Part C 02

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Answer

A – incidence has been hugely higher in the past decade
C – unlike popular perception, alcoholism is not the leading trigger factor
B – liver cancers typically have an underlying liver condition behind it
B – liver conditions reveal fewer symptoms until they have progressed much
A – she considers it to be a simple lab test that should be done more often
A – patients do not present due to the social stigma associated with liver problems

問題の解説（作成中）

Transcript

Woman:	Dr. Catherine from that. Some of the numbers we were reading were really kind of shocking. I was reading that the number of unresectable liver cancer has actually grown by 115% in the past decade. Why are we seeing some of these numbers rise when it comes to liver cancer?
Dr. Catherine:	So, liver cancer, or cancer that starts in the liver, is really caused. Most patients who have liver cancer have underlying liver disease or Cirrhosis of the liver, scar tissue in the liver. And we are seeing more patients with fatty liver causing Cirrhosis and an increase in liver cancer because of that. And then also (we are) still seeing a lot of patients with Hepatitis C developing liver cancer, even though we’ve got great treatments for that virus as well.
Woman:	So, a lot of times people connect liver disease with people who drink excessive amounts of alcohol, but as you’re saying, Hepatitis as a factor here, and we’re seeing it in more people that maybe aren’t abusive of alcohol.
Dr. Catherine:	Absolutely, alcohol isn’t even the most common cause for Cirrhosis. The most common reason really is fatty liver, which is associated with diabetes, high cholesterol, obesity and the metabolic problems that we’re seeing on the rise as well. And then Viral Hepatitis is the second most common.
Woman:	So, when we’re talking about treatments of liver disease, liver cancer, there’s really not too many options out there. What are we looking at, as far as new treatments and treatments that have been shown to be somewhat successful?
Dr. Catherine:	Yeah. So, when we’re thinking about liver cancer, as I said, most people have underlying liver disease. So liver cancer is a little different than other cancers, because we have to think about the underlying liver problems in addition to thinking about cancer itself, which is why a lot of liver cancers are treated by liver doctors and not necessarily cancer doctors. So most of the time, the best treatments are surgical, either cutting it out or doing a liver transplant. But unfortunately, most patients, about 80% of patients aren’t diagnosed in time to get that surgical treatment. And that’s when we really are talking about the unresectable or inoperable liver cancers, where we’re now thinking about the new treatments that we have available.
Woman:	And I would imagine, as we see with other cancers, the reason it’s being diagnosed so late is because the symptoms are kind of all over the place. So let’s talk about the symptoms and what those typically are for both liver disease and liver cancer.
Dr. Catherine:	Yes, so liver disease really doesn’t cause a lot of symptoms until it’s advanced. And this is part of the problem with diagnosing liver disease and diagnosing liver cancer. As I say to my patients, the livers are very forgiving organs. So it has to go through a lot of damage before it actually causes symptoms and that might be things like tiredness, itching, yellow eyes, swelling in the legs, swelling or water build up in the abdomen and confusion and not thinking clearly. Those are some of the advanced symptoms that we see. But when it’s early liver disease, we really don’t see a lot of symptoms at all. Liver cancer is the same way. So if you think about the liver, it’s about the size of a football. We want to find cancer when it’s the size of a golf ball and you can hide a lot of golf balls inside of a football without having any symptoms at all. So when somebody has liver disease, it’s important that we actually do screening for liver cancer and we check them every six months with lab tests and imaging tests and ultrasound or a CAT scan or a MRI so that we can find these cancers when they’re early.
Woman:	How… who is a good candidate for doing screening before there are any symptoms? Maybe you have a history of it in your family. Maybe you know that you haven’t been exactly great about your alcohol use or smoking, (or) other risk factors. Can you walk into your doctor and say, “Hey, could I have screening for my liver function?”.
Dr. Catherine:	Absolutely. So liver function screening is really just a lab test if there’s an easy lab panel that we can get. And primary care doctors often do it, but not always as part of the yearly physical. But if you have risk factors for liver disease, it is important to know what your liver panel looks like and know whether you have liver problems or not.
Woman:	Okay. And are there different ways to diagnose what the problem might be if the liver function test is…
Dr. Catherine:	So if somebody has elevated liver function tests, then the next step is we do a whole panel of labs to try to diagnose why they have those liver function problems because there’s a lot of things that can affect the liver. We also see sometimes where people can just have one time elevations of liver tests and it goes back to normal. And that doesn’t mean anything if it’s just one time elevated unless you also have risk factors.
Woman:	So again, the forgiving organ… And really liver cancer, even though we’ve seen these numbers kind of skyrocket, it doesn’t seem to get the attention that some of the other cancers do. Why do you think that is?
Dr. Catherine:	So, I think that liver cancer right now is actually the fifth most common cause of cancer related deaths, and it’s actually the one of the few cancer deaths that’s actually increasing in incidents and frequency as compared to decreasing most cancer deaths are actually going down. With liver problems, as you said, oftentimes are associated with alcohol or drug use or things like that. So there’s a lot of social stigma that happens when people who have liver disease. And I think that’s part of it where we’re not really seeing that information come through, because there is that stigma.