Once diagnosed with cancer, what a patient needs is morale support from friends and family to cope with their overwhelming grief, fear and confusion.

ILLUSTRATION: CHOOPONG EAMORAPHAN

“But what they need most is self morale. It’s very unfortunate that many of us died because they gave up too early,” said cancer patient Somsak (not his real name).

After learning that he had advanced liver cancer, Somsak said he broke down, cried and cried.

Somsak knew he had the hepatitis B virus 10 years ago. After that, he noticed he began to experience chronic fatigue and unexplained weight loss. his dark orange-coloured urine also worried him.

In addition, he suffered acute abdominal pain. An ultrasound screening detected an abdominal mass in the upper right area of his body. A CT scan and biopsy later confirmed the diagnosis of liver cancer.

“I was shocked when my doctor told me that the cancer was in advanced stage. And that I might only be able to live six more months.”

Never saying die, Somsak decided to join “the Advanced Liver Cancer Patient Assistance Programme” following his doctor’s suggestion. The programme gives patients cancer oral medicine support.

“I’m lucky because I have responded relatively well to the medication.” he said.

After two years of medication, Somsak continues to fight bravely against the deadly disease despite some adverse side effects from the medication.

“It is as good as it gets,” he said. “Apart from medication, I believe that positive thinking and good emotional health is equally important to fight cancer. we need to be strong and brave if we want to live longer.”

The liver cancer that Somsak has is called hepatocellular carcinoma (HCC), explained Dr Thiravud Khuhaprema, chairman of the National Cancer Institute Foundation. this form of liver cancer is closely linked to chronic hepatitis B and C. it is the most common type of liver cancer that begins in the cells of the liver itself.

“These patients are often found to have a history of viral hepatitis B or C infection. HCC is one of the main cancers that causes death in Thailand and chronic hepatitis B is found in 80% of these cases,” said Dr Thiravud. “The infection can cause continual damage to the liver and develop into cirrhosis and cancer.”

He said the frequency of liver cancer is highest in developing countries and quite rare in developed countries. Each year, it is estimated that there are about 350,000 new cases of liver cancer. And two-thirds of the cases are found in countries in Asia. Mongolia is ranked first and Thailand fifth.

In Thailand, liver cancer is the most common cancer in males. it is the third most frequent cancer in females, but it’s the number one cause of death among female patients. The incidence rate and the mortality rate of liver cancer in Thailand are steadily rising.

Assoc Prof Narin Voravud, an expert in medical oncology from Chulalongkorn University Hospital pointed out that the relative high rates of HCC in Thailand is reflected in the high frequency of hepatitis B infection.

“One person in every 12 people suffers from hepatitis B infection in Thailand,” he said. Meanwhile, the number of people with viral hepatitis C infection has been on the increase.

Heavy drinking is also another important cause of liver cancer in Thailand, he noted. The chance for liver cancer is even higher if the drinkers have snacks that contain alfatoxin, a dangerous mould in foodstuffs commonly found in peanuts, wheat and corns that are stored in a wet or humid environment. It’s odourless, colourless and tasteless.

“Most Thai people drink alcohol paired with peanuts. These combined factors may trigger the development of HCC,” said Dr Narin. 

HCC liver cancer often does not show any symptoms in its early stage. like Somsak, patients with advanced stage may experience fatigue, loss of appetite, weight loss, yellowing of the skin and the eyes, abdominal pain (particularly in the upper right area where the liver is present).

Primary liver cancer that affects just a small part of the liver is often treated with surgery to remove the cancerous tumour and the surrounding liver tissues to preserve the important areas of the liver for normal body function. it is possible for patients to suffer from the recurrence of the disease, however.

“Only 10-20% of HCC can be completely removed using surgery. And the recurrent rate is about 50-60%,” Dr Narin said.

Another treatment option involves inserting particles into the liver artery to block the flow of blood to the tumour. Liver transplants to replace the diseased liver can cure the disease but a living donor graft and matching of organ donors is not easy to find.

It is unfortunate that patients with HCC often suffer from liver cancer, viral hepatitis B infection and cirrhosis of the liver at the same time, he said.

It is not uncommon that patients with liver cancer die shortly after the diagnosis. if the cancer cannot be completely removed, the decline is rapid. Patients may usually continue to live only three to six months.

“Treating patients with liver cancer can be very challenging as we have to deal with three conditions simultaneously,” Dr Narin said.

Most chemotherapy drugs are not effective to liver cancer. And chemotherapy has not been shown to help patients live longer, he said. The liver often cannot tolerate radiation which harms healthy liver tissues.

“The good news is that the patients who cannot be treated with surgery can now resort to new liver cancer drugs,” he said. this new medication tackles the cancerous cells and tumour blood vessels directly.

A liver tumour needs new blood vessels for it to grow. since this medication blocks the growth of new blood vessels, the growth of the tumour is then stopped. The possible side effects include diarrhoea, skin rash and high blood pressure.

In clinical trials overseas, the drug succeeded in extending the lives of patients who cannot be treated with surgery and injection by 44 % one year when compared to 33% of those who received a placebo, said Dr Narin.

In Thailand, a clinical trial involving 140 Thai patients with advanced liver cancer showed that the patients continued to live up to 14 months.

“An improvement of survival probability of four months in Thai patients means that the drug is effective with Thai patients,” said Dr Narin.

The bad news is that this new medication is extremely expensive. it costs about 250,000 baht a month for the drugs.

“This is why the patients with advanced liver cancer may consider joining the Advanced Liver Cancer Patient Assistance Programme,” said Dr Thiravud.

The programme which requires participants to pay for the medicine for the first three months before they are accepted, is a collaboration between the National Cancer Institute Foundation and the country’s leading pharmaceutical company. since its inception in 2009, more than 170 patients have participated in the programme.

“But prevention is better than cure,” stressed Dr Thiravut. to keep liver cancer at bay, people should be vaccinated for hepatitis B. Meanwhile, patients with viral hepatitis B should also be periodically monitored for HCC.”

For more on the Advanced Liver Cancer Patient Assistance Programme, call the National Cancer Institute Foundation at 02 354 7025 ext.1221.

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