Dr Abia Nzelu writes on the dangers of liver cancer and how to prevent needless deaths from the scourge.
Viral hepatitis is inflammation of the liver caused by a group of virus known as hepatitis A, B, C, D, and E. The liver is the largest internal organ. It is shaped like a pyramid and lies under the right ribs just beneath the right lung. The liver is an indispensible organ. It has several important functions including: break down and storage of many of the nutrients absorbed from the intestine; production of most of the clotting factors that prevent excessive bleeding from cuts or injuries; release of bile into the intestines to help absorb nutrients (especially fats) as well as the removal of harmful substances from the blood.
Annually, viral hepatitis affects 400 million people worldwide, causing acute and chronic liver disease and killing about 1.5 million people (4,000 people daily), mostly from hepatitis B and C (HBV & HCV). Yet, it is entirely preventable. With better awareness and application of its preventive measures, this life-threatening disease could be eliminated and 4,000 lives could be saved daily.
Viral hepatitis is one of the most communicable diseases in the world. It is spread through contaminated blood, intravenous drug abuse and sexual contact with an infected person. In highly endemic areas like sub-Saharan Africa and Asia, hepatitis B is most commonly spread from mother to child at birth (perinatal transmission). In addition, infection can occur during medical, surgical and dental procedures, tattooing, or through the use of razors and similar objects that are contaminated with infected blood.
Infection with HBV or HCV is the main cause of liver cancer; viral Hepatitis causes 80 per cent of liver cancer deaths. This fact makes hepatitis a target disease of the Big War Against Cancer in Nigeria, the current focal cause of the Committee Encouraging Corporate Philanthropy (CECP-Nigeria). The first phase of the Big War is aimed at “Taking holistic health care to the Grassroots” by raising funds to acquire and deploy 37 Mobile Cancer Centres (MCC), one for each state and Abuja.
Over 83 per cent of cases of liver cancer occur in developing countries. In Nigeria, liver cancer is the second leading cause of cancer death, accounting for over 11,000 deaths yearly and 32 deaths every day. Liver cancer is rare in children and teenagers. The average age of occurrence in Nigeria is about 46 years compared to the developed world where the average age of occurrence is in the mid 60s. Liver cancer is more common in men with a male : female ratio of about 2 in 1.A recent well- known male Nigerian casualty is Senator Khalifa Zanna, a recently re-elected Senator of Borno State, who died at the age of 60 on May 16, 2015. On that same day, 31 other Nigerians also died of liver cancer, unknown and unsung, but not unloved. Liver cancer is also the second leading cause of cancer deaths worldwide, accounting for more than 700,000 deaths each year.
The leading cause of liver cancer is cirrhosis (damage of liver cells and replacement with scar tissue) due to either HBV, HCV, or chronic alcoholism. In 2013, 300,000 deaths from liver cancer were due to hepatitis B, 343,000 to hepatitis C and 92,000 to alcohol.
Aflatoxin exposure is another important cause of liver cancer especially in developing countries in Africa, South-East Asia and China. The aflatoxins are a group of chemicals produced by a fungus Aspergillus. Ingestion of food contaminated by the fungus is very toxic to the liver. Common foodstuffs contaminated with the toxins are cereals, peanuts and other vegetables. Concurrent HBV infection and aflatoxin exposure increases the risk of liver cancer to over three times that seen in HBV infected individuals without aflatoxin exposure. Other risk factors include: obesity, diabetes, and smoking.
Signs and symptoms of liver cancer often do not show up until the later stages of the disease. Some of the most common symptoms of liver cancer are: weight loss (without trying), loss of appetite, feeling very full after a small meal, nausea or vomiting, liver and spleen enlargement, belly pain or pain near the right shoulder blade, swelling or fluid build-up in the belly, itching, yellowing of the skin and eyes (jaundice). Other symptoms can include fever, enlarged veins on the belly that can be seen through the skin, and abnormal bruising or bleeding. For people who have chronic hepatitis or cirrhosis, worsening of their usual symptoms or just changes in laboratory test results may indicate progression to cancer. The survival rate from liver cancer is generally poor because liver cancer progresses rapidly, and treatment options are limited. Thus, prevention is the key to reducing liver cancer deaths.
One of the most successful ways of preventing liver cancer is vaccination against hepatitis B. This vaccine has been available since 1982 and the first dose is now being given at birth. The vaccine is safe and effective, protecting from HBV infection for life and the development of chronic disease and liver cancer due to HBV. Vaccination for HCV is currently unavailable. However, antiviral medicines can cure HCV infection. Other ways of preventing hepatitis include limiting transmission of these viruses by avoiding sharing of needles and other items such as toothbrushes, razors or nail scissors. Avoid getting tattoos or body piercings from unlicensed facilities and screening of blood donation products. Furthermore, safer sex practices, including minimizing the number of partners and using barrier protective measures (condoms), also protect against transmission. Reducing alcohol abuse, obesity, and diabetes would also reduce rates of liver cancer.
Aflatoxin prone foods include tree nut (almonds, cashews, and walnuts), peanut, rice, corn, dried fruits and cereals. Aflatoxin exposure can be avoided by post-harvest intervention to discourage mold. These include storing food in dry places, refrigeration of food, avoiding contact between foods and insects, throwing away any moldy, discoloured or shriveled food. Roasting, baking, frying, X-radiation, and pressure cooking also help to reduce aflotoxin levels in food. Aflatoxin prone foods should not be stored for months unless frozen.
Screening and early diagnosis can prevent health problems that may result from viral hepatitis infection and prevent transmission of the virus. Treatment with drugs, including oral antiviral agents can decrease the risk of liver cancer.
To significantly reduce the current hepatitis and liver cancer epidemic, there is need for massive awareness and widespread availability of these interventions. In Nigeria, the Mobile Cancer Centre (MCC) being championed by the CECP-Nigeria would be an excellent means of facilitating health education, screening as well as vaccination against hepatitis at the grassroots.
An MCC is much more than a Mobile Mammogram. Rather, it is a clinic on wheels, in which cancer screening, follow-up and treatment (including surgeries), can take place. It also contains facilities for screening against most common diseases, including the Ten Major Cancer-related killer diseases (Diabetes, Renal Disease, Obesity, Malaria, Schistosomiasis, Helicobacter pylori, Hepatitis, HIV/AIDS, Human Papillomavirus (HPV) and Hypertension).
The MCC is perhaps one of the most important means of raising the life expectancy of Nigeria which is currently the 12th lowest globally. Cancer and these ten disease conditions are the main culprits responsible for this low life expectancy. A single MCC in a state in Nigeria could make a huge positive difference. That state would be divided into smaller units such that every community would be reached by the Mobile Cancer Centre at least once a year.
In line with the theme of this year’s World Hepatitis Day, the CECP- Nigeria hereby invites all Nigerians to ACT! (Attack Cancer Together! Attack Cancer Today!! Attack Cancer Totally!!!). This could be done through advocacy and by donating towards the acquisition and deployment of the MCC. Be a voice today for the 1,800 lives that will be lost to hepatitis.
Dr. Abia Nzelu (Executive Secretary, CECP-Nigeria) can be reached via email@example.com or firstname.lastname@example.org