Rising cases of liver cancer in Nigeria: Hepatitis is coming home to roost

Few days ago, a friend posted on Facebook the news of the death of a mutual senior friend. These days, I have become quite curious about causes of deaths, especially of young to middle age people, so I inquired from the deceased’s brother the nature of the sickness that snuffed life out of the late friend. The answer was what I didn’t want to hear, but which is one of the most common answers I get from my curious inquiries, – liver cancer.

The reader might be wondering what kind of man makes such morbid inquiry. Well, the answer is simple: I am an hepatitis patient, I know I am also at risk for liver cancer. I read almost every news about hepatitis, locally and globally, and I see what many ordinary people don’t see. I have taken it upon myself to spread the message, and this is my third essay on the subject. As at 2010, about 20 million Nigerians were infected with Hepatitis B.  What that means is that one out of every eight Nigerians is infected, but more than 80% of those people don’t know. The symptoms usually come at two different times. First, few weeks after infection (the body system will react to new foreign body in it) and the symptoms are like that of malaria or typhoid, and many people recover from those symptoms and continue to live life. Savvy doctors discover this (like mine in 2009), but some treat the symptoms (as they would for malaria) without diagnosing Hepatitis at that point, and with some rest, the patient usually gets back on his feet, and life goes on. For some people, it may even be totally asymptomatic at the point of infection and they may never notice any significant symptoms, and may not even have to visit the hospital. The second stage when symptoms manifest significantly is when the damage is done – when liver cancer or any other form of advanced liver damage (advanced cirrhosis, liver failure etc) has set in. Unfortunately, this is the point in which many people get to know about hepatitis infection. 

Hepatitis generally means inflammation of the liver, but it is commonly used to describe the virus that infects the liver and damages it over time, from five to twenty or more years. As at 2009 when my diagnosis forced me to read every single material on the subject, I got to read that more than 20 million Nigerians were living with chronic hepatitis infection. With many victims not knowing, and the virus slowly damaging many livers, massive deaths from liver complications are a time bomb waiting to happen. Unfortunately, it appears it is already coming home to roost as I have noticed rising cases of deaths from liver complications, especially hepatocellular carcinoma (liver cancer), in the last one year. The examples I used to open this article are just people I have direct or indirect link with, there are many more I read in newspapers, like that of a Nollywood veteran actor, a musician, a production staff with an Abuja-based national daily and many more. Outside of our shores, a former Barcelona defender, now with a French club, also recently did liver transplant owing to tumour developed from long time hepatitis infection. I follow news of deaths from liver complications before as someone at risk too; I know I have to be on my toes in fighting it. 

I am aware that hepatitis virus is not the only cause of liver complications. Alcohol, hard drugs intake and some lifestyle chronic conditions like diabetes can also destroy the liver and cause death from it. That is why I have not mentioned in my examples a late global boxing legend and a Nigerian multi-millionaire son of another popular multi-millionaire Lagos high chief, who also died between 2010 and 2013 from liver diseases but not hepatitis virus-induced. But the fact is, majority of the deaths from liver damage are caused by prolonged infection with hepatitis virus.

While hepatitis infection can be treated, the global consensus among doctors and researchers is that the cure has not been found yet. I’m not unmindful of the many claims to cure by some local and international herbs practitioners, but I prefer to go with research-backed global consensus. We patients are waiting for that day when cure will finally be found and the day appears to be near as two promising drugs are currently under clinical trial. We hope to hear the big news before our liver finally cave in for the monster.

While hepatitis has no cure yet, it is also globally agreed that it can be treated and well managed when diagnosed on time before serious damage is done to the liver. I have met people that were diagnosed far back thirty years ago, some were born with the virus (transmitted from their parent) and their liver has not caved in. To show that it can actually be well managed. Unfortunately, in Nigeria here, the short term death rate is frightening.  This is usually due to the fact that many people don’t know about their condition until it has done advanced damage to the liver. 

I wrote an article about a year ago express my concern about the knowledge deficit about this ailment, even among healthcare practitioners. Notably, I said that the tendency of doctors to dismiss it after diagnosis and telling patients that it is no big deal, that it is inactive and all that is not the best. I narrated the story of someone that was diagnosed of the virus in 2002 but was told by the diagnosing doctor that he should forget about it, that it was inactive. The gentleman forgot about it, and by the time he was diagnosed of liver cancer in 2010, he recalled hepatitis virus had been found in his system some eight years ago and he was told to forget about. He didn’t make it. The truth is hepatitis virus is never inactive; the pace of damage can only be extremely low. 

I also expressed reservation about reliance on ultrasound scan to detect liver damage as is common here. While ultrasound scan is no doubt globally accepted as a means of checking abdominal organs damage, the truth is, by the time liver damage is visible to ultrasound machine, the damage is irreversibly advanced already. Liver biopsy – an invasive procedure that involves cutting a minute bit of the liver and testing for damage – is the alternative and used in Nigeria here. But liver biopsy itself has its risk, and that is why it is recommended that it should not be done more than once in 3 years. Another alternative, which, to me, is better, given that fact that it is a non-invasive process (it doesn’t involve cutting the body like biopsy), is Fibroscan. Fibroscan is a machine that was recently developed specifically to scan the liver for damage. It is a more reliable way of detecting liver damage at early stage and I am witness to that. Far back January 2013, when I travelled to a country in the Middle East, I did Fibroscan and my result was 6.1 kpa (normal liver is below 5.7 kpa, and very advanced damage – cirrhosis – occurs when it reads more than 15 kpa). I already have mild fibrosis (very mild damage). I repeated the scan in same country when I travelled there again about four months ago, I got almost same result (6.3 kpa, still mild fibrosis). Yet, as recently as two weeks ago, the ultrasound scan I am doing in Nigeria is still showing normal liver and not detecting anything. I have done ultrasound scan in different choice hospitals and radiology centres in Nigeria and the machine still returns normal liver. That is why I and many other patients that follow global trends in hepatitis management advise that patients that can afford biopsy or Fibroscan should do. They are more reliable ways of detecting liver damage at early stage than the widely used ultrasound scan which detects liver damage only at advanced stage. Unfortunately, the Fibroscan machine is not in use in Nigeria yet. I implore the Society for Gastroenterology, Hepatitis and Internal Medicine, to advance this cause and bring Fibroscan to Nigeria. Unlike biopsy, it is a riskless way to detect liver damage on time, in addition to blood tests. I undergo it when I travel out of the country, and but for it, I would not have known that I already have mild liver damage. 

While hoping that many Nigerians would go and voluntarily do test to know their status, the good news is after our generation and few generations after ours, this monster will be a thing of past because since the discovery of an effective vaccine (for hepatitis B only, C-type, though far less prevalent, doesn’t have vaccine yet). Hepatitis B vaccine is now part of the national healthcare scheme and children are being given at birth. It has been proved to have 95% potency rate. Yet, some children, like those born at places other than hospitals or in the rural areas where there are no standard hospitals, do not have access to this vaccine, which is given in 3 shots(one within 24 hours after birth, another after six weeks and the last after 6 months). While that taken at birth can immune one for lifetime, the vaccine has also been proved to be able to protect adults that take it for at least 20 years. 

This is why I keep advising everyone to go and confirm their status, such that if negative, they can take vaccine immediately, if positive, they can commence management plan like some of us.

I am not happy reading news of deaths from liver complications. That is why I am taking the challenge of sensitizing Nigerians on this very important subject. 

JOHN ADAMU