Editor's Note:

Hundreds of liver cancer patients on the Chinese mainland now have access to better treatment, thanks to the efforts of a team of specialist doctors from Hong Kong traveling to Shenzhen on a regular basis. Ming Yeung reports.

After three years of preparation, a group of Hong Kong doctors is making progress on the mainland, in the long fight against one of Asia's deadliest killers, liver cancer. The team, led by Albert Chan Chi-yan, set out last January at University of Hong Kong-Shenzhen Hospital (HKU-Shenzhen Hospital)'s liver cancer clinic, to assure mainland patients could receive the same cutting-edge technology and medical expertise accumulated over years at Hong Kong's Queen Mary Hospital.

Why is this such an important crusade for Chan and his team? Liver cancer is epidemic in China. Two leading causes are prevalent in China. One is Hepatitis B which is endemic to the country. The medical journals Lancet and Gastroenterology have reported independently that one third of the more than 400 million people worldwide afflicted by the virus are in China. Second is Hepatitis C, a viral scourge whose infection rate shot up in China from 0.7 per 100,000 people in 1997, to 15 per 100,000 in 2012, according to data from the US Center for Biotechnology Information. There are more than 350,000 deaths every year from liver cancer on the Chinese mainland.

Patients waiting for medical consultations at the University of Hong Kong-Shenzhen Hospital in Futian, Shenzhen, which provides cutting-edge surgical technology and medical expertise available in Hong Kong.

Chan and his colleagues have accumulated valuable experience treating patients at Queen Mary Hospital, which has been pioneering novel therapies for liver cancer for over two decades. Queen Mary Hospital has also earned global acclaim for its approach to liver transplantation. Most mainland people however had no access to the revolutionary advances, before the clinic opened at HKU-Shenzhen Hospital.

Within a few months, the clinic had started drawing patients from as far away as the Xinjiang Uyghur autonomous region. Chan dismisses standard medical practice on the mainland as sloppy and inconsistent, leaving a wide open door to liver cancer.

Leader of the liver cancer clinic at the University of Hong Kong-Shenzhen Hospital Albert Chan Chi-yan conducts a follow-up consultation with a patient, in his effort to build up follow-up consultation culture for liver cancer patients on the mainland. Photos By Roy Liu / China Daily

Hepatitis patients need regular screening and monitoring. They need medications to prevent the virus from replicating and progressing to cirrhosis of the liver. On the mainland, regular screening is rare. Often, people don't bother getting checkups until symptoms manifest. By then it's too late. Hepatitis infections are so numerous it's difficult for doctors to find donors for liver transplants.

A patient surnamed Liang was lucky. In June, he sought treatment for a stomach ache at a Shenzhen hospital. Doctors found a small tumor which was bleeding on his liver. He was told it was cancer.

The 50-year-old Shenzhen resident wasted no time deciding to undergo surgery to remove the 6x4 centimeter tumor. He chose HKU-Shenzhen Hospital in preference to the renowned cancer hospital in Guangzhou. Liang had heard good recommendations about HKU-Shenzhen Hospital. His cousin had surgery on a cancerous gall bladder there.

Liang was afraid. He wanted to do all he could to get rid of the cancer. He felt more confident putting himself in the hands of Hong Kong doctors using the latest facilities.

Typical treatments for liver cancer patients on the mainland, Chan says, lag behind the world-class, inter-disciplinary options available in Hong Kong. Mainland patients normally are channeled into one of three treatment streams: chemotherapy that uses drugs to attack cancer cells; TACE or transarterial chemoembolization, a type of minimally invasive surgery that cuts off the blood supply to tumors; and standard surgical removal of tumors.

Chan's team takes a collaborative, interdisciplinary approach in which patients are not swept into just one treatment stream. According to Chan, who heads the hospital's pancreatic surgery department and is also a clinical associate professor at HKU's Department of Surgery, surgeons across the border don't have the equivalent updated surgical skills as their Hong Kong counterparts. He hand-picked eight surgeons from the mainland, who have shown considerable promise to be a part of the team. The mainland surgeons join the five Hong Kong doctors who work shifts at the clinic on a rotational basis.

Labor of love

It's a labor of love for the HKU-Shenzhen Hospital doctors. Chan says there are days when he starts surgery at 9 o'clock in the morning and finishes at 11 o'clock at night when there are surgical complications. "We had to cross the border from Shenzhen Bay Port, which closes at 11:45 pm. I had to rush to the border at 11:30 pm. The immigration hall was empty, except for me and the officers. Rarely do you get to see the immigration hall that empty," he recounted.

