The new score signals significantly earlier that something alarming is going on with the liver cells of these patients: an incipient liver tumor
This week, Erasmus MC was one of the first hospitals in the world to start using a new diagnostic score to detect early signs of liver cancer.
The score – called GAAD – is designed for people with an increased risk of liver cancer because they have cirrhosis of the liver. Cirrhosis of the liver can be caused by diseases such as chronic viral hepatitis, an autoimmune disease of the liver, or fatty liver disease – whether caused by alcohol abuse or not.
Blood test
‘We have hundreds of such patients. They are under treatment with us and periodically come to the outpatient clinic. Until now, they have been monitored every six months with ultrasounds and blood tests,’ say gastroenterology specialist Prof. Rob de Man and clinical chemist Dr. Christian Ramakers.
The new score signals significantly earlier that something alarming is going on with the liver cells of these patients: an incipient liver tumour. ‘And that is particularly important if judging the ultrasound is difficult,’ says De Man.
Tumor marker
The main change in the score is in the blood test. Previously, the blood was monitored with a single blood value: alpha-fetoprotein (AFP). Now two blood values are measured: AFP and DCP: des-gamma-carboxy prothrombin.
‘Both AFP and DCP are tumor markers that are often only produced by cells of a tumor in the liver. We calculate a score based on the values of these two tumor markers, plus the age and sex of the patient,’ says Ramakers.
CT of MRI
If that score, which can range from 0 to 10, rises above 2.57, it is an indication that something is going on in the cells of the diseased liver. ‘Then we’ll do a CT scan or an MRI scan very quickly.’
Such a scan is much better than an ultrasound to see what is going on in the liver, say De Man and Ramakers. ‘But a scan is expensive and stressful for the patient, and we prefer to use it only in a very targeted manner. The new GAAD score is then a good tool to assess whether there is a good indication for this.’
Arm stroke
The advantage of early detection of an incipient tumor is that it is easier to treat. De Man: ‘Cancer in a liver that is already diseased is difficult to treat. But when a tumor is still very small, you can often burn it away or embolize its vessels. This is less invasive than surgery to remove part of the diseased liver. The patient recovers faster. Early detection gives you, as it were, more scope for your treatment.’
GAAD is an acronym and stands for Gender Age AFP DCP. Gender and age are important factors because liver cancer occurs more often in men and because the risk increases with age. The score is used at Erasmus MC for patients who come to the outpatient clinic for Liver Diseases. But MDL doctors in other hospitals can also request the score for their patients.
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