FRONTLINE CANCER: Fighting liver cancer, Part 2

Second of two parts.

Untreated, hepatocellular carcinoma (HCC) — or what people more commonly call liver cancer — is quickly fatal, usually within a year or so.

Traditional chemotherapy does little to control the disease. Surgery to remove a tumor can provide a local cure, but it does nothing to stop new tumors from forming in the cancer factory that is the cirrhotic liver, a condition that typically precedes HCC.

More advanced disease can be held in check by minimally invasive procedures that directly infuse chemotherapy into the blood vessels that feed the tumors, but these procedures do not offer a cure.

Once the disease is very advanced, the options become extremely limited. The last resort for patients with cirrhosis and HCC may be a liver transplant, but again, the numbers are not good. More than 17,000 people are currently on the approved national waiting list for a donor liver. There are approximately 6,000 liver transplants each year. Most people on the waiting list die waiting for a transplant.

The news is not all grim, however. The best way to beat HCC is to prevent it altogether. Improving hepatitis vaccination rates in at-risk populations will help prevent HCC. It also means detecting and treating fatty liver disease, which is extraordinarily common in the United States — an estimated 100 million Americans have it — before it progresses to cirrhosis and cancer.

Prevention is particularly important in San Diego because of the increased incidence of HCC in Asian and Hispanic populations here. Jeffrey Schwimmer, M.D., professor of clinical pediatrics at UC San Diego School of Medicine, is studying fatty liver disease in children because of the rising rates of obesity and diabetes in youth, which portends even earlier development of cirrhosis and HCC in the future.

UC San Diego and Moores Cancer Center physician-scientists like Claude Sirlin, M.D., and Rohit Loomba, M.D., have studied early changes in fatty livers and have developed new MRI techniques to spot problems earlier.

They are also working to develop effective ultrasound tests to detect nonalcoholic steatohepatitis (or NASH, an inflammatory condition that often precedes cirrhosis) and liver fibrosis — the scarring that can lead to cirrhosis. There are far too few MRI machines in the world to serve the estimated 1 billion people with fatty liver disease. A good ultrasound test, which can be done quickly and safely in a clinic, would be a major advance. Sirlin, Loomba and associates are also investigating novel treatments to reverse fatty liver and NASH before it can progress to cirrhosis and HCC.

In patients that have progressed to cirrhosis, the key to survival is to detect HCC at its earliest stages before the cancer has become incurable. This requires the use of relevant screening tests repeated on a regular basis.

Currently, national guidelines recommend ultrasound of the liver every six months in patients with cirrhosis to detect small HCCs. But ultrasound is less effective at detecting small cancers in obese patients — precisely the group at risk for NASH-related cirrhosis and HCC. Accordingly, Sirlin and colleagues have developed a 10-minute MRI examination to more effectively screen for HCC in obese patients, and they are now using this more advanced screening tests with patients.

It is vital that these innovations reach members of minority populations in the San Diego area who are at increased risk for HCC. To address this need, we’ve just launched a new HCC task force at Moores Cancer Center. This task force is co-directed by Sirlin and Isabel Newton, M.D., Ph.D., an assistant professor of radiology, who specializes in targeted treatments of HCC. Joining the task force are leading clinicians and scientists with expertise covering the gamut of HCC biology, diagnosis and therapy. This task force will critically assess the key gaps in knowledge and technology needed to beat this cancer.

Based on the task force’s recommendations, we will marshal our efforts and resources and bring every weapon and tool we have to bear.