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Tag Archives: liver cancer

You’ve Lost the Hepatitis B Surface Antigen, Go Celebrate, But Keep Monitoring

By Christine Kukka

Image courtesy of stockimages at FreeDigitalPhotos.net
Image courtesy of stockimages at FreeDigitalPhotos.net

After years of living with “inactive’ chronic hepatitis B—with low viral load and no signs of liver damage–some patients may finally lose the hepatitis B surface antigen (HBsAg) and even develop surface antibodies.

This event merits a celebration and a huge sigh of relief, but if you think you will never have to get another blood draw or worry about your liver, think again. We hate to be the bearer of bad news, but hepatitis B really never goes away.

Image courtesy of stockimages at FreeDigitalPhotos.net
Image courtesy of stockimages at FreeDigitalPhotos.net

Think herpes, mono, or chicken pox and shingles. Children infected with chickenpox get rid of the infection and the ugly blisters, but very small amounts of the chickenpox (varicella) virus remains in the spinal nerves. As we grow older and our immune systems weaken with age,  our bodies aren’t able to suppress the varicella virus any more and it reactivates, causing painful shingles.

The hepatitis B virus (HBV) behaves in the same way. When we lose HBsAg and even develop surface antibodies (anti-HBs), there are still HBV lurking in our livers. When we’re healthy, our immune systems suppress the virus and prevent any reactivation, but old age or another disease or medical condition can weaken our bodies and allow the viral infection to reactivate.

So, even after we clear HBsAg, we need to stay vigilant and continue to get our liver health monitored regularly. Here is what you need to know:

First, what are my chances of ever getting rid of HBsAg and developing the surface antibody? It can happen, especially in older adults after a long period of “inactive” hepatitis B infection.

About 1 to 3 percent of people with chronic hepatitis B lose HBsAg each year, and about half of all people with chronic infections who live up to age 75 will lose HBsAg, depending on the amount of HBV DNA in their blood.

Your chances of losing HBsAg and developing the surface antibody increase if you have a healthy lifestyle and avoid alcohol, cigarettes and obesity (fatty liver). Another report found that people with the hepatitis B strain or genotype C have higher rates of clearing HBsAg over time than those with genotype B.

Image courtesy of taoty at FreeDigitalPhotos.net
Image courtesy of taoty at FreeDigitalPhotos.net

Once you clear HBsAg, the chance of developing surface antibodies over the next two, five and 10 years are 24 percent, 58 percent and 78 percent respectively, according to a recent report in the September 2016 journal of Epidemiology and Infection.

After I clear HBsAg, how often do I need to get my liver health monitored? According to Dr. Robert Gish, medical director of the Hepatitis B Foundation and professor consultant of gastroenterology and hepatology at Stanford University, once you have cleared HBsAg, 12 months later you need to:

  • Check all of your liver enzymes and liver function
  • Get your platelet count and hepatitis B blood tests done, and
  • Have an ultrasound of your liver and spleen.

These tests become your new “baseline” that your doctor can refer too in the years ahead while monitoring your liver health.

Your baseline ultrasound should examine your liver and measure its portal vein (it should be under 12 mm) and spleen (it should be under 12 cm) to make sure it’s normal with no signs of cirrhosis or portal hypertension.

If you had cirrhosis before you cleared HBsAg: You need to be surveyed for liver cancer (with an ultrasound, alpha fetoprotein (AFP) blood test and a Des-gamma-carboxy prothrombin (DCP) test) every six months for at least five years, because cirrhosis puts you at high risk of liver cancer. Once an ultrasound finds no evidence of cirrhosis and all other tests are normal, including the cancer tests, then the testing can become less frequent and your doctor can prescribe a new monitoring schedule.

If you’ve had elevated liver enzymes (called ALT or SGPT) in the past, (higher than 19 in women and 30 in men), you need to continue to get tested every six months until you’ve had two consecutive healthy ALT readings. If your ALT remains elevated, make sure you are not drinking alcohol and do not have fatty liver disease. Talk to your doctor about a new monitoring schedule.

Tell all of your current and future doctors you’ve had hepatitis B, and beware of immune-suppressing drugs used to treat various cancers and rheumatoid arthritis. Our immune systems, which are working to keep the residual HBV in our bodies in check, can also take a hit from medications that deliberately suppress our immune systems in order to fight cancer, psoriasis or rheumatoid arthritis.

