ICMR drafts rules to manage and treat liver cancer

While India still doesn’t have a strong data collection mechanism in place, on the basis of one million verbal autopsies, British Medical Journal, The Lancet, reported that liver cancer has emerged number four among cancer cases in the country.

Country’s research regulator, Indian Council of Medical Research (ICMR), has issued a draft consensus document for treating the most common type of liver cancer— hepatocellular carcinoma (HCC) — that could work as reference point for doctors and caregivers.

HCC accounts for 90% of cancers of the liver worldwide, with a growing incidence in most countries. Globally, HCC is the fifth most common cancer (7.5 lakh new cases annually) and is the third leading cause of annual deaths due to cancer (7 lakh deaths each year) after lung and stomach cancer.

While India still doesn’t have a strong data collection mechanism in place, on the basis of one million verbal autopsies, British Medical Journal, The Lancet, reported that liver cancer has emerged number four among cancer cases in the country.

“This consensus document may be used as framework for more focused and planned research programmes to carry forward the process. The aim of the Indian Council of Medical Research guidelines is to assist oncologists in making major clinical decisions encountered while managing their patients…,” the document reads.

While several large international working groups have drafted consensus guidelines based on the unique concerns of clinical circumstances and population affected, this is the first time India-specific guidelines have been drafted.

The document elaborates where CT, MRI or PET-CT will be useful in tumours in liver, especially in a cirrhotic liver and what medicines work best for Indians.

Around 70-90% of HCC has been reported in cirrhotic patients globally, making liver cirrhosis the single most important risk factor for developing liver cancer.

Other more common risk factors are chronic Hepatitis B and C infection, heavy alcohol consumption, male gender, increasing age, and exposure to certain chemicals. Obesity, diabetes, non-alcoholic fatty liver disease (NAFLD) are also considered risk factors but have lower risk in comparison.

Regular surveillance is strongly recommended in the document for high risk people, especially those with cirrhotic liver. Abdominal ultrasound should be done in once in six months by a trained radiologist and experts recommend Hepatitis B vaccination in newborns and health workers.

However, the guidelines are not binding on treating doctors, who are free to take a call on the line of treatment on the basis of a patient’s individual requirements and wishes.

The document is uploaded on ICMR website — icmr.nic.in — and stakeholders can send in suggestions and comments by July 17, 2018.