What Is Hepatocellular Carcinoma
Hepatocellular carcinoma is the most common form of liver cancer. It is a serious illness that can be life-threatening. If it diagnosed early, hepatocellular carcinoma can be treated with surgery to remove the cancerous tumor or with a liver transplant. Other treatments can shrink the tumor or slow its growth and relieve your symptoms. Hepatocellular carcinoma is linked to cirrhosis of the liver and non-alcoholic fatty liver disease . People who have cirrhosis or NAFLD should be regularly checked for signs of hepatocellular carcinoma.
Alcoholic Fatty Liver Disease
As the name suggests, AFLD is attributed to excessive alcohol consumption that causes hepatic injury by the build-up of fats, inflammation, and scarring leading to HCC, which could be fatal . Globally, the prevalence of AFLD is increasing and has become a significant contributor to the liver disease burden accounting for 30% of HCC related deaths . The safe levels of drinking as defined in the dietary guidelines in the United States is two drinks for men and one drink for women per day as one alcoholic drink accounts for about 14 g of alcohol . By contrast, excessive alcohol consumption is considered to cause AFLD . The threshold level of alcohol intake causing hepatotoxic effect varies and it depends on a variety of factors such as gender, ethnicity, and genetics .
Treatment For Hepatocellular Carcinoma
Hepatocellular carcinoma treatment is guided by several factors including the size of the tumor, number of tumors, location of tumor, overall liver function and other health factors. Every person is different and so too is each diagnosis of liver cancer. Working with their treatment team to make a personalized plan based on the cancer stage is important for every patient.
Choosing a doctor and healthcare team is an important and very personal decision. The chosen treatment plan may mean that the doctor that diagnosed the liver cancer is not the one doing the majority of the treatment. Consider working with a multidisciplinary team if possible. A multidisciplinary team is a group of health care professionals from different specialties working together to suggest a treatment and care plan based on your diagnosis, personal health, and preferences.
Physicians involved in liver cancer care may include
Each treatment is different and most treatments have some side effects that affect people differently. It is important to remember that while people may have some side effects from treatment, most people do not experience all of the potential side effects. Talk often and openly about what to expect for treatment and plan to manage side effects before and when they happen.
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What Questions Should I Ask My Doctor
You will have different questions throughout your diagnosis and treatment. Some initial questions you might want to ask are:
- How well is my liver working?
- Has my cancer spread beyond my liver?
- Can my cancer be cured?
- What are my treatment choices?
- Why do you suggest these choices?
- What are the side effects of each treatment?
- How will each treatment affect my daily life?
- How quickly do we need to decide on treatment?
- How will we know if treatment is working?
- What are my options if the initial treatments dont work?
How Can I Reduce The Risk Ill Develop Hepatocellular Carcinoma
Fortunately, there are several ways you can reduce your risk of developing hepatocellular carcinoma:
- Get your hepatitis B vaccination. There isnt a vaccine for hepatitis C.
- Talk to your healthcare provider if you think you might have hepatitis B and hepatitis C.
- Cut back on the amount of alcohol you drink.
- Maintain a healthy weight.
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How Is Hepatocellular Carcinoma Treated
There are several ways to treat hepatocellular carcinoma. Your healthcare providers will develop a treatment plan that takes into account your overall health, whether your liver is working well and your tumors size.
Beyond that, theyll talk to you about treatment goals, options and potential side effects. They want you to have a complete picture of your situation so you can feel confident about your decisions. Once theyve shared information, theyll ask about your personal preferences. Your final treatment plan will reflect your providers recommendations and your preferences.
The Expression Of Rufy3 Is Up
As shown in , , in 35 pairs of cases, the RUFY3 mRNA and protein levels in cancer tissues were significantly higher than those in adjacent normal tissues. Consistently, the IHC analysis of RUFY3 expression in all cases further demonstrated the similar outcome .
Expression levels of RUFY3 in HCC tissues. Detection of RUFY3 mRNA expression in HCC tissues and adjacent normal tissues by qRT-PCR. Detection of RUFY3 protein expression in HCC cancer tissues and matched normal tissues by western blot analysis. Detection of RUFY3 expression in HCC tissues and matched normal tissues by IHC analysis. Quantitative analysis of RUFY3 expression in HCC tissues and adjacent normal tissues according to IHC staining scores. Kaplan-Meier analysis of overall survival for HCC patients with different levels of RUFY3 expression. *P< 0.05.
Secondly, the correlation between the expression of RUFY3 and clinicopathological features of HCC patients showed that the high expression of rufy3 was significantly correlated with tumor size, microvascular invasion, TNM stage and Edmonson stage . Kaplan Meier analysis showed that the overall survival of RUFY3 positive HCC patients was shorter than that of RUFY3 negative HCC patients .
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Taking Care Of Yourself
While you’re getting treatment, there are lots of things you can do to manage side effects and stay healthy.
Since chemotherapy can sometimes upset your stomach, you can try changing some of your eating habits. For instance, stay away from fried or spicy foods. You can also try eating five or six small meals a day rather than the traditional three meals.
If your treatment makes you tired, you can try to take short naps. You also might find that short walks can help boost your energy.
If you’re stressed about your treatment, sometimes deep breathing and meditation might help you relax.
