TMC PULSE

27 t m c » p u l s e | m a r c h 2 0 1 9 "Not only does Texas lead the nation, but south Texas Latinos lead Texas in the risk of liver cancer," El-Serag said. "The question is why and theories are abounding. We believe it is a combi- nation of multiple risk factors led by obesity and diabetes, both of which increase the risk of fatty liver which alone can cause liver cirrhosis and liver cancer, but also worsens the impact of other factors like hepatitis and alcohol drinking." El-Serag's research has been funded by the Cancer Prevention Research Institute of Texas. He's also part of the Texas Hepatocellular Carcinoma Consortium, founded in 2015. Together, investigators in Houston, Dallas, San Antonio and the Rio Grande Valley have assem- bled a large representative cohort of patients with cirrhosis—the condition that predisposes to liver cancer—to examine risk factors and the biomark- ers related to the development of liver cancer. The group is looking at these risk factors with a special emphasis and focus on obesity and the related metabolic factors, such as diabetes, high triglycerides and insulin resistance. "It is estimated that one in four adults in the state of Texas would have fatty liver disease and, among Latinos, it is estimated that one in three adults would have fatty liver disease," El-Serag said. "It is quite common and we don't know the risk of progression from this very common disease to liver cancer. We have a disease that impacts virtually a third of adults. What makes some of them progress to complications of cirrho- sis and liver cancer?" Importantly, liver cancer does not present with obvious symptoms until the disease has pro- gressed substantially. "The liver is a very resilient organ. It has a huge amount of reserve, which means that one can lose 80 to 90 percent of liver function with- out showing any signs or symptoms," El-Serag said. "When symptoms arise, it is typically too late—these symptoms include jaundice, edema, generalized fatigue, muscle weakness, sponta- neous bleeding. The early manifestations are best detected through biochemical testing." The Dan L Duncan Cancer Center treats patients from Texas Children's Hospital, Ben Taub Hospital, the Michael E. DeBakey VA Medical Center, Houston Methodist Hospital and CHI St. Luke's Health. In addition to the alarm- ing liver cancer rates across Texas, researchers have noticed upward ticks in other cancers in the Houston area, too. "One is breast cancer, for which obesity is a SiennaPlantation.com 20+ MODEL HOMES Homes from the $250s MILLION + #1 Selling Community in TEXAS! • Seven on-site Fort Bend ISD schools K-12 • Acres of parks + trails, resort-style waterparks • On-site fitness centers, golf, tennis, sports complex and stables 610 45 6 TEXAS 8 8 59 90 288 521 risk factor, and particularly for triple-negative breast cancer in African-Americans—that is a more aggressive type of breast cancer," Osborne said. "Prostate cancer in African-American men is problematic and aggressive. Another cancer that is increased with obesity is pancreas cancer." Osborne is also deeply concerned about the rise is esophageal cancer. "Esophageal cancer, cancer of the distal esoph- agus, is the most rapidly growing cancer in white males because of abdominal obesity," he said. "The beer belly, if you will, pushes on the stom- ach and the stomach juices and the gastric acid refluxes back into the esophagus and burns it." To properly address these cancers, doctors know tackling the obesity crisis is essential. "One of the ways to reduce these cancers is to reduce the obesity epidemic and find ways of beating obesity that can range from behavioral science all the way up to surgery that results in weight loss," Osborne said. "We cover the whole waterfront in the obesity epidemic and, last year, we put all of these people together in a unified program at the cancer center called the Obesity Working Group, where they can collaborate and address the problem from different angles."

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