“Liver Cancer” threats amid the Songkran celebration - a leading cause of death among Thais that cannot be overlooked

Bangkok, Thailand - April is the long-awaited month for most Thais, as it coincides with the Songkran celebration and the long holiday. Although this year, the government have asked for cooperation to refrain from Songkran activities and gatherings of large numbers, we are still able to continue with the age-old tradition of religious ceremonies, such as the act of paying respect to elders. However, when it comes to a celebration, one seemingly indispensable element for most is alcoholic beverages. 

Studies have shown that, the risk threshold for developing liver cancer increases by 1.5 times when the amount of daily alcoholic beverages consumption is between 41-80 grams, and 7.3 times when the amount of daily alcoholic beverages consumption is higher than 80 grams, compared to the non-drinker counterparts or those who limit their daily intake to lower than 40 grams. Added, even if a person stops drinking, the risk of liver cancer remains[1]. Statistics from the World Cancer Research Fund in 2018 revealed that liver cancer has the 5th highest incidence of cancer in men and 9th among women worldwide, with more than 840,000 new cases in 2018. Furthermore, Thailand ranked 8th in the world for the highest number of liver cancer patients, with the prevalence of liver cancer at 21 cases per 100,000 people[2].

The Department of Medicine by the National Cancer Institute revealed that in 2020, liver cancer is the number one cancer found in Thai people. Each year there are approximately 16,000 deaths from this disease, with risk factors associated to Hepatitis B and C virus infection, consumption of a high-fat diet and obesity, excessive alcohol intake, as well as exposure to aflatoxin, food with saltpeter and fermented foods – which is a carcinogen caused by fungi that contaminate various foods. 

Pongpasin Nuanla-or, former liver cancer patient, shared his personal experience ranging from diagnosis, symptoms, treatment to recovery, as quoted: “At first, I was diagnosed with Hepatitis C back in 2008. From that stage, it took me a few years to return to normal, after which I regained my appetite and started eating whatever I wanted again. Soon, my body began to send signals of irregularities, including a sharp pain under my right rib cage that spread to my shoulder and the feeling of constant drowsiness. The medical consultation in late 2010 confirmed that there were cancer tumors in my liver. Just over a year later, the cancer has spread to stage IV, whereby during that time I had been in constant care of the doctor. In 2012, I finally noticed that my swollen stomach gradually became smaller and smaller, as my body condition restored. Thinking back to when I was diagnosed with liver cancer, of course, the feeling of depression, frustration and hopelessness loomed large. I exhibited food boredom and excreted asphalt-coloured stools once a week. To alleviate pain, the doctor had to administer morphine for me every six hours. Each day I was injected with four needles of morphine, but each needle only lasted a couple hours, meaning that the other four hours I was left suffering from the pain. Apart from the constant physical torment, my mental condition was in a bad state as well. My brain was in constant thought about the disease and its grim hope. For a moment, I thought about my family which, to me, was like a tiny spark of hope. Even though the chances of survival were still dim, but with a strong willpower I told myself ‘I could not die now. I needed to fight.’ Oftentimes, I found inspiration in thinking about the people around me, who never ceased to love and care for me throughout my patient journey. My wife took a year off to look after me and sold three plots of land in the city centre to fund my medical fees and home expenses.”

“During the advanced stage, my body was too weak to undergo any chemotherapy. Therefore, the doctor had to inject medication to block the blood vessels that were feeding the cancer tumors. This resulted in the shrink of my liver cancer, from 21 to only 7 centimetres – as the swelling went down from my stomach. Later, the doctor continued with thermal ablative therapy, which is a very risky procedure as it can cause blood vessel rupture. In my case, I was not that lucky as the procedure caused one of my blood vessels to burst, resulting in an immediate suspension of my treatment and 10 hours in the intensive care unit (ICU). Thankfully, in the end I was able to receive a liver transplant, which allowed me to recover fully from the disease. Since then I continue to comply strictly with the doctor’s advice, follow regular checkups, choose the right diet, get adequate rest and exercise, in order to preserve my new liver in the best way I can manage. I would like to provide emotional support to individuals who are undergoing cancer treatment to never lose hope. Keep on fighting with good spirits, and trust in the medical advancement.”

In closing,Rojanamatin, MD, Director of the National Cancer Institute of Thailand, elaborates on the challenges that come with liver cancer in today's society: “According to the National Cancer Registry of Thailand collected by the National Cancer Institute, liver cancer is the number one killer among Thai men and second among Thai women. Whereby, patients often seek medical help in the advanced stage, due to lack of symptoms shown in the earlier stages. As a result, most of the patients from this group will soon succumb to the disease, because treatment options are limited in the later stages of diagnosis. In addition, the Office of the National Economic and Social Development Board predicted that Thailand will fully enter an aging society by 2021, meaning that the number of people aged 60 and above will make up 20 per cent of the population. Hence, this factor may tremendously worsen the liver cancer situation in Thailand. Premature mortality can lead to major losses in adequate workforce and labor productivity that is an important force behind the country's economic growth. It is estimated that the economic losses from liver cancer caused by excessive alcohol consumption alone account for 11,836 million THB in males and 706 million THB in females[1]. Given these dire circumstances and impacts, it is crucial that we continue to improve the efficacy of treatments for liver cancer patients, in order to reduce the rate of premature deaths and the subsequent impact on the future of Thai economy."

Today liver cancer is no longer a distant threat. In fact, it is a risk close to home faced by a considerable number of Thais, especially during the Songkran celebration. Nevertheless, the risk of developing liver cancer can be reduced by means of good lifestyle choices, such as healthy diet, alcohol intake reduction, adequate rest, regular exercise, along with routine screening for risk assessment and prevention. Although liver cancer is considered a deadly threat that attacks the body without warning, there are life-prolonging treatments that help patients recover and better their quality of lives.

Reference

1. “มะเร็งตับ.” หน่วยสารสนเทศมะเร็ง, โรงพยาบาลสงขลานครินทร์, 19 Jan. 2009,

2. "Liver Cancer Statistics." World Cancer Research Fund. American Institute for Cancer Research, 2018.

3. Cancer Preparedness in Asia-Pacific. Progress toward universal cancer control