How is liver cancer treated in Ukraine?

Liver cancer is the 6th most common cancer among men and the 10th among women, according to statistics from the World Health Organization. What is the situation with the incidence of this illness among Ukrainians and how is it treated in Ukraine — we asked leading specialists in the country — Oleksandr Hrynenko and Vadym Kondratyuk.

Vadym Anatoliyovych Kondratyuk

Senior Researcher at the Shalimov National Institute of Surgery and Transplantation

• Doctor of Medical Sciences (D.Sc.)

Oleksandr Valentinovych Hrynenko

Head of the Department of Liver Transplantation and Surgery at the Shalimov National Institute of Surgery and Transplantation

• Candidate of Medical Sciences (Ph.D.)

How many people in Ukraine suffer from liver cancer?

Oleksandr:

In Europe, the average incidence is 10 people per 100,000 population. In my opinion, the incidence rate in Ukraine is also quite high, but due to poor screening programs, I cannot give exact numbers.

Why does liver cancer occur?

Oleksandr:

In 90% of cases, it occurs because of certain chronic inflammatory diseases of the organ: viral hepatitis B and C, alcoholic hepatitis (which occurs due to alcohol abuse), autoimmune liver diseases, etc. The remaining 10% of cases are due to genetic factors.

Can liver cancer be prevented?

Oleksandr:

Prevention consists in eliminating the causes listed above. People who do not have the opportunity to eliminate these causes, for example, if they already have cirrhosis or a deep stage of liver fibrosis, should be actively monitored by doctors.

Only regular tumor screenings will help detect and cure cancer in its early stages.

In Ukraine, unfortunately, active risk groups are not screened, so we identify patients with liver cancer already in the late stages who need more serious treatment.

I want to emphasize that this type of cancer, in its early stages, does not have specific symptoms. The liver is a physically large organ, there are no nerve endings inside, so a person initially does not feel a neoplasm. When a pain syndrome or liver failure occurs, then, as a rule, the window of opportunity for radical treatment is already closed.

How is liver cancer treated?

Oleksandr:

Most often, it occurs because of cirrhosis, in which case the organ does not work properly, and we are deprived of a surgical maneuver. That is, we cannot take a large part of the organ because the person will simply die of liver failure. Considering these nuances, several ways of treating this tumor have been developed: from surgical (resection or transplantation) to minimally invasive (ablation, chemoembolization). Which method to choose depends on the specific situation. A multidisciplinary approach is mainly required: a surgeon, a transplant specialist, an interventional specialist, an endovascular surgeon, etc. The teamwork of these specialists is the key to successful liver cancer treatment.

I want to highlight that, in severe cases, only a multidisciplinary approach works. Therefore, I would recommend patients consult various specialists and be generally knowledgeable.

I will give an example of our work with a complex person who has cancer and cirrhosis: the resection technique may not be suitable for him due to the risk of liver failure. Therefore, we include him in the waiting list for transplantation, and meanwhile, we perform ablation or chemoembolization. These minimally invasive methods are a chance for the person to wait for a transplant.

What are the most effective methods of liver cancer treatment?

Oleksandr:

Transplantation is the most effective type of treatment for classic cases — cirrhosis and cancer.

Ablation is a fairly effective method for small tumors. The advantages of it are minimal trauma, that is, the operation is performed without incisions, and after 2–3 days, the patient can return home.

Larger tumors require resection surgery. We have to remove part of the organ with the tumor.

All applicable methods are available in Ukraine. I will repeat that the correct approach is always a comprehensive one — it is necessary that the patient has access to all possible treatment options.

Chemoembolization is a minimally invasive treatment designed to help patients with liver cancer and types of cancer that do not respond to other treatments. Simply put, it can make inoperable tumors operable.

What is the difference between chemoembolization and chemotherapy?

Vadym:

Chemotherapy is the placing of anticancer drugs intravenously. With this type of placement, the chemical is distributed evenly throughout the body.

Transarterial chemoembolization is an endovascular technique for blocking the arteries that feed the tumor with a special material containing an anticancer drug. It combines embolization of tumor vessels and saturation with a chemical drug — at the same time, most of the drugs remain in the tumor and have a prolonged effect.

It is most often used for the treatment of liver tumors.

How effective is chemoembolization?

Vadym:

We cannot discuss the effectiveness of chemoembolization as a separate method since it is typically combined with others. However, I would like to point out that the combination of it with radiofrequency ablation can significantly reduce or destroy the tumor by almost 100%.

Chemoembolization has been used in Ukraine since the mid-1990s, and many people have been treated during this time.

How do patients perceive this method of treatment?

Vadym:

They usually have a positive attitude towards this technique, especially when all aspects of the treatment are honestly explained to them. It is important to avoid excessive expectations for a quick and complete recovery, but it is also essential not to lose faith in the method’s effectiveness.

The main myth is that such a method is not used in our country or is performed poorly. In fact, our technique of performing chemoembolization does not differ from the one generally accepted all over the world — the same technique, the same equipment, the same drugs.

How to effectively diagnose and timely treat liver cancer?

Vadym:

It is crucial to teach people to undergo regular professional examinations to detect the illness in its early stages. This especially applies to patients with liver cirrhosis — an ultrasound should be done every few months. When a tumor is detected or suspected, the person should be checked by an oncologist, preferably in specialized centers, for a complete examination and determination of indications for surgery. If surgery is not needed, palliative treatment types come to the rescue, one of which is chemoembolization.

Oleksandr:

Doctors should remember: the earlier they can detect cancer, the more effectively it will be treated or cured.

Clinics must continuously educate their specialists who deal with chronic liver diseases. Therapists, gastroenterologists, hepatologists, and infectious disease specialists must know that some of their patients will have a cancer problem eventually, and they must be able to recognize it in time.

And these should be specialists in a clinic that has all the methods. Then the percentage of successful treatment will increase significantly!