According to medical guidelines, all oncologists and other specialists who use these powerful drugs are supposed to test all  their patients for hepatitis B and carefully monitor anyone who had hepatitis B in the past, which is indicated by a positive test for the hepatitis B core antibody (anti-HBc).

Even if you’ve cleared HBsAg, doctors may pre-emptively treat you with antivirals during and after your treatment for cancer, immune disorders such as arthritis or psoriasis, and hepatitis C and monitor your HBsAg and viral load regularly to make sure your hepatitis B does not reactivate.

These screening guidelines exist, but no one is perfect and your oncologist may not know you’ve been infected, may forget to screen you for hepatitis B, or may not understand the testing. So, tell everyone if you have an active or resolved hepatitis B infection. The last thing you want is to be battling both cancer and a reactivated hepatitis B infection simultaneously.

While hepatitis B never really goes away, once you clear HBsAg your risk of liver damage and liver cancer diminish tremendously. It’s worth a celebration, but you need to continue to be monitored as you age.

Beating the Odds: A Liver Cancer Survivor’s Story

Liver cancer, caused by hepatitis B and C, is on the rise in the U.S. and it is also the second deadliest. Fewer than 15 percent of patients with liver cancer will survive five years after their diagnosis. It is the third-leading cause of cancer deaths among Asian-Americans and the eighth-leading cause of cancer deaths among Caucasian-Americans.

Despite this bleak outlook, there are people with liver cancer who are beating the odds and surviving. The medical community is also working hard to develop new drugs and effective strategies to treat liver cancer. Here is one survivor’s story.

By Frank Gardea

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net
Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

In late 2008, during routine testing before surgery, I found out I had hepatitis C and liver cirrhosis. It was a double whammy because having both viral hepatitis and cirrhosis put me at high risk for liver cancer.

Then the abdominal pain started. I suffered for almost three years and was in and out of the emergency department. They could not pinpoint the cause of the pain. When they finally diagnosed my liver cancer, the tumor was over 8 cm in size. Continue reading "Beating the Odds: A Liver Cancer Survivor’s Story"

Your Doctor Not Screening You for Liver Cancer? Time for a Talk

Image courtesy of FreeDigitalPhotos.net
Image courtesy of FreeDigitalPhotos.net

The longer we have hepatitis B, the higher our risk of developing liver cancer. With every decade of life, our liver cancer risk increases 2.7-times, according to a report on Viral Hepatitis in the Elderly published in the American Journal of Gastroenterology.

But current medical guidelines don’t spell out exactly when liver cancer testing should begin in many hepatitis B patients who don’t have liver damage (cirrhosis) or a family history of liver cancer, and are not of Asian or African descent.

Age is clearly an important factor when it comes to liver cancer, “… but current guidelines only provide age-specific recommendations for (liver cancer) surveillance in hepatitis B carriers of Asian ethnicity (men over age 40 and women over age 50),” a team of University of Miami and Veterans Affairs researchers wrote in the journal article. Continue reading "Your Doctor Not Screening You for Liver Cancer? Time for a Talk"

When Is That Pain Hep B-related and When Is It Something Else?

Image courtesy of Ohmega1982 at FreeDigitalPhotos.net
Image courtesy of Ohmega1982 at FreeDigitalPhotos.net

When people with chronic hepatitis B experience abdominal pain, we often wonder if it’s related to our liver and if our hepatitis B is getting worse.

According to experts, hepatitis B rarely causes abdominal pain. Here are some insights to help you understand what might be behind your abdominal pain when you live with chronic hepatitis B.

First, it’s not called the silent infection for nothing. When first infected, most children and nearly 70 percent of adults never experience any direct symptoms from hepatitis B. When people do have symptoms, such as aches, nausea and fever, they usually last for only a few days. Only a very small percentage have symptoms that persist long-term. Continue reading "When Is That Pain Hep B-related and When Is It Something Else?"

