Benefits of a combination of ultrasound and blood test in liver cancer screening
- Combining ultrasound imaging with blood test boosts detection of liver cancer in patients with cirrhosis.
- Combination of these two tests yields better detection outcome than ultrasound alone.
- Abdominal ultrasound is traditionally used for liver cancer screening.
Detection of liver cancer in patients with cirrhosis is improved by at least forty percent (40%) when ultrasound imaging is combined with blood test. This is the finding of a recent research at the UT Southwestern's Simmons Cancer Center.
Earlier detection is important to improving survival of patients with liver cancer, a disease that is on the rise and the fastest increasing solid-tumor cancer in the U.S., according to the National Cancer Institute (NCI).
‘The study finds that the use of ultrasound imaging alone to detect early-stage liver cancer (Hepatocellular carcinoma - HCC) shows a low level of sensitivity in patients with cirrhosis. Addition of blood test (alpha fetoprotein - AFP) to ultrasound analysis significantly increases the sensitivity of liver cancer detection in clinical practice.’
"If the cancer is found early, then we can perform curative therapies, allowing patients to live many years," said hepatologist Dr. G. Amit Singal, Associate Professor of Internal Medicine and Clinical Sciences with UT Southwestern Harold C. Simmons Comprehensive Cancer Center. "Unfortunately, most liver cancer in the United States is discovered at later stages, when curative treatment is not possible and survival is much worse."
While the incidence of most cancers is decreasing in the U.S., the incidence of liver cancer has increased by 2.7 percent a year over the last 10 years, according to the NCI, which estimated about 40,700 new cases of liver cancer will be diagnosed in the U.S. in 2018. Risk factors for liver cancer, also known as hepatocellular carcinoma or HCC, include hepatitis C infection, chronic heavy alcohol consumption, and nonalcoholic fatty liver disease related to diabetes and obesity. Symptoms can include upper abdominal pain or swelling, loss of weight or appetite, white chalky stools, and general fatigue.
Liver cancer screening for patients with liver disease
Liver cancer screening guidelines for patients with cirrhosis vary, with some guidelines calling for just imaging and other guidelines calling for both imaging and AFP measurement.
"Liver cancer screening in patients with chronic liver disease has traditionally been performed using an abdominal ultrasound. While ultrasound is readily available and noninvasive, it misses many cancers when they are small," said Dr. Amit Singal, who holds the David Bruton, Jr. Professorship in Clinical Cancer Research. "Our study found that adding the blood biomarker alpha fetoprotein increased detection of early-stage hepatocellular carcinoma from 45 percent with ultrasound alone to 63 percent using the two tests in combination."
AFP is a plasma protein that is produced in abundance by the liver cells in the fetus. In adults, AFP levels are normally low, but liver cancer can cause AFP levels to rise.
Simmons Cancer Center is among just 30 U.S. cancer research centers to be designated by the NCI as a National Clinical Trials Network Lead Academic Participating Site.
"Our results highlight the importance of continued development and validation of blood-based biomarkers for liver cancer early detection. Most important, our results support a change in clinical practice and the routine use of ultrasound and biomarkers together for liver cancer screening," said Dr. Singal, Dedman Family Scholar in Clinical Care at UT Southwestern, which is recognizing its 75th anniversary this year.
- Kristina Tzartzeva, Joseph Obi et al. Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis, Gastroenterology DOI: https://doi.org/10.1053/j.gastro.2018.01.064