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On 27th October 2022 the British Liver Trust launched Liver Cancer UK in response to rising cases of liver cancer across the country.

Liver cancer is the fastest rising cause of cancer death in the UK. Over the past decade, liver cancer incidence rates have increased by almost half (45%) in the UK and the number of people dying from liver cancer has risen the fastest out of all the twenty most common types of cancer. There are now over 40% more deaths from liver cancer in both men and women than there were a decade ago (1&2).

The disease also has a high mortality rate. Every year over 6,000 people are diagnosed with liver cancer country-wide and just 13% of them will survive for five years or more. (3) Survival rates depend on several factors, including the stage of the disease when it is diagnosed.

Many patients with liver cancer will only be diagnosed after an emergency admission to hospital or an emergency GP referral after symptoms have become severe and the cancer is more advanced. (4) In England, 44.9% of liver cancers are diagnosed in an emergency setting, such as an A&E department (5).

Liver Cancer UK will provide much needed information and support for patients affected by this devastating cancer and provide a focus for action to address this escalating situation. It will aim to improve the lives and outcomes of people affected by liver cancer and, ultimately, reduce cases of the disease.

The British Liver Trust will continue to work towards a world free of all liver diseases in addition, and as part of, its commitment to tackle liver cancer. Liver cancer is most common in people who already have liver disease, especially if they have cirrhosis (damage and scarring) of the liver which is most often caused by viral hepatitis, alcohol or obesity (6).

Pamela Healy OBE, Chief Executive of British Liver Trust, said:
“Liver cancer patients have told us that they didn’t realise that the British Liver Trust was also here for liver cancer patients - they were often confused and worried and did not know where to turn for help. We’ve created new resources and a website with targeted information to make it easier for people to get the help they need. The new programme of activity is in response to the very worrying increase in cases across the UK. We’re also deeply concerned that survival rates for liver cancer remain so low. It’s a situation which needs to urgently change.

“Liver Cancer UK, as part of the British Liver Trust, will be dedicated to saving and improving the lives of people affected by liver cancer by raising awareness, providing support and campaigning for faster diagnosis and more research into treatments and cures.”

Fiona Bailey (age 48), a liver cancer patient from Hampshire, said:
“When I was diagnosed with liver cancer, aged 45, my husband and I weren’t sure where to turn for support. At the time, I didn’t know anybody who had gone through it apart from my father-in-law who was diagnosed ten years earlier. I was diagnosed in time for surgery although I do continue to live with the ‘worry’ that it could come back. It’s brilliant that the British Liver Trust is launching Liver Cancer UK to provide dedicated information and support to patients like me and to increase awareness of liver cancer to ensure more people are diagnosed earlier. When you’ve been through something like this you just want to help other people.”

As well as the rising cases, late diagnosis of liver cancer continues to be a problem. This is partly due to the population’s low awareness of the symptoms of the disease. In 2021, the Less Survivable Cancers Taskforce released data showing that only 5% of people in the UK were able to correctly identify all symptoms of liver cancer from a list presented to them.

Professor Stephen Ryder, Medical Advisor to the British Liver Trust and Consultant Hepatologist at NHS Nottingham University Hospital, added:

“Lack of awareness of primary liver cancer and its causes is a common problem in the UK.

“The causes of liver disease and HCC, the most common primary liver cancer, are similar and interlinked. The good news is that there are things you can do to reduce the risks. Maintaining a healthy weight, avoiding drinking alcohol excessively and protecting yourself against viral hepatitis are the best defences against both liver disease and liver cancer.

“People can also develop cancer of the liver and gallbladder without the associated risk factors and should be concerned if they have any symptoms that are persistent and not normal for them. If you’re experiencing symptoms such as loss of appetite, nausea, a swollen stomach or yellowing of your skin and/or eyes, please don’t ignore them - make an appointment with your doctor to get them checked out.”

Symptoms of liver cancer include unintentional weight loss, loss of appetite, feeling very full after eating, feeling and being sick, pain or swelling in your abdomen, jaundice (yellowing of your skin and the whites of your eyes), itchy skin, feeling very tired and weak, fever with shivers, vomiting blood, dark black tarry poo or dark urine. However, the majority of these symptoms do not occur until liver cancer is at an advanced stage, so the British Liver Trust is calling for all people who are diagnosed with cirrhosis and who are most at risk to be regularly screened for liver cancer.

Visit Liver Cancer UK to find out more.

1.Over the last decade, liver cancer incidence rates have increased by almost half (45%) in the UK. Rates in females have increased by almost two-fifths (38%), and rates in males have increased by almost half (46%) (2016-2018): https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/liver-cancer#heading-Zero 
2.Liver cancer has shown the fastest increase in mortality (within the current 20 most common UK causes of cancer death) over the past decade in the UK for both females and males. Liver cancer mortality rates have increased by 45% in females and 42% in males over the past decade in the UK. Reference: Cancer Research UK (2019). Cancer mortality for common cancers. [online]. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/mortality/common-cancers-compared (last accessed October 2022).
3.https://britishlivertrust.org.uk/liver-cancer-awareness-month/ 
4.The Emergency Presentation Route comprises different emergency pathways into secondary care, including A&E attendance, emergency GP referrals to an inpatient setting (non–two week wait referrals) and emergency admissions to either an inpatient or outpatient setting.
5. https://www.cancerdata.nhs.uk/emergencypresentations . Data compared for 2020 Q3. Percentages differ slightly when compared to the National Cancer Registration Dataset due to diagnostic coding - this data is only currently available for 2006-2016.
6.https://britishlivertrust.org.uk/information-and-support/living-with-a-liver-condition/liver-conditions/liver-cancer-hcc/ 

Download Clinical recommendations for pre-treatment assessment of people preparing to initiate therapy for chronic hepC infection.pdf

Please contact Professor Foster directly by email g.r.foster@qmul.ac.uk if you have any questions. 

