October is globally observed as "Liver Cancer Awareness Month". During this time, initiatives are undertaken to raise public awareness and education about liver cancer, as well as to support those affected by the disease.
The goal is to inform people about risk factors such as hepatitis B and C, metabolic syndrome, alcohol consumption, and obesity. The campaign encourages early detection and inspires the adoption of a healthy lifestyle to prevent liver cancer.
Global scenario of liver cancer
Liver cancer is currently the 5th most common cancer and the 3rd leading cause of cancer-related deaths worldwide. Its prevalence is rising rapidly. The increasing rates of hepatitis B and C infections and fatty liver disease are major global health concerns. Experts believe that the fight against liver cancer lies in prevention, awareness, early diagnosis, and appropriate treatment.
In 2020, about 900,000 people were diagnosed with liver cancer globally, and over 830,000 deaths occurred due to this disease. The World Health Organization (WHO) forecasts that by 2030, more than one million people may die from liver cancer. Its global burden might increase by 56.4%. Alarmingly, about 75% of liver cancer cases occur in Asia, with nearly 90% being hepatocellular carcinoma (HCC). In most cases, the disease remains asymptomatic in the early stages, making diagnosis and treatment challenging.
Liver cancer in the context of Bangladesh
In Bangladesh, the prevalence of hepatitis B is approximately 5.5% and hepatitis C is 0.6%. It is estimated that around 10 million people in the country are infected with the hepatitis B or C viruses. Among those with chronic hepatitis, 20%–25% develop liver cirrhosis at different stages, and 5%–20% may eventually develop liver cancer, depending on diverse factors.
Additionally, metabolic dysfunction-associated fatty liver disease (MAFLD) affects between 4% and 34% of the Bangladeshi population. Many of these cases progress to metabolically-dysfunction-associated steatohepatitis (MASH)-related cirrhosis, which can lead to liver cancer—a trend that is increasing day by day. Liver cancer is currently the third leading cause of cancer-related deaths in Bangladesh.
Causes and risk factors
The major risk factors for liver cancer are hepatitis B and C infections, which are responsible for about 70%–80% of cases. In addition, MAFLD-related cirrhosis has become a significant and fast-growing contributor. Diabetes, obesity, and dyslipidemia are key underlying causes. Alcohol-related liver disease is also a major risk factor.
Furthermore, in 80%–90% of cases, liver cirrhosis (due to any cause) has the potential to develop into primary liver cancer (HCC) at different times.
Diagnosis and detection
Most liver cancers have no symptoms in the early stage. However, some non-specific symptoms—such as unexplained weight loss, loss of appetite, nausea, vomiting, upper abdominal discomfort, mild pain in the upper abdomen, swelling or feeling of a mass on the right side, jaundice, weakness, fatigue, fluid in the abdomen (ascites), or itching—should be taken seriously. Medical advice should be sought promptly.
Treatment options
Liver resections and liver transplantations offer long-term survival benefits for selected patients. However, many cases are diagnosed at advanced stages where these surgeries are not feasible.
When liver resections or transplantations are not possible, palliative procedures like TACE, TARE, RFA, and MWA may be applied based on the tumor stage and patient's condition. These methods are used for palliative treatment or as down-staging or bridging therapies to reduce tumor load and make curative procedures possible in selected patients.
Targeted drugs such as Sorafenib and Lenvatinib, and immunotherapies like Nivolumab and Atezolizumab + Bevacizumab, have opened new horizons in liver cancer treatment.
Nutritional support, weight control, and maintaining quality of life are equally important for patients undergoing treatment.
Preventive measures
Screening for HCC (surveillance)
Individuals with chronic hepatitis, liver cirrhosis, MAFLD, obesity, diabetes (type II), dyslipidemia, and alcoholics should undergo regular screening and medical evaluation for liver cancer.
Liver ultrasound every 6 months and AFP (when necessary) should be done so that liver cancer can be detected at an early stage.
Globally, about 60% of liver cancer cases are preventable if risk factors such as viral hepatitis (hepatitis B & C), alcohol intake, and metabolic dysfunction-associated steatotic liver disease (MASLD) can be controlled. Early detection and prompt treatment are crucial for long-term survival.
Let us all become aware of liver cancer during this Liver Cancer Awareness Month and spread awareness messages among our families and communities. From prevention to modern treatment, a comprehensive approach can save thousands of lives.
Professor Mohammad Ali is secretary general of the National Liver Foundation of Bangladesh.