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Medical Author:

Keith E. Stuart, MD

Keith E. Stuart, MD

Dr. Keith E. Stuart is a medical oncologist specializing in the study and treatment of cancers involving the gastrointestinal tract, with a special interest in tumors involving the liver. He was educated at Harvard University (graduating magna cum laude) and Albert Einstein College of Medicine and did his medical training at the New England Deaconess Hospital.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In the modern world, unfortunately, another evaluation becomes important in deciding what type of treatment to pursue: the financial one. While many of the techniques described above are effective in some patients, they are not necessarily always covered by insurance plans. Costs of the machines and drugs can be prohibitive to individuals: radioembolization can cost more than $90,000 for a single treatment; sorafenib is more than $5,000 for a month of therapy. This can make individual and institutional decisions even more heart-wrenching than usual on a personal level. At a societal level, these kinds of costs associated with treating this cancer makes it even more crucial to find ways to avoid developing it in the first place.

Theoretically, hepatoma should be an almost entirely preventable disease. Hepatitis, alcohol abuse, and obesity could all be avoided through social, medical, and lifestyle changes. Some of this has already been attempted around the world, so there is cause for optimism. For instance, children in Taiwan have been immunized against hepatitis B since 1984. This has led, so far, to a 70% decrease in the rate of teenagers developing hepatoma. In the United States, where the incidence is already much lower than it is in Asia, hepatoma due to hepatitis B has fallen by half since immunization began. While there is not yet a vaccine against hepatitis C, this is a much easier virus to avoid now that blood products are being screened and people are more aware of preventing infection from used needles. Once someone is infected, treatment with the drug interferon can reduce the chance of developing hepatoma dramatically. Diabetes and obesity, clearly, can be reduced by modifications in diet and lifestyle, as difficult as that obviously continues to be in our society.

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