The northeastern part of India has the highest incidence of cancer in the country, according to the latest report of the Indian Council of Medical Research (ICMR). Data from different PBCRs show that the most common cancers in men are that of the lung, mouth, oesophagus, stomach and nasopharynx. The most common cancers in women are that of breast, cervix, uterus, oesophagus and lung.
Due to our national policy, the State NCD cells screen all citizens above 30 for common cancers i.e. oral, breast and cervical. Here we would like to draw the attention to Liver Cancer. It remains the second most common cause of death from cancer.
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Hepatitis is one of the most prevalent viral infection and highly contagious. 400 million people are affected worldwide and 4000 deaths occur every day because of Hepatitis virus. Liver cancer is the fifth most common cancer in men and the ninth most common cancer among women. Further these data become graver with every state and districts especially in Northeast. Approximately 80% of liver cancers happen due to the hepatitis virus.
Hepatitis is an inflammation of the liver. In Hepatitis the functions of the liver like detoxifying the blood, storing vitamins and producing hormones are disrupted because of inflammation. There are five main types of hepatitis viruses – A, B, C, D and E. These five types must cause grave concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.3 In Arunachal Pradesh, for example, liver cancer is the most common cancer among men along with oral.
While Hepatitis A and E are typically caused by ingestion of contaminated food or water; Hepatitis B and C are both viral infections that attack the liver cells, and have similar symptoms. Mostly hepatitis B is transmitted from the bodily fluids of an infected person but Hepatitis C virus usually spreads through blood-to-blood contact. Hepatitis B and C viruses cause acute and chronic infections that can lead to liver cirrhosis and hepatocellular carcinoma (HCC). Approximately 90% of all primary liver cancer cases happen due to HCC making Hepatitis C the leading cause of liver cancer.2
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It is estimated that about one-third of the global population – around 2 billion people – have been infected with the hepatitis B virus at some stage in their lifetime. Of these two billion people, about 360 million people remain chronically infected carriers of the disease – most of them unaware they are infected but are capable of spreading the disease to others.1
Some common ways in which Hepatitis A and E are spread are eating or drinking contaminated food or fluid, sharing contaminated eating utensils, household contact with an infected person and sexual contact with an infected person. Some common routes of transmission of Hepatitis B & Hepatitis C include occur through infected blood and blood products including contaminated tools. In Kamrup (Metro), the incidence rate of Liver Cancer stands at AAR 6.9% among males and has grown substantially over the decades.
Symptoms
According to the latest ICMR report, new liver cancer cases will grow from 36,000 in 2015 to almost 50,000 new cases in 2020. It is then prudent to identify common Hepatitis virus symptoms. They include dark yellow urine, fatigue, fever, joint pain, nausea, pale or grey stools, vomiting, yellowing of the skin or eyes. The virus type is diagnosed through a diagnostic test. In hepatitis C, approximately 80% of people do not exhibit any symptoms after initial infection. By the time symptoms show up the disease has progressed to secondary stage and serious liver damage.
Prevention
The crude incidence rate for liver cancer in males in 2016 was highest in Arunachal Pradesh, followed by Kerala, Sikkim, and Mizoram, making three Northeast features within the top four states. Thus, the best prevention involves avoiding all the risk factors of hepatitis A, B, C & E and getting vaccinated for Hepatitis B.
If a person has risk factors for hepatitis B or C, such as sharing needles, a history of unprotected sex or a blood transfusion before 1992, they should speak to a doctor about testing. All family members of infected persons should check for Hepatitis B and C viruses immediately. Those who are negative for Hepatitis B should take vaccination against Hepatitis B virus.
As awareness rises, there will new efforts towards Hepatitis management & its treatment under expert medical care. By fighting Hepatitis, we will lay the road to fighting liver cancer in its entirety and at its roots.
Event:
On the World Hepatitis Day, we seek to draw the reader’s attention to the different aspects of this largely unknown illness. The North East Digestive and Liver Foundationis organising a Runathon for awareness on Hepatitis called “Run For Your Liver” – a rally for greater awareness and prevention of Hepatitis B & C”. On 28th July, 2019 at 6 am, we hope to run for a Hepatitis free world by 2030. In association with department of Gastroenterology, Gauhati Medical College Hospital (GMCH) and Tata Trusts, we will be running from – GMCH campus to Nehru stadium.
Dr BD Goswami is a renowned gastroenterologist & hepatologist based in Guwahati.
References:
- https://www.who.int/immunization/diseases/hepatitisB/new_vaccine/en/index3.html (accessed, July 17, 2019)
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597741/ (accessed, July 17, 2019)
- https://www.who.int/features/qa/76/en/ (accessed, July 17, 2019)
- http://gco.iarc.fr/today/data/pdf/fact-sheets/cancers/cancer-fact-sheets-7.pdf (Accessed 15 July 2019)
- https://www.cancer.net/cancer-types/liver-cancer/risk-factors-and-prevention (Accessed 15 July 2019)
6.http://www.searo.who.int/entity/emerging_diseases/topics/hepatitis_brochure.pdf?ua=1(Accessed 17 July 2019)
- https://www.who.int/news-room/fact-sheets/detail/hepatitis-b (Accessed 17 July 2019)
- https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (Accessed 17 July 2019)