Every year on October 20th, the Korean Liver Society was established.
The cause of liver cancer is clear, but there are no symptoms, so it is difficult to detect
Immuno-cancer drug development increases the possibility of a complete cure
“Early diagnosis and active treatment are important”
[아시아경제 김영원 기자] Every year, October 20th is ‘Liver Day’ established by the Korean Liver Society. As the liver is called the ‘silent organ’, there are no symptoms even if there is serious damage, so active examination for early detection is necessary. In particular, among all liver diseases, ‘liver cancer’ has the highest physical, economic, and social burden. Liver cancer was found to be fatal in the 4050 generation with active social and economic activities. According to ‘Statistics of Causes of Death in 2021’ published by the National Statistical Office, liver cancer ranked first among the causes of cancer death among those in their 40s and 50s.
Liver disease terminus ‘liver cancer’… The risk of developing chronic epilepsy ↑
Compared to other cancers, liver cancer is characterized by a distinct occurrence in patients with chronic liver disease. It is known that the risk of developing liver cancer is 20 times higher when infected with the hepatitis virus. Liver cirrhosis, in which cells become hardened due to chronic inflammation and cause fibrotic changes in the liver, accompanies about 80% of all liver cancer patients, and the incidence of liver cancer among cirrhosis patients is about 1 to 5% per year.
The main symptoms of liver disease include fatigue, loss of appetite, and jaundice, but most of them are asymptomatic. When liver cancer occurs in patients with cirrhosis, symptoms of jaundice or ascites may suddenly appear. Symptoms of liver cancer include pain or lump in the right upper abdomen, abdominal distension, weight loss, severe fatigue, and indigestion. However, most of these symptoms appear after the cancer has advanced significantly.
In some cases, cancer is discovered while undergoing a health checkup when there are no symptoms or ambiguous conditions. For that reason, experts say that regular check-ups are important, especially for high-risk groups, so early screening is important. Heo Jeong, a professor of gastroenterology at Pusan National University Hospital, said, “Hepatitis B virus is the cause in 72% of liver cancer patients, and hepatitis C virus and alcohol are the causes of liver cancer in many cases.” Due to the nature of the process, early diagnosis in high-risk groups is very important, as many people feel symptoms only after the disease has progressed and visit the hospital late.”
Curative treatment at the early stage of liver cancer… Possibility of complete cure with recent advances in treatment ↑
For liver cancer, the treatment policy is determined by comprehensively considering the degree of cancer progression, liver function, and systemic condition. If the liver function or systemic condition is not very bad, curative treatment such as liver resection, liver transplantation, radiofrequency ablation or ethanol injection is performed.
Hepatic resection is considered preferentially when tumor resection is possible and liver function is sufficient. Liver transplantation is a treatment that can expect a good prognosis for early liver cancer where there is usually only one tumor and is less than 5 cm, or when there are three or less (each less than 3 cm) and the cancer has not invaded blood vessels and has not metastasized outside the liver. . However, even with curative treatment, liver cancer may recur in about half of the patients.
Non-curative therapy is used to treat liver cancer that is highly advanced, such as multiple tumors or vascular invasion tumors. About half of liver cancer patients have multiple tumors, vascular invasion tumors, or impaired liver function. For this reason, it is difficult to consider surgery as a priority, and the most commonly used treatment is carotid artery chemoembolization (TACE). It is a method to block blood vessels by administering anticancer drugs to the arteries that supply oxygen and nutrients to liver tumors.
Chemotherapy may be considered if there is metastasis to other parts of the body, such as lymph node metastasis, lungs, or bone, or if several treatments do not work. For about 10 years, ‘targeted anticancer drugs’ have been used for hepatocellular carcinoma chemotherapy. Unlike past cytotoxic anticancer drugs, targeted anticancer drugs rarely attack normal cells and act in a way that prevents proliferation by inhibiting the activity of biomaterials that occur during cancer formation. However, there was a disadvantage in that the response rate of chemotherapy, that is, treatment options and effects, were limited.
Recently, ‘immuno-cancer drugs’ have been developed and used that improve the response rate and survival rate of cancer treatment and use the body’s immune system to kill cancer cells. Immunotherapy is a treatment that stimulates the body’s immune system to make immune cells attack cancer cells better, rather than attack the cancer itself. Major global guidelines in the U.S. and Europe and the ‘2022 Hepatocellular Carcinoma Treatment Guidelines, which were revised in June,’ are designed to give priority to the first treatment of patients with unresectable liver cancer. is recommending
The Tecentriq-Avastin combination therapy reduced the risk of death by about 40% compared to conventional therapies in global clinical trials, and showed the longest median overall survival (19.2 months) data among treatments approved in Korea so far. In particular, ‘complete remission’ in which all tumors disappear was observed in about 8% of the patients who participated in the study, so a cure can be expected even in metastatic hepatocellular carcinoma.
Since May, domestic health insurance benefits have been applied to the Tecentriq-Avastin combination therapy for liver cancer. Previously, Tecentriq’s health insurance coverage was only applied to secondary non-small cell lung cancer, urothelial cancer, and small cell lung cancer. Accordingly, the annual medication cost, which was about 66 million won before the application of health insurance, has been reduced to the current level of 3.3 million won, greatly reducing the burden of treatment costs.
Professor Huh said, “Metastatic hepatocellular carcinoma in the past was a very desperate cancer due to its low survival rate, but the latest immunotherapy combination therapy that can even be cured in advanced hepatocellular carcinoma has emerged and the treatment landscape is changing,” said Professor Huh. Because a good prognosis can be expected only when the patient is in good condition, regular check-ups and consistent and active treatment are important for the prevention and treatment of liver cancer and various liver diseases.”
Reporter Kim Young-won [email protected]