Liver cancer is a type of cancer that starts in the liver. Some cancers develop outside the liver and spread to the area. However, only cancers that start in the liver are described as liver cancer. The liver, which is located below the right lung and under the ribcage, is one of the largest organs of the human body.
A 2018 report from the World Health Organization (WHO) indicated that liver cancer in Rwanda was in fourth place, following the cancer of the cervix, breast, colorectal and stomach.
Fidel Rubagumya, a cancer specialist working at Rwanda Military Hospital in Kanombe, says there are many risk factors, including infection with hepatitis B and C.
He says other factors include alcohol consumption and other toxins called aflatoxins. Hereditary diseases can also affect the liver, like cirrhosis (chronic liver damage from a variety of causes leading to scarring and liver failure).
For instance, he says, if one has hepatitis B or C and it’s not treated, it will take time for the liver cells to be destroyed which will eventually lead to cirrhosis. Once this happens, it can lead to liver cancer.
Rubagumya explains that hepatitis B and C are transmitted mainly through contact with blood or body fluids of a person with the virus.
One can also get these diseases through unprotected sex. For children, he says, they can get it from the mother during birth.
People who use drugs are at risk of getting the disease because of sharing needles.
"The way someone gets infected with HIV is the same way they can get hepatitis B and C. In most cases, people aren’t as afraid of these diseases as they are when it comes to HIV/AIDS; yet the mode of transfusion is the same and the complications are even worse,” he observes.
He says long term heavy consumption of alcohol leads to liver cell damage; once the cells are damaged for a long time, it leads to cirrhosis and then liver cancer.
Alcohol consumption could lead to liver complications, including cancer.
PREVENTION
Dr Francoise Uwinkindi, the director of Cancer Diseases Unit at RBC, says people should focus on what brings about liver cancer.
He says, for example, focusing on the risk factors that can be controlled or moderated is important. Also, avoiding unprotected sex, moderate use of alcohol, and not sharing needles is important.
Rubagumya says many of the patients he has seen with liver cancer got it due to the infection of hepatitis B and C.
Unfortunately, he says, hepatitis B and C symptoms are not noticed instantly—it can take more than five years before one starts experiencing the signs.
Within this period, he says, the cells of the liver are being destroyed. This is unfortunate and that’s why they always advise people to know their hepatitis B and C status.
"Even if one feels okay and they don’t have any health issues, it’s advisable to go for testing, which ensures one is safe from hepatitis B and C,” he says. He adds that people notice that they have liver cancer at an advanced stage where little can be done.
TREATMENT
Liver cancer, just like any type of cancer, has stages one to four and that stage one and two are potentially curable; which can be cured by tumour resection if it’s one, two or three small tumours.
Liver transportation is another option when it comes to treatment of cancer for stage one and two.
He says there other modalities, like trans-arterial chemo remobilisation liver, where they inject drugs via some veins and arteries in the liver and get into the liver to kill the cancer cells.
With stages three and four, the disease is at an advanced level. Uwinkindi says what is done here is to help patients manage the pain.
Unfortunately, Rubagumya says, the people he normally attends to with liver cancer are young people.
"People need to be screened for hepatitis B and C. The hypothesis is that the people who are at a young age and have Hepatitis B and C might have gotten it from their parents,” he says.
For expectant mothers, he says it’s important to be checked for hepatitis B and C to prevent transmission.