Hepatocellular Cancer Screening Gives Quicker Diagnosis in Cirrhotic Patients

According to a study of cirrhotic patients at the Michael DeBakey VA Medical Center in Houston, those who were screened for hepatocellular cancer had their cancer discovered at earlier stages compared to with those who went unscreened.

Previous studies were inconclusive as to whether screening cirrhotics using a-fetoprotein and hepatic ultrasound for hepatocellular cancer (HCC) provided a statistically significant benefit in terms of reduced morbidity and mortality. The Houston VA study compared patients screened between 1999 and 2005 and found significant differences.

Of the 155 patients studied, 26 were appropriately screened and 129 were not. Screened patients were three times as likely to have their HCC discovered during stage A than unscreened patients, and half as likely to have it discovered at stage D.

Hepatocellular cancer is the fifth most common cancer in the world, with higher rates seen among those with chronic compensated cirrhosis. Among that population, there is a 3-4% annual incidence of HCC.

Arthritis Treatment Has Risk of Skin Cancer

Treatment of rheumatoid arthritis (RA) with tumor necrosis factor (TNF) inhibitors may increase the likelihood of risk for non-melanoma skin cancer and melanoma, according to researchers at the Washington University School of medicine in St. Louis.

Researchers examined skin cancer risk in a cohort of 20,648 VA patients with RA. The group was divided into two sections: those treated with a non-biologic disease-modifying antirheumatic drugs (DMARDs) and those treated with TNF-a antagonist DMARDs.

Incidence of non-melanoma skin cancer (NMSC) was 18.9/100 patient-years for patients receiving TNF inhibitors and 12.7/100 patient-years for those receiving the non-biologic Dads . Risk was also greater for patients who were older, male, and had used nonsteroidal anti-inflammatory drugs.

Previous studies have linked TNF-a inhibitors to an increased risk of cancer. While TNF plays a role in RA, it also helps protect the body from cancer. To date, the drugs have not been shown to increase the risk of developing any other types of cancers.

According to the researchers, physicians should be aware of the risk and screen patients receiving TNF-a antagonists for pre-cancerous skin lesions and skin cancer. 

1: Amati W, Zeringue AL, McDonald JR, Caplan L, Eisen SA, Ranganathan P. Risk of non-melanoma skin cancer in a national cohort of veterans with rheumatoid arthritis. Rheumatology (Oxford). 2011 Aug;50(8):1431-9. Epub 2011 Mar 16. PubMed PMID: 21415022.

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