Wu Mengda was only 3 months from the discovery of liver cancer to his death, why did he not prevent a preventable cancer?

Reporter/Du Wei

On the afternoon of February 27, Hong Kong movie star Wu Mengda died of liver cancer, and his life was frozen at the age of 68. Wu Mengda's friend Tian Qiwen said in an interview with the media that when Wu Mengda found out that he had liver cancer at the end of 2020, the cancer cells had spread, from the diagnosis of liver cancer to his death in only 3 months.

Just over 20 days ago, Zhao Yingjun, a well-known musician and actor who was only 43 years old in China, also died of liver cancer, and he was already in advanced stages when he found liver cancer.

Liver cancer is one of the most common malignancies worldwide. In China, the incidence and mortality rate of liver cancer has been the highest in the world for many years. According to the latest global cancer burden data released by WHO's International Agency for Research on Cancer in December 2020, liver cancer ranks 6th in malignancy and 3rd in mortality. In 2020, the number of liver cancer patients and deaths in China accounted for about half of the world, the incidence rate ranked fifth among all kinds of tumors, the mortality rate ranked second, and among the 410,000 new patients, men accounted for more than 70%.

In the common malignant tumors, lung cancer, breast cancer, etc. have advanced early screening methods and treatment methods, and so far there is no good way to find liver cancer as soon as possible, often a discovery is advanced, it is also known as the "silent killer". Still, we're not helpless against liver cancer.

The attribution ratio of liver cancer in China has changed

Today, there are nearly 100 million people living with hepatitis B and 10 million people living with hepatitis C in China. Wang Guiqiang, chairman of the Infectious Diseases Branch of the Chinese Medical Association, director of the Department of Infectious Diseases and director of the Liver Disease Center of the First Hospital of Peking University, analyzed China News Weekly that China is a big country with hepatitis B, based on the high rate of hepatitis B infection, so that 80% of China's liver cancer is transformed from hepatitis B, and the remaining proportion of liver cancer is caused by hepatitis C, alcoholic hepatitis, steatohepatitis, autoimmune hepatitis and so on. Hepatitis-hepatic fibrosis-cirrhosis is a few steps of liver cancer, and people with liver fibrosis are at high risk of potential liver cancer.

Zhang Xiaodong, chief physician of the Department of Gastrointestinal Oncology at Peking University Cancer Hospital and director of the Early Cancer Screening Center of Peking University International Department Jingxi Cancer Hospital, told China News Weekly that people with hepatitis B, cirrhosis or long-term alcohol abuse are specific groups that may develop liver cancer, and there is not enough scientific evidence to support liver cancer and genetic factors.

Since the 1970s and 1980s, China has been involved in hepatitis B, and in 2002 the hepatitis B vaccine was officially included in the immunization programme. In the 1960s and 1970s, if people born with hepatitis B were not well controlled and had cirrhosis, they have now entered the stage of possible liver cancer, so the current age of liver cancer patients is concentrated in the fifties and sixties. Due to the large number of this group, liver cancer will remain the top five most prevalent in China for the next 10 to 20 years.

Zhang Xiaodong pointed out that in Western countries such as Europe and the United States, the main causes of liver cancer include hepatitis C and alcoholic liver. An article titled "Burden of Liver Cancer Disease in Chinese Population: Multi-data Source Evidence Update and Integration Analysis" published in the Chinese Journal of Epidemiology in 2020 said that the potential risk factors for liver cancer in China include infectious factors, behavioral factors such as smoking and alcohol consumption, and metabolic factors such as obesity and diabetes.

Since the inclusion of hepatitis B vaccine in immunization, the proportion of liver cancer attribution in China has changed, in addition to viral hepatitis, liver cancer caused by factors such as alcohol consumption and non-alcoholic steatohepatitis should arouse vigilance, especially in recent years, the incidence of non-alcoholic steatohepatitis has increased. Chi Xiaoling, chief physician of the Liver Disease Specialty of Guangdong Provincial Hospital of Traditional Chinese Medicine, quoted a medical research data in an interview with the media and said that the probability of non-alcoholic fatty liver disease patients becoming cirrhosis and liver cancer is 150 times that of normal people.

With the rapid change of lifestyle, nearly 1/3 of Chinese have non-alcoholic fatty liver disease, which has become a major public health problem. An article published in the European Journal of Liver Disease in 2018 said that China has the largest number of fatty liver patients in the world. According to the current incidence rate, by 2030, the number of non-alcoholic fatty liver patients in China may reach 315 million, and the number of non-alcoholic fatty liver patients may reach 48 million, which means that the conversion rate of steatohepatitis is more than 10%.

