I was drawn to this field because liver cancer is one of the biggest health problems in the world – particularly in South America, Asia and Africa. When I started medical school in the early 1980s, many people were dying from liver cancer and almost no one was being cured of this devastating disease. Once cancer hit the liver, it was thought to be incurable and such a hopeless situation that patients were often told not to bother with treatment. Hard to believe that was the case just 30 years ago.

We know that primary liver cancer – which means cancer that starts in the liver – can be triggered by viruses that attack the liver. Hepatitis B and C are the main culprits. But now we also understand that diet, diabetes, and obesity can play significant roles as well. Liver cancer is a growing problem wherever you have large populations of overweight people and diabetics, as we do in this country – and increasingly in other countries. When you are overweight and you have diabetes, your liver will get deposits of fat (called steatosis) – and that fat with associated inflammation can lead to cancer.

Anything that damages the liver – whether virus or dietary inflammation – will cause it to try and repair itself. The more damaged it is, and the more times it tries to fix itself, the more likely it may turn on the wrong “growth” genes – the ones that also cause cancer.

Besides coming from China – where Hepatitis B and liver cancer are so prevalent – I also saw this field as my calling because, along with pancreatic surgery, liver surgery is regarded as one of the most technically challenging to undertake. I enjoy working with my hands – you’ll find me tinkering in my garage most weekends – and this type of surgery was a way for me to apply what I enjoyed doing to good use, helping people when they needed it most.

So personally, all the pieces fit and, even more, it all came together on the cusp of what would be great progress over the next 30 years.

It was in the early 1980s with the help of then newly-invented CAT scanners that we started to realize the liver is also quite good at killing cancer. There are many cancers , such as colon cancers, that travel by blood to the liver. It turns out the liver can filter out and kill most of these tumor cells and not allow them to spread elsewhere. This is why you would see tumors in the liver but you wouldn’t see them anywhere else. And so this is when we started surgically removing tumors that we found in the liver – and we soon realized that we could effectively cure 25% of patients with surgery alone.

That number is now over 50% when chemotherapy is also part of the treatment plan. The unfortunate part is that not everyone understands the huge advances we’ve made in this area in the past three decades. I recently saw a patient with a single tumor in his liver who had been told he would die if his chemotherapy didn’t work. That patient actually had a 60% chance of being cured. We removed the tumor and he’s now off chemotherapy and doing well.

I’m not saying that we can cure everyone, but we do need to educate everyone – including physicians – that there’s now the possibility of being cured. Just as much, we need to educate people about ways they might be able to prevent liver cancer as well.

Take Hepatitis B, for example. Sad to say, but relatively few people seek or receive treatment for it, even though we’ve had safe drugs with minimal side effects for more than a decade. By shutting down viral replication in the liver, these drugs have the potential to prevent diseases associated with Hepatitis B, such as cirrhosis of the liver and even cancer. All the patient has to do is take a pill as if they were taking a vitamin, and suddenly the virus goes into dormancy and disappears from detection; the liver stays healthy and people have a better chance of living longer, cancer-free lives. It’s simple therapy, but not enough people know about it or don’t trust how easy it is.

With Hepatitis C, there is a new drug just out that could cure a patient with 18 months of treatment. Here the issue is not just getting the word out to people who need the treatment, but how do we make it more accessible and affordable? It’s an important drug with huge potential – especially when you consider that the treatment available up to now (Interferon) has side effects that make it difficult for people to finish their treatment all the way through. After one bad experience, these patients may be reluctant to try again, even though what we have now is a much better treatment option.

Knowing that someone has hepatitis or a fatty liver, we now know to screen them for cancer. For example, if somebody has Hepatitis C and cirrhosis of the liver, their chances of getting cancer are 5% per year. If you screen them over 10 years, you will find cancer in half of those people – sooner than you would without screening.

When I first started in this field, liver and pancreatic surgeries were a big deal. But now with screening, we can find tumors earlier when they’re smaller, and do much less invasive surgery – or sometimes no operation at all.

An incision to remove a liver tumor used to be quite large and surgery would take months of recovery time. Now we have robotic surgery and laparoscopic surgery where we can insert a tiny camera instead of making a big incision. Instead of 10-14 days in the hospital, patients can go home in a day or two, and depending on their job they could be back to work in as little as 2-3 weeks. The goal is to respond to the needs of the patient by making it possible to recover faster and get back to their normal lives as soon as practical.

To sum up what we do and are always striving to do more of:

Better cures and caring – in other words, better cures must go hand-in-hand with better understanding of how those cures are perceived – culturally and otherwise – by our patient populations. A big part of why we develop new drugs is to do less harm with less side effects. But patients may see a new drug or treatment that doesn’t hurt as much as one that is not as strong or not going to be as effective as a traditional one.

Less invasive – as with better drugs, we can treat and cure people and harm them less in the process with less invasive surgery. City of Hope has one of the largest robotic surgery programs in the world, and we’re helping to lead the next generation of robotic implementations.

More access – when new treatments become available (such as the hepatitis drugs), it can take a long time to filter down through the ranks and for people to realize that they exist. We want everyone to be able to get the best possible healthcare, and that means better education and communication – and greater respect for language and culture.