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Sólo el 10% de los casos de cáncer hepático se detectan a tiempo
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Sólo el 10% de los casos de cáncer hepático se detectan a tiempo

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Sólo el 10% de los casos de cáncer hepático se detectan a tiempo

Entre un 10 y un 15% de los pacientes con cirrosis desarrollan un cáncer de hígado en los cinco primeros años de seguimiento.

Solo un 10% de los casos de cáncer hígado se detectan a tiempo, según expertos reunidos en el XXXVIII Congreso Anual de la Asociación Española para el Estudio del Hígado (AEEH), quienes han subrayado la necesidad de poner en marcha campañas de prevención en cáncer hepático.

Y es que, en el caso de que se detecte a tiempo, es posible operar para extirpar el tumor, realizar un transplante o llevar a cabo una ablación cutánea para eliminar el tumor, en función de la extensión del carcinoma y de las características de cada paciente. Del 10% de casos que se diagnostican y se tratan con estas opciones, entre el 50 y 70% conseguirán sobrevivir los cinco primeros años.

El cáncer hepático se produce como consecuencia de un daño continuado en el hígado. Inicialmente se generan nódulos infracentrimétricos precancerosos que finalmente evolucionan a malignidad. A partir de los tres centímetros, el cáncer ya no puede considerarse inicial y las posibilidades de curación disminuyen.

En general, el pronóstico en cuanto al tratamiento y a la curación del cáncer de hígado es poco alentador, ya que la mayor parte de casos se diagnostican en fase avanzada, cuando ya no es posible administrar un tratamiento curativo. Si se diagnostica en fase avanzada, la enfermedad puede llevar a la muerte en el plazo de un año.

"Se ha demostrado que el cáncer de hígado es la principal causa de muerte entre los pacientes con cirrosis hepática. Entre un 10 y un 15% de los pacientes que tienen cirrosis desarrollarán un cáncer de hígado en los cinco primeros años de seguimiento", ha señalado el director del grupo de Oncología Hepática del Servicio de Hepatología del Hospital Clínic de Barcelona, el doctor Jordi Bruix. Actualmente, como medida preventiva, en los pacientes con cirrosis que están en riesgo de cáncer se realizan ecografías periódicas del hígado.

Conocimiento molecular

Bruix ha destacado que se está trabajando en nuevas líneas de investigación que se centran en "la evolución de la medicina intervencionista hacia el conocimiento molecular". Precisamente, a su parecer, "el mejor conocimiento de estos mecanismos moleculares, que son capaces de determinar la aparición y progresión del tumor, ha posibilitado descubrir nuevos agentes, como los antiangiogénicos, y se están investigando nuevos fármacos prometedores, pero que todavía están lejos de la práctica clínica convencional".

Además, la revolución en los últimos años en las técnicas de imagen permite en la actualidad detectar tumores de un centímetro en el hígado, lo que ha hecho posible, en los casos en los que estas pruebas se llevan a cabo, detectar el cáncer en una fase más inicial y, así, reducir la mortalidad por cáncer de hígado. Estas pruebas facilitan un diagnóstico no invasivo con lo que se reduce el número de biopsias.

Criterios para el trasplante

Por otro lado, en la actualidad, se sigue un criterio estándar para determinar si se puede indicar el transplante, y que consiste en que el tumor debe estar formado por un nódulo menor de cinco centímetros o por tres nódulos menores de tres centímetros, ya que en estos pacientes se puede observar una supervivencia superior al 70%.

El debate ahora se centra en expandir o mantener este criterio. Según este experto, "el principal inconveniente para expandir este criterio es la escasez de hígados, por lo que, de momento, no es recomendable realizar transplantes en pacientes con tumores más grandes, ya que los resultados serían peores".

En la actualidad, solo un 5% de los pacientes con cáncer de hígado pueden llegar a beneficiarse de un transplante hepático, ya que la mayoría de casos se diagnostican en una fase avanzada. Entre los trasplantados, un 70% sobreviven en los primeros cinco años y, en un 15% de los casos, el cáncer se vuelve a reproducir.

En España, la prevalencia del cáncer hepático se ha estabilizado, gracias a que la infección viral, que, junto con el alcohol, es la principal causa de cirrosis y, por tanto, de cáncer hepático, ya está más controlada. Actualmente, afecta anualmente a entre 10 y 11 personas por cada 100 000 habitantes, lo que sitúa a España en una escala intermedia en comparación con otros países.

En general, la incidencia de cáncer hepático es más alta en Asia y en países del África subsahariana, mientras que, en el norte de Europa y en el continente americano, su presencia es menor, ya que también lo es la diseminación de la hepatitis viral.

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