It is often found to be late

Zhang Xiaodong said that from a pathological point of view, liver cancer is divided into hepatocellular carcinoma and hepatobiliary duct cell carcinoma, that is to say, the cancer tissue is different. Liver cancer caused by hepatitis B and alcoholic liver mainly belongs to the former; hepatobiliary duct cell carcinoma is rare, unexplained, and malignant.

Regarding liver cancer treatment, it is divided into early and advanced stages. Early small liver cancer generally refers to no more than three centimeters in diameter. If small liver cancer occurs on the basis of cirrhosis, the cure rate is relatively high by means of surgery or radiofrequency ablation. If it is more than 5 centimeters in diameter, it is called large liver cancer, and the cure rate is very low, and surgery cannot be performed. The lesions on the liver are large, or although the lesions are not large, but there is more than one, densely packed, which means that liver cancer is in advanced stages, targeted and chemotherapy drug treatment and recent immunotherapy effects are very limited, "this is a very headache problem all over the world." The metastasis of cancer cells to blood vessels, abdominal cavity, lungs and other tissues or organs means that liver cancer has reached a super advanced stage.

But often, liver cancer is found to be advanced. Wang Guiqiang explained that this is determined by the characteristics of the liver itself. "Hepatitis, liver cancer in the early stage of the time do not feel, so you have to rely on the feeling to go to the doctor, many times to the hospital is very late, liver cancer to the advanced stage of the pain, early can not have any symptoms." In addition, the failure of key populations to be screened regularly is also an important cause of the high incidence and death of liver cancer. Although many people receive antiviral therapy for hepatitis B and C, there is still a possibility of progression to liver cancer during treatment. "Some people take antiviral drugs and stop screening regularly." Many people do not know that they have hepatitis C, and eventually develop cirrhosis and even liver cancer. Wang Guiqiang said that in terms of the treatment of hepatitis, China is almost the same as other countries, but compared with developed countries with good economic conditions, the domestic regular screening mechanism is weak. "Patients with chronic hepatitis are required to be screened once every six months, and patients with cirrhosis are screened for three months, but many places cannot do it."

In order to avoid discrimination against hepatitis B patients, China has also issued a policy that hepatitis B screening is not carried out for admission, kindergarten, and work physical examination, and that informed consent is required for five hepatitis B tests, which has led many medical examination institutions not to use hepatitis B screening as routine screening. "And hepatitis C was not checked before, and it is still the same, so that hepatitis C is not found in time." Wang Guiqiang said, "Under the premise of establishing a confidentiality mechanism, we hope that during the physical examination of institutions or individuals, hepatitis B and C screening will be carried out, and early detection and early treatment will be carried out." ”

Liver cancer is a preventable cancer

So far, for liver cancer, there is no newer, better, and universally applicable early screening method in the clinic, and some technologies are still being studied and translated, and daily routines rely more on routine examinations.

But thankfully, "hepatocellular carcinoma is the only cancer in the digestive system that can be prevented." Zhang Xiaodong said that for people with hepatitis B or long-term alcohol consumption caused by alcoholic cirrhosis, blood AFP (alpha-fetoprotein) testing and liver B ultrasound can be done regularly to find small liver cancer and deal with it in time. Liver cancer is the only tumor in the digestive tract that can be diagnosed by clinical indicators without relying on pathological examination. When liver cancer is suspected by ultrasound or blood tests and the diagnosis cannot be confirmed, in order to accurately distinguish sclerotic nodules, hemangiomas and liver cancer, the diagnosis can be confirmed by the "gold standard" - nuclear magnetic resonance (MRI). But often, MRI is not used as a means of early screening for liver cancer.

Zhang Xiaodong said that from the current point of view, the focus of liver cancer prevention is to reduce the rate of hepatitis B infection in the population and vaccinate against hepatitis B; after getting hepatitis B, control the course of the disease and avoid developing cirrhosis.

Wang Guiqiang said that from the perspective of etiological control, people with chronic hepatitis B and hepatitis C must go to the hospital for systematic diagnosis and treatment to reduce the probability of liver cancer, which is the most critical means to control the occurrence of liver cancer, which can solve the problem from the root. All chronic hepatitis should be monitored regularly. In addition, because alcoholic liver, fatty liver can also lead to liver cancer, from the perspective of etiological control, to quit alcohol, fatty liver should lose weight and weight, control diet, proper exercise, pay attention to develop a healthy lifestyle.