Medicine Cabinet

Liver cancer is the fourth most common cancer in the country, with 10,594 new cases and 9,953 deaths reported in 2020. Its incidence in men is about two and a half times that of women, according to the Department of Health (DoH). 

The American Cancer Society said that common symptoms of liver cancer are unintended weight loss; loss of appetite; feeling very full after a small meal; nausea or vomiting; an enlarged liver, felt as fullness under the ribs on the right side; and an enlarged spleen, felt as fullness under the ribs on the left side.  

Included in the symptoms are pain in the abdomen or near the right shoulder blade; swelling or fluid build-up in the abdomen; itching; yellowing of the skin and eyes (jaundice); fever; enlarged veins on the belly that can be seen through the skin; and abnormal bruising or bleeding. It is important to consult your doctor if you experience these symptoms. 

The most common risk factor for liver cancer is chronic (long-term) infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). “People infected with both viruses have a high risk of developing chronic hepatitis, cirrhosis, and liver cancer. The risk is even higher if they are heavy drinkers who consume at least six alcoholic drinks a day,” said the American Cancer Society. 

The World Health Organization (WHO) estimated that one in 10 people in the country has chronic hepatitis B, and six in 1,000 have chronic hepatitis C.  

The DoH noted that liver cancer is much more common in countries where HBV carriers are prevalent, such as the Philippines and other Southeast Asian countries, as compared to most developed countries where hepatitis B is less prevalent. 

The HBV and HCV can spread from person to person through sharing contaminated needles (such as in drug use), unprotected sex, and childbirth.  

The US Centers for Disease Control and Prevention (CDC) recommended that all children, as well as adults at risk, get the HBV vaccine to reduce the risk of hepatitis and liver cancer. While there is no vaccine for hepatitis C, the best way to prevent it is by avoiding behaviors that can spread the disease.  

The CDC recommended getting tested for hepatitis C because treatments can cure most people with hepatitis C in 8 to 12 weeks. You can also lower your risk for liver cancer by not smoking, limiting alcohol intake, and maintaining a healthy weight. 

The coronavirus disease 2019 (COVID-19) pandemic has made the management of Filipino patients with liver diseases more challenging, said Dr. Jenny Agcaoili-Conde, public relations officer of the Hepatology Society of the Philippines (HSP). “At the start of the pandemic, surgery of many patients with liver disease had to be canceled or deferred because we knew little about COVID-19 at that time.” 

While telemedicine enabled doctors to provide continuity of care, patients with liver diseases require strict monitoring through diagnostic tests. “To undergo these tests, they have to go out of the house and risk potential exposure to the coronavirus. It’s a difficult time for both patients and doctors,” Dr. Agcaoili-Conde said. Hopefully, with the progressive decline in COVID-19 cases in the country, continuity of care for patients with liver diseases will improve. 

She also noted the country’s low hepatitis B vaccination coverage. “The hepatitis B vaccine has been part of the government’s vaccination program since 1992. However, only 45% of babies born in 2014 were given the first vaccine dose. Completion of the 3-dose hepatitis B vaccine regimen dropped to only 77% in 2012. Moreover, the pandemic impacted supply chains, further hindering the availability of medicines and vaccines.”  

The WHO estimated that only 50% of newborn infants in the country are administered with the hepatitis B birth dose within 24 hours after birth. 

Under the auspices of its mother organization, the Philippine Society of Gastroenterology (PSG), HSP is working with the DoH and other partner stakeholders to promote liver health awareness and early detection of liver diseases, particularly liver cancer and viral hepatitis, among the general public. It also established the Philippine Liver Education online platform which aims to serve as the reliable virtual learning resource for liver disease management for Filipino physicians with special interest in hepatology.   

 

Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP), which represents the biopharmaceutical medicines and vaccines industry in the country. Its members are at the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.