Communication during surgical procedures across the border could be difficult at times in the beginning. Surgeons, nurses and anesthetists all have trained at different places, and different ways of doing things. Facilities also were not on a level with Hong Kong hospitals. But the clinic has already procured the same facilities that have been in use in Hong Kong.

Chan is confident that HKU-Shenzhen Hospital will complete 100 tumor removals by the end of the year.

The clinic also has had to train its patients. Mainland people didn't like appointments at first. They were content to line up. "We have been doing a lot to change their practice and now we see more people becoming accustomed to the appointment system," Chan said.

Patients have also warmed up to the absence of mystery in their medical bills. The hospital has an inclusive treatment plan with everything up front.

At HKU-Shenzhen Hospital, Liang appreciated the absence of unnecessary prescriptions that didn't improve his health but jacked up the fees. He paid a little over 10,000 yuan ($1498) on top of his security insurance for his surgery, which he regarded as very affordable. That kind of surgery could cost around 100,000 yuan in a well-known mainland hospital, he said.

Advanced treatment can be a life saver for many mainland patients, or at least it can extend their lives. The seriousness of the issue is underscored by the fact that 80 percent of the world's liver cancer cases come from Asia, and 55 percent of those, come from the mainland and Hong Kong. About 80 percent of those patients are caused by Hepatitis B which is most commonly spread from mother to child at birth. Carriers of the Hepatitis B virus are 100 times more likely to develop liver cancer than non-carriers.

In Hong Kong, liver cancer is the third leading cause of cancer deaths and has been for years, according to the Department of Health. Annual statistics show that 1,500 to 2,000 people die from liver cancer every year in the SAR, despite the fact that Hepatitis B sufferers are given medication to prevent the condition from progressing to liver cirrhosis, which is incurable.

Cirrhosis normally associated with older people is common among young people on the mainland. That's because they don't get proper checkups.

"Many young people know only that they have Hepatitis B, but they rarely know they need periodic medications and checkups to monitor the condition. Then they show symptoms. By that time the tumor has already gotten too big," Chan explained.

Novel surgery

Chan describes liver cancer as "evil", a serial killer that needs to be destroyed fast. In cases of liver cancer, surgery to remove tumors is one of the most effective treatments, thanks to the liver's ability to regenerate.

The liver has two lobes, if the cancer is in the larger right lobe, cutting this part of the liver away creates a high risk of liver failure among patients with small livers or poor liver function.

Now, using an ultrasonic dissector, the two lobes can be separated, allowing the smaller left lobe to grow with the main blood vessel attached, while the right lobe is still able to function. After seven to 10 days, when the left lobe has grown to one third of the size of the right, the right lobe is then removed.

"The new surgery will take two parts: first to ligate the blood vessel of the right lobe to let the blood flow to the left lobe. Then, about a week later, the left lobe will grow very fast, then we perform the second surgery to take out the right lobe," Chan said, adding that dissection requires a high level of skill which only allows dissection with precision and minimal bleeding. Patients' post-surgery management is also vital to avoid internal bleeding.

The new method, called associated liver partition and portal vein ligation for stage hepatectomy, was first performed in 2013 in Hong Kong. Three years of experience has enhanced the Hong Kong team's confidence to deliver this most advanced surgery to the mainland. There were a couple of surgeries of this kind being performed over the past year.

Thanks to a larger base of patients who will undergo this surgery on the mainland, in addition to patients at Queen Mary Hospital, Chan and his colleagues are able to accumulate data quickly to test the efficacy of the new surgery. Without numerous surgeries, medical staff probably would have to wait four or five years to achieve the same result.

A successful surgery is not good enough. Chan is keen to establish follow-up consultation culture for liver cancer patients. Even after successful surgery, the follows-ups are necessary to monitor any recurrence.

Liang just had his first follow-up consultation after the surgery performed in June. He says he feels great. All he needs to do now is go back to the hospital for check-ups every three months, eat healthy and take up regular exercise to keep his immune system strong. That way he has a good chance of escaping any recurrence of the deadly disease.

Contact the writer at

mingyeung@chinadailyhk.com

(HK Edition 10/06/2016 page4)