagnosed with HCC and dying from the disease have increased faster than any other cancer, and it’s now the sixth-leading cause of cancer-related death in the United States.

But we can fight back. Our approach to HCC care involves effective treatments for the disease’s underlying causes, aggressive HCC screening and treatment, and research into new therapies. 

Causes and risk factors of HCC

HCC can develop as a result of many underlying liver diseases that cause scarring, or cirrhosis, of the liver. Worldwide, hepatitis B is the leading cause of HCC, though it’s less common in people who were born in the U.S. because a vaccine has been available since 1982.

In the U.S., the main cause is hepatitis C, which accounts for more than half of all cases. About 3.5 million Americans have hepatitis C, but only about half know it. According to the Centers for Disease Control and Prevention (CDC), 75 percent of Americans with hepatitis C were born between 1945 and 1965. If you were born within this time span, the CDC recommends that you get tested. We’re also seeing many new cases due to the nation’s opioid epidemic because people with the hepatitis C virus can spread it to others by sharing needles.

We are seeing increasing numbers of people who develop cirrhosis without having hepatitis B or C. Texas ranks second in the number of deaths from cirrhosis nationwide. One of the liver’s functions in the body is to filter out toxins such as alcohol from the blood. Drinking too much alcohol can damage your liver and lead to a buildup of fat, resulting in a condition called fatty liver disease. Over time, fatty buildup in your liver can lead to cirrhosis. 

People also can develop nonalcoholic fatty liver disease, a condition that is common in people who are obese or who have Type 2 diabetes. Between three and four of every 10 people in the U.S. are estimated to have some degree of nonalcoholic fatty liver disease, making it the most common liver condition in the country.

Related reading: What is fatty liver disease, and what are we doing to treat it?

Why early detection and treatment are key

Fortunately, hepatitis C is now completely curable with oral medications taken over two to three months. This is one of our most effective strategies for preventing HCC because successful treatment of hepatitis C reduces liver cancer risk by 75 percent.

If you have a chronic case of hepatitis B, which requires lifelong care, we can provide medications to keep the virus in check and reduce its risk of damaging your liver. Detecting and treating hepatitis B early can reduce the risk of liver cancer by 50 to 80 percent.

If you have liver disease, you should limit the amount of alcohol you drink to avoid putting increased stress on the liver. For people with fatty liver disease, whether caused by excess alcohol or not, I typically recommend abstaining from alcohol completely. If your fatty liver disease is caused by obesity or diabetes, regular exercise and a healthy diet are critical to reducing the amount of fat buildup in your liver. A heart-healthy diet and active lifestyle can improve overall health and liver function.

Sadly, many people with liver diseases aren’t under the care of either a primary care doctor or a liver specialist like me, so that limits our ability to find and treat the disease before it leads to HCC. 

“The best way for us to protect patients from hepatocellular carcinoma (HCC) is to prevent them from developing it in the first place. We have to screen patients aggressively for liver disease that cause HCC and link them to effective treatment.”

Amit Singal, M.D., M.S.

Screening and treatment for HCC

Cirrhosis often doesn’t cause any noticeable symptoms for years. If you have a liver disease that can cause scarring, or if you’re at risk for one of these diseases, you should be monitored regularly to make sure you don’t develop HCC. 

We have shown that screening for HCC should involve two simple tests:

● Abdominal ultrasound, in which we place a probe on the skin, very similar to examining an unborn baby during pregnancy, and check the liver for signs of cirrhosis

● A blood test for alpha-fetoprotein, a substance that shows up in high amounts in people with HCC

When we regularly screen people who have liver disease with these two tests, we can find nearly 70 percent of HCC cases at an early stage, when we can treat the disease successfully. I led a research team that investigated HCC screening, and we found that early screening leads to better disease detection and improved survival for patients.

Depending on how far a patient’s HCC has progressed, we can recommend one of the following treatments to cure the disease:

● Tumor ablation, or using heat to destroy a liver tumor

● Surgical resection of the liver, or cutting away the cancerous portion (also called a hepatectomy)

● Liver transplant

These treatments have the potential to greatly improve survival. More than half of patients who undergo one of these procedures survive longer than 10 years. However, if we don’t find HCC until it has progressed to its more advanced stages, these options won’t work, and the average survival is only one to two years. That’s why it’s crucial for us to find and treat HCC early in the process.

Continual process improvement for better HCC care

We’ve made great progress against HCC in recent years, but there’s still more to do. Some of our successes against the disease here at UT Southwestern have come because we tend to see patients early in the disease process, either before HCC has developed or while it’s still curable. But that’s not the case when we look at large populations of people with cirrhosis of the liver nationally.

Fewer than one of five patients with cirrhosis are screened regularly for HCC. That’s not good enough, so we’ve tested several processes to increase our screening rate among patients who are at risk for the disease. In one study of 1,800 participants, we contacted people who had cirrhosis and told them they should be screened for HCC. Then we compared their screening rates to patients who were not contacted. We saw a significant increase in the number of screenings among patients we contacted. Based on those results, we’re now testing this process in a larger trial of 3,000 participants in several Texas health systems. We are also leading several statewide and national efforts to identify new screening tests that we believe will help us diagnose more cases of HCC in the early stages. 

In regard to treatment, our only option until recently for patients with advanced HCC was a targeted therapy called sorafenib, which received approval from the Food and Drug Administration in 2007 for treating liver cancer. However, we’ve seen promising results from clinical trials of four new medications, and I expect these soon will be available for general use. These medications will help us care for patients who are no longer responding to sorafenib therapy.

We’re also closely watching for results of a large clinical trial on an immunotherapy treatment for HCC. Immunotherapy has revolutionized the treatment of some other types of cancer, such as kidney cancer and lung cancer. We’re expecting the results from this trial later in 2018, and if they’re positive, I expect they could revolutionize how we treat advanced HCC. 

The fight against HCC forges ahead. As research continues into the treatments of the future, it’s critical for patients to know their risk and work with their doctors to keep this dangerous disease at bay.

To find out whether you might benefit from liver disease or HCC screening, call 214-645-8300 or request an appointment online.

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