Is there any way for people with chronic hepatitis B virus infection to stay away from liver cancer?

This is the 3805th article of Da Yi Xiao Hu

When Dr. Fang is doing outpatient work, he often sees anxious patients with chronic hepatitis B virus infection who ask, "Dr. Fang, I have been feeling dull pain and discomfort in the liver area, fatigue and weakness, no appetite for anything, and insomnia at night. Do I have liver cancer?"

Seeing the patient's nervous expression, haggard and exhausted from insomnia, Dr. Fang felt deep sympathy and could only comfort him: "Don't let your imagination run wild for now. Let's check it out first."

Of course, in most cases, the patients' conditions are stable after the examination, and their liver function is normal. The discomfort they feel has no direct relationship with liver disease. Dr. Fang often comforts patients like this, "Don't worry, the test results are normal, and the disease itself will not cause you to suffer from insomnia, but excessive worry about the disease will cause you to have these uncomfortable symptoms. In fact, except for the positive hepatitis B virus marker, you are exactly the same as a healthy person in other aspects. Just live your life like a normal person."

Dr. Fang recalled that he had been a hepatologist for more than 20 years, and one of the biggest concerns of patients with chronic hepatitis B infection was whether they would get cancer in the future. In fact, although the incidence of liver cancer in patients with chronic hepatitis B is higher than that of normal people, it is a minority after all. Only when the disease progresses but is not intervened and treated in a timely and effective manner, will the disease continue to develop, and eventually cirrhosis or even liver cancer may occur; but if patients pay attention to the disease, early detection, early diagnosis and early treatment, then the quality of life and life expectancy of most patients will not be affected, just like normal people.

So, how can patients with chronic hepatitis B virus infection avoid liver cancer?

From the perspective of a professional hepatologist, Dr. Fang gives the following suggestions to patients with chronic hepatitis B virus infection:

1. Pay attention to annual health check-ups so that if you are infected with hepatitis B virus, you can detect, diagnose and treat it in time.

2. See a doctor promptly to assess your condition. If you already know that you are infected with the hepatitis B virus, you should go to the liver disease department or infectious disease department to check and assess your condition, listen to the advice of the specialist, and start effective treatment in time if necessary.

3. Firmly establish the concept of long-term antiviral treatment. Antiviral treatment is the most fundamental treatment for patients with chronic hepatitis B. Current antiviral drugs, especially oral antiviral drugs, require continuous medication to work, so once antiviral treatment is started, it is important to note that this is a relatively long treatment process, and even a lifelong treatment for some patients, so remember not to stop the drug at will. If you stop the drug, you must stop it under the guidance of a liver disease specialist. Close monitoring is required after stopping the drug. Once the disease relapses, it must be discovered in time and antiviral treatment must be restarted.

4. Pay attention to regular check-ups. If the condition is stable, patients with chronic hepatitis B are recommended to have a check-up at least once every six months, and patients with cirrhosis are recommended to have a check-up every three months. This way, doctors can monitor the efficacy of treatment, drug side effects, drug resistance, and the occurrence of liver cancer in a timely manner, and promptly detect and deal with problems to ensure the efficacy and safety of patients.

5. The more thorough the virus control, the better. If the virus is not thoroughly controlled, the condition may still progress towards liver fibrosis and cirrhosis in the case of low viral load, so the lower the virus level is controlled, the better. With the improvement of detection level, the lower limit of virus detection is getting lower and lower. During antiviral treatment, it is necessary to pay attention to using highly sensitive virus quantitative detection methods at least once a year to promptly detect the presence of low viremia, adjust treatment in time, and control virus replication as soon as possible; or strengthen health education for patients, improve medication compliance, and prevent poor antiviral effects caused by poor medication compliance.

6. Pay attention to liver cancer screening. Currently, the most common liver cancer screening tools in most hospitals are alpha-fetoprotein and abdominal B-ultrasound examinations. However, some patients may have normal alpha-fetoprotein levels when they develop liver cancer, and the sensitivity of abdominal B-ultrasound examinations is not 100%. If conditions permit, it is recommended to simultaneously check for alpha-fetoprotein isomers and abnormal plasma coagulation factors. These two items combined with alpha-fetoprotein and abdominal B-ultrasound can further improve the sensitivity of primary liver cancer diagnosis and increase the early diagnosis rate. Japan has greatly improved the early diagnosis rate of primary liver cancer by adding these two items of screening, and the 5-year survival rate of patients has also been significantly improved.

7. Pay attention to family history. If there is a family history of liver cirrhosis or liver cancer, it is recommended to start antiviral treatment as soon as possible. If conditions permit, oral medication combined with interferon treatment can be used. Because interferon has the effects of activating immunity and anti-proliferation, it can prevent the occurrence of tumors. Many clinical studies have found that combined interferon treatment can further reduce the occurrence of primary liver cancer compared with oral antiviral treatment alone.

8. Maintain an optimistic and positive attitude. Dr. Fang has been working in clinical practice for decades and has seen all kinds of liver cancer patients. Generally speaking, whether liver cancer occurs, as well as the survival time and quality after it occurs, are closely related to the patient's mentality. Positive and optimistic people are less likely to develop tumors than negative and pessimistic people; and patients who face tumors positively and optimistically respond better to the treatment effect than negative and pessimistic patients. Although some patients have liver cancer discovered very early, because of their bad mentality, excessive fear, pessimism, and despair affect their appetite and sleep, and eventually their immune function is disordered, leading to rapid disease progression, large adverse reactions to drug treatment, poor efficacy, and short survival time; while positive and optimistic emotions enable patients to maintain a good diet, sleep and immunity, better overall drug efficacy, better tolerance to side effects, and fewer side effects. In other words, good emotions will amplify patients' response to the efficacy of drugs and treatments, while bad emotions will amplify patients' adverse effects on drugs and treatments. Therefore, overcoming fear and treating diseases with a positive and optimistic attitude is also an important magic weapon to defeat diseases.

Based on the review, I hope that the majority of chronic hepatitis B patients can attach importance to the disease strategically and not be afraid of the disease tactically. In this way, I believe you can stay away from the disease!

Author: Department of Hepatology II, Shenzhen Third People's Hospital

Wang Fang