I HAVE received an influx of wedding invitations at the moment and despite the fairly modern lifestyles we have adopted, we must still keep our traditions and equip the young brides with skills and knowledge that has been passed on from generation to generation by holding ‘lessons’ for them.
As we prepare these young women, the theme ‘Umwaume nipamala’ (context – feed your husband) is reiterated.
Who does not know that pockets of extra body tissue around the cheeks and tummy represent good living and happiness in our society?
I have, in the recent past, been a recipient of ‘compliments’ on how much weight I have gained much to my embarrassment.
Apparently, I ‘look better’ and ‘more mature’, unlike my size zero version!
I actually remember one of my aunties narrating how her sisters used to put extra pieces of chitenge in their skirts to appear ‘fuller’.
As a health practitioner, that kind of beauty aspiration sets the alarm bell off.
I make a mental note to play my part and encourage these young brides to feed their husbands well but only with the correct type of food so that they can enjoy a long healthy life as a family.
It is common knowledge that obesity has a lot of detrimental effects on one’s health.
It predisposes us to developing diabetes, cardiovascular disease, bone and joint problems, respiratory problems, gallstones and liver problems and more close to home for me, certain types of cancer.
A certain acquaintance once told me how losing weight had also helped her ‘clear her mind’.
As clinicians, we use a measure called Body Mass Index (BMI) to determine nutrition status.
It is calculated using one’s height and weight by a simple formula of dividing your weight by height squared (kg/m2) or nowadays, the use of a telephone app can be employed.
A score between 18.5 and 25 is considered ideal,  25.6 – 29.9 is considered overweight and above 30 considered obese.
Obesity within itself is divided into low-risk (score 30.0 – 34.9), moderate-risk (35.0 – 39.9) and high-risk (>40.0).
This risk refers to the chance of developing the above mentioned health problems.
Now one would ask me; why is obesity bothering me so much as a cancer specialist? Previous data has shown us that breast, ovarian, oesophageal endometrial and some other common cancers have a strong link to obesity.
However, at a recently attended European Society of Medical Oncologists (ESMO) conference, a strong message backed with scientific data for the association of hepatocellular carcinoma and obesity was relayed.
Hepatocellular carcinoma, or simply liver cancer, is a particularly aggressive type of cancer.
Previously, we put large emphasis on the association of liver cirrhosis with liver cancer.  Now other factors are emerging which point to a wider group of people at risk.
The thought of a liver cancer pandemic invokes some hysteria within me because its treatment, whatever the stage, requires resources that are not easily accessible in any environment.
Surgery requires highly specialised surgeons whilst the medical options remain expensive.
Many share my particular hysteria with regard to this disease.
Recently, a physician at one of the private hospitals in Lusaka expressed frustration at the poor results we have treating patients with liver cancer and challenged me with an answer for five-year survival rates of this disease in the country.
I was honestly lost for words, and not wanting to add to the gloom of dire state of affairs, deflected the conversation.
Given this information, it made me think about how we need to nip liver cancer in the bud.
As for the majority of cancers, we need to look at the ‘lifecycle’ of the disease from prevention to early detection, treatment for cure and palliation.
Prevention of liver cancer can be partly addressed by diet.
A diet, which reduces your chances of developing obesity, is our step one to preventing liver cancer.
Apparently, a non-alcoholic fatty liver is an independent prognostic factor to developing liver cancer.
Most people associate a healthy diet with a bland diet but this is not necessarily the case. I have come across very scrumptious healthy recipes, which include local ingredients.  Excessive alcohol consumption also leads to liver disease that predisposes one to liver cancer.
The second important risk factor of developing liver cirrhosis and further liver cancer is infection.
This is Hepatitis B and C infection; recently people have been talking about Epstein Barr Virus as well.
Vaccination against Hepatitis B is widely available.
This immunity is long term and thought to last up to 20 years.
For both Hepatitis B and C, safe sexual and good hygiene practices protect you from acquiring the causative virus.
If one already has a history of Hepatitis infection or liver cirrhosis, it is prudent to be closely followed up by your doctor.
A simple ultra sound to detect any lesions on the liver every six months suffices.
A blood test called alpha-fetoprotein is also used to determine presence of a tumour but cannot be solely relied on.
Treatment of early disease includes liver transplant if certain criteria are met.
Resection (cutting out), ablation, arterially directed therapies or external beam radiotherapy are all options of treatment.
If the disease is inoperable and too advanced for local treatment, a systemic approach is taken.
Currently, a targeted agent called sorafenib is being offered.
This drug is very expensive and is in the thousands of dollars per month for life or till disease progression.
As such, prevention remains better, simpler and cheaper than cure.
Sometimes when there is no benefit of active intervention with regard to the liver, an approach called best supportive care is employed.
This includes addressing the physical, emotional and spiritual discomforts of a patient.
Symptoms that liver cancer patients may experience include nausea, vomiting, abdominal pain and distension, fluid in the abdomen (called ascites) and swelling of lower limbs. Other clinical syndromes associated with liver damage may exacerbate the feeling of unwellness in the patients.
The psychological impact of the cancer diagnosis and more over an aggressive form of cancer also needs to be addressed.
That, in a nutshell, is liver cancer.
Prevention is better than cure.