Hepatitis C in Survivors of Childhood Cancer

Source: Fall 1999 CCCF Newsletter

The liver is the body's largest internal organ and one of the most complex. This wedge-shaped organ is located beneath the rib cage in the upper right part of the abdomen. The liver performs hundreds of functions that are essential for life. It converts food into energy, removes toxins from the body, keeps blood clotting normally, and manufactures proteins.

Hepatitis C

Hepatitis C (HCV) is an inflammation of the liver caused by the hepatitis C virus. HCV is spread by blood transfusions (given prior to effective testing of blood products), sharing needles for intravenous drug use, and less commonly, through sexual intercourse. Nearly 4 million people in the United States are infected with the hepatitis C virus, making it the most common chronic blood-borne infection in the country.

Before 1992, a laboratory test to identify blood carrying the hepatitis C virus was not available, and some children and teens with cancer received infected blood. Since more effective tests for the virus have been used by blood banks since 1992, the current risk of getting HCV from a single blood transfusion is very small, only 1 in 100,000.

If you are infected with the hepatitis C virus, there are five possible outcomes:

  • Your body's immune system may eliminate the virus and you will have no further problems.
  • You may have a life-long infection, but your liver sustains no damage.
  • You may develop inflammation of the liver, with or without symptoms.
  • You may develop progressive inflammation and scarring of the liver. When this scarring (fibrosis) is spread throughout the liver, it is called cirrhosis. This process occurs over many years, and usually results in symptoms. It can eventually lead to liver failure.
  • In rare cases, liver cancer develops after years of chronic hepatitis C and cirrhosis.

Signs and symptoms

Because hepatitis C can silently damage the liver, a survivor may not be aware of the infection until many years later when late complications of liver disease cause symptoms. Though most people with hepatitis C have no symptoms at the onset of the infection, some may experience jaundice (yellowish eyes and skin), fatigue, loss of appetite, nausea and vomiting, low grade fever, pale or clay colored stools, dark urine, itching, or diarrhea.

Screening

Your yearly follow-up examination should include a discussion about your liver and history of blood transfusions. You should get tested for HCV if any of the following apply to you:

  • If you have been notified that you received blood from a donor who later tested positive for hepatitis C
  • If you have had a stem cell or bone marrow transplant
  • If you received any blood products before July, 1992
  • If you had solid organ transplant before July, 1992
  • If you have signs or symptoms of liver disease (e.g., abnormal liver enzyme tests or enlarged liver)

Many institutions recommend a blood test (ALT, alanine transaminase) every 2 to 5 years to monitor liver function. During your annual physical examination, your health care provider should palpate (feel) your abdomen to check for an enlarged liver. If you had a stem cell or bone marrow transplant, you should also have a test for iron overload. Any abnormal findings should result in a referral to a gastroenterologist for further evaluation and treatment.

Treatment

There is no specific treatment for acute hepatitis. Rest may be recommended during the acute phase if symptoms are severe. The acute infection usually disappears three to four months after symptoms begin. About 50 percent of people infected with hepatitis C develop chronic hepatitis.

Chronic hepatitis can be treated with a number of medications. Alpha-interferon, which stimulates the immune system to fight the infection, and ribavirin, an anti-viral antibiotic, are usually given together. This combination treatment is effective in up to half of patients. These drugs are not licensed for persons under 18 years of age. Children with hepatitis C should be referred to a children's specialist in liver diseases.

Because the liver can become so damaged that it can no longer perform its crucial functions, some people who have had hepatitis C for many years may need a liver transplant.

Survivors who have had chronic hepatitis C and develop cirrhosis (scarring of the liver) may develop a type of liver cancer called hepatocellular carcinoma. The chance of developing this cancer is greatly increased in those who drink alcohol. To screen for this type of cancer, a blood test (alpha-fetoprotein) may be periodically checked in the survivor with cirrhosis.

If you have HCV, you can do the following to protect your liver:

  • Don't drink alcohol - it greatly increases damage to the liver. This includes even occasional beer or wine.
  • Don't use over-the-counter medications, such as Tylenol (acetaminophen) or Advil (ibuprofen), herbal or dietary aids, or prescription medications without first discussing it with your doctor. Many of these can cause more damage to the liver.
  • Get vaccinated against hepatitis A and B.
  • See your doctor regularly.

Because the infection can be spread to a partner by sexual intercourse, it is important to use barrier protection, such as condoms.

Unfortunately, there is not a vaccine against hepatitis C. Thus, a spouse (or sexual partner) of a survivor with hepatitis C can also get the infection. Because of this risk, the spouse (sexual partner) should be periodically screened for hepatitis C.

Rarely, hepatitis C can be transmitted to an infant during pregnancy. It is important that the female survivor with hepatitis C tell her obstetrician, pediatrician, or family physician about the infection.

Many people with HCV infections find comfort in participating in a support group. These are available in many communities since the disease is now so widespread.

For more information on Hepatitis C, read the frequently asked questions on the US Center for Disease Control Hepatitis C website: www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm or call them at (888) 4-HEP-CDC.