Updates in Hepatitis B-related Liver Cancer Care

Image courtesy of stockimages at FreeDigitalPhotos.net
Image courtesy of stockimages at FreeDigitalPhotos.net

While liver cancer cases continue to climb in the U.S., so has the medical community’s ability to care for hepatitis B patients affected by liver cancer. Here are some updates and reminders to help you talk to your doctor and get the best care possible. Continue reading "Updates in Hepatitis B-related Liver Cancer Care"

HBV Journal Review – June 2015

ChrisKHBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
 latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • HBV Liver Cancer Requires Aggressive Treatment from the Start
  • Experts: Treat Cirrhotic Patients, Even if Viral Load Is Low
  • Some Patients Can Safely Stop Antiviral After Four Years
  • Tenofovir Safe and Effective in Pregnant Women with Drug Resistance
  • Researchers Discover Why Children Become Chronically Infected
  • Expert Recommends Treatment for Mental Confusion from Cirrhosis
  • Antivirals Increase Survival After Liver Cancer Treatment
  • HBV Patients with Diabetes Have a Higher Risk of Liver Cancer
  • Long-term Antiviral Use Increases Hip Fracture Rates Slightly
  • Second Vaccine Series May Be Needed for Children with Celiac Disease
  • Researchers Find HBV B Strain in Cuba Did Not Come from Africa

Continue reading "HBV Journal Review – June 2015"

May is Asian Pacific American Heritage Month

moon-anncart-logo-for-blog-300x180In celebration of Asian Pacific Heritage Month, Dr. moon Chen, Principal Investigator for the Asian American Network for Cancer Awareness Research and Training (AANCART) and UC Davis professor, reflects on the unnecessary cancer burden in Asian American and Pacific Islanders, including the burden of  hepatitis B related liver cancer.  Continue reading "May is Asian Pacific American Heritage Month"

Clinical Trials in Liver Cancer: What You Need to Know

diversegroupMyth: Clinical trials are only for people with advanced stages of cancer.

Fact: No! Trials are available for all stages of cancer, not just for people who have advanced cancer that is not responding to treatment.

If you or a loved one needs treatment for liver cancer, clinical trials are an option to think about. Continue reading "Clinical Trials in Liver Cancer: What You Need to Know"

HBV Journal Review – January 2015

ChrisKHBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
 latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • Having Hepatitis B and a Family Member with Cancer Raises Cancer Risk Dramatically
  • VA Tests Only 21.8% of Its Patients for Hepatitis B, Missing Many at Risk of Infection
  • Research Shows Importance of HBV Screening Before Chemotherapy Begins
  • Younger Age and Low HBsAgLevels Benefit Patients Who Stop Antivirals
  • Doctors Debate Benefits of Interferon vs. Antiviral Treatment
  • New Study Finds Fibroscan Accuracy on Par with Liver Biopsies
  • Mild Kidney Problems and Bone Loss Linked to Antivirals
  • Hepatitis B Vaccine Effectiveness Challenged

Continue reading "HBV Journal Review – January 2015"

AASLD 2014 Liver Meeting – HBV Coverage

Unknown-5Get HBV Advocate’s Christine Kukka’s take on the top HBV related, published reports from the AASLD Liver Meeting as she provides her Top Ten List! 

 

Top Ten Reports from the 65th Annual Liver Meeting
By Christine M. Kukka, HBV Advocate 

Hepatitis B experts from around the world met at the 65th annual American Association for the Study of Liver Diseases (AASLD) conference in Washington D.C. this week to share the latest in hepatitis B treatment and research.

  1.  Which combination of antivirals and interferon works best against hepatitis B
  2. Tenofovir continues to excel with no signs of drug resistance after eight years
  3. Tenofovir treatment is safe over an entire pregnancy for both mother and child
  4. Tenofovir and entecavir combination successful against drug-resistant HBV
  5. Who remains at risk for hepatitis B in the U.S.?
  6. Antivirals appear to lower liver cancer risk
  7. But antivirals don’t reduce cancer risk in older patients with cirrhosis
  8. How long do patients have to keep taking antivirals after they lose HBeAg and achieve undetectable viral load?
  9. Liver cancer risk remains, even after HBsAg clearance in older, male patients
  10. Experts say treatment is needed when ALT levels are only moderately elevated

Continue reading "AASLD 2014 Liver Meeting – HBV Coverage"