As a healthcare professional, do you have experiences of the COVID-19 pandemic that you would like the public to hear? As we learn to live with COVID-19, is there anything you think the public needs to know? Are there things about the pandemic that you think should be recorded for posterity?

We can help to get your voice heard.

The Royal College of Physicians (RCP) Archive and Museum are recording the experiences of healthcare workers and of those close to them during the COVID-19 pandemic.

Those working in healthcare have been at the forefront of protecting society throughout the pandemic; help us to document your experiences by completing the survey linked to below.

Your experiences may become part of the 2023 RCP at Regent’s Park exhibition, ‘Sharing doctors’ voices; experiences of the COVID-19 pandemic’. Featuring photos, stories, recorded interviews, and objects, this exhibition will centre the voices of individuals, demonstrating the effects of the pandemic on the people working to combat it, in their own words.

Share your experiences with the RCP  > Here

More information can be found on the RCP website > Here

The BASL Equality, Diversity and Inclusiveness Strategy 2021-2024 document has been compiled as part of the BASL Inclusiveness Project and has received BASL Committee approval.

This, alongside our updated Equality, Diversity and Inclusiveness Policy and the policies that have been developed to support it can be found in the members area of our website by logging on > here .

With the rapid rise in cases of the Omicron variant of COVID-19 in the UK the NHS potentially faces another surge in hospital admissions and we are all facing familiar uncertainty and drawing on our resilience mechanisms again. The uncertainty is compounded by not yet knowing the severity or otherwise compared to the Delta variant, the moderating effect of vaccination and whether enough of the population are either vaccinated or boosted to exert this effect, and how the new monoclonal antibody drugs for symptomatic mild to moderate disease in the community will impact on admissions. Below is a summary from the relevant policies, with links, for your information.

These new monocolonals now have conditional marketing authorisation for use in non-hospitalised patients in the UK (read the cas.mhra.gov.uk website alert by clicking > here ). 

• Sotrovimab is given by single intravenous infusion and is reported to reduce the relative risk of hospitalisation or death by 85%.
• Molnupiravir is given orally by capsules for 5 days and is reported to reduce the relative risk of hospitalisation or death by 30%.

Patients must meet all of the eligibility criteria and none of the exclusion criteria. Prehospitalised patients are eligible for treatment if:
• SARS-CoV-2 infection is confirmed by polymerase chain reaction (PCR) testing within the last 5 days
AND
• Onset of symptoms of COVID-193 4 within the last 5 days
AND
• A member of a ‘highest’ risk group (as defined in Appendix 1).

Symptoms listed are: feverish, chills, sore throat, cough, shortness of breath or difficulty breathing, nausea, vomiting, diarrhoea, headache, red or watery eyes, body aches, loss of taste or smell, fatigue, loss of appetite, confusion, dizziness, pressure or tight chest, chest pain, stomach ache, rash, sneezing, sputum or phlegm, runny nose.

Appendix 1 includes liver disease in the following categories:
• Patients with cirrhosis Child’s-Pugh class B and C (decompensated liver disease).
• Patients with a liver transplant
• Liver patients on immune suppressive therapy (including patients with and without liver cirrhosis)
• Patients with cirrhosis Child’s-Pugh class A who are not on immune suppressive therapy (compensated liver disease)

Patients will be anxious, and as clinicians we may be contacted for advice. How the delivery of these drugs is to be organised is being worked out at local operational levels. Members are advised to make enquiries within their Trusts for local arrangements. The Liverpool COVID-19 interactions checker is a useful resource (click > here ). We checked these drugs against the more commonly used immunosuppressants and, for those not familiar with this tool, it is easy to use (no expected interactions for tacrolimus, ciclosprin, azathioprine, mycophenolate, prednisolone).

Members will no doubt be aware that casirivumab and imdevimab (Ronapreve®) has authorisation in hospitalised patients admitted with acute COVID-19. This seems to be less effective in patients with the Omicron variant. Thus where Omicron accounts for more than 50% of the local hospital prevalence, Ronapreve is only recommended where genotyping results are available and confirm infection with a non-Omicron variant. Where genotyping is not available or genotyping confirms infection with the Omicron variant, the December 2021 rapid policy statement advises nMABs can only be offered as part of a formal trial.

Nosocomial acquisition is a bit different. Ronapreve can be used in non-Omicron cases where known, meeting high risk criteria and Sotrovimab has also now been authorised for hospitalised patients who acquire Omicron variant COVID-19 during their hospital stay and meet high risk criteria - for our patients with liver disease, these are the same as those listed above. (read the cas.mhra.gov.uk website alert by clicking > here ). 

Again, members are advised to check their local Trust policies, but nosocomial acquisition of COVID-19 in patients with liver disease may well meet criteria for the use of these drugs so we thought we would draw your attention to this.

Hepatologists and gastroenterologists have faced very challenging changes to practice over the last two years and rising numbers of patients with liver disease. We know the changing Covid-19 landscape continues to bring new challenges. We hope you all stay safe and well during this period.

Rebecca Jones, President BASL
John Dillon, Vice President Hepatology, BSG

Download Joint BASL_BSG message re monoclonal antibody drugs vs COVID-19.pdf

(Added December 20th 2021)