Reach out to family and friends who can give you emotional support when you need it.
Cell Migration And Invasion Assays
In short, the transwell chamber were coated with or not coated with Matrigel was used to measure cell invasion and migration. The cells were maintained in serum-free medium and inoculated in the upper cavity. 20% FBS was added to the medium as a chemical attractant. After incubation for 24 h, the cells on the bottom of the insert were fixed and stained. Finally, the migration and invasion cells were counted in five randomly selected regions by microscope.
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How Does Hepatocellular Carcinoma Affect My Body
Over time, hepatocellular carcinoma can cause liver failure. Before that happens, however, hepatocellular carcinoma can keep your liver from managing your bodys vital functions. Among other things, your liver:
- Keeps track of your bodys nutrients, converting them into substances your body can use, storing and delivering them to your cells as needed.
- Gathers toxic substances, making sure they are harmless or released from your body.
- Supports healthy blood flow, producing substances that help your blood to clot and removing bacteria that cause infection.
What Are Other Treatments For Hepatocellular Carcinoma
Other treatments are:
- Ablation therapy. Your healthcare provider uses a special needle to burn your tumors.
- Embolization therapy or chemoembolization therapy. Healthcare providers inject chemotherapy drugs into your livers main artery, which carries the drugs to your tumor. Then they temporarily block your artery so the drugs stay in your tumor longer.
- Targeted therapy. This treatment blocks the growth of cancer cells and limits damage to healthy cells by targeting the cancer cells genes.
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Can Hepatocellular Carcinoma Be Cured
Researchers continue to search for ways to cure hepatocellular carcinoma. If your condition was diagnosed early on, you might be treated with surgery to remove the tumor. You might have a liver transplant. People whose condition was diagnosed later can still have treatment and support that helps them to live longer and to have a good quality of life.
North America And Western Europe
The most common malignant tumors in the liver represent metastases from tumors which originate elsewhere in the body. Among cancers that originate from liver tissue, HCC is the most common primary liver cancer. In the United States, the US surveillance, epidemiology, and end results database program, shows that HCC accounts for 65% of all cases of liver cancers. As screening programs are in place for high-risk persons with chronic liver disease, HCC is often discovered much earlier in Western countries than in developing regions such as sub-Saharan Africa.
Acute and chronic hepatic porphyrias and tyrosinemia type I are risk factors for hepatocellular carcinoma. The diagnosis of an acute hepatic porphyria should be sought in patients with HCC without typical risk factors of hepatitis B or C, alcoholic liver cirrhosis, or hemochromatosis. Both active and latent genetic carriers of acute hepatic porphyriasare at risk for this cancer, although latent genetic carriers have developed the cancer at a later age than those with classic symptoms. Patients with acute hepatic porphyrias should be monitored for HCC.
The incidence of HCC is relatively lower in the Western Hemisphere than in Eastern Asia. However, despite the statistics being low, the diagnosis of HCC has increased since the 1980s and it is continuing to increase, making it one of the rising causes of death due to cancer. The common risk factor for HCC is hepatitis C, along with other health issues.
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Diagnosing And Staging Hepatocellular Carcinoma
If liver cancer is suspected, your healthcare team may order certain tests to gather more information. These tests can include:
Liver function blood tests examples include: AST, bilirubin, albumin, prothrombin time, Alkaline phosphatase, ALT, INR, viral hepatitis panel, AFP,
Imaging tests examples include: Ultrasound, CT, MRI
Liver biopsy is a sample of liver tissue that is removed with a thin needle and looked at under the microscope
Liver biopsy is the gold standard for diagnosing liver cancer, although not needed in all cases since some liver cancers can be diagnosed on imaging. Increasingly, biopsy is being used to help characterize the subtype of liver cancer in order to guide the choice of treatment, especially for advanced liver cancers
If liver cancer is diagnosed, your healthcare team will do additional imaging studies to determine if the cancer has spread from beyond your liver to nearby lymph nodes, the lungs, or other organs in the body. These additional tests allow your healthcare team to stage the liver cancer.
Knowing the stage of the liver cancer allows the treatment team to make recommendations for treatment to ensure the best outcome. There are several different staging systems that are used for staging hepatocellular carcinoma. The two most commonly used systems in the US are the TNM and Barcelona Clinic Liver Cancer systems.
The TNM System
The Barcelona Clinic Liver Cancer System
In Vivo Tumorigenesis And Metastasis Assays
All procedures were approved by the ethics committee of the First Affiliated Hospital of Soochow University. In order to investigate the effect of RUFY3 on tumor formation, cells were subcutaneously injected into nude mice, and then the tumor volume was measured with the following formula every five days: volume = 2× × 0.5. The nude mice were killed 30 days after injection, and the tumor was isolated for IHC analysis of RUFY3 and Ki-67 levels. In order to study the effect of RUFY3 on tumor metastasis, we injected cells into nude mice via tail vein. After 30 days, the lung tissues of nude mice were resected to count the metastatic nodules, and the expression levels of RUFY3, E-cadherin and N-cadherin were analyzed by Western blot.
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Rufy3 Promotes Emt In Hcc Cells
As shown in , , compared with normal human liver cell line , the mRNA and protein levels of RUFY3 in HCC cells were significantly increased. Among them, the expression levels of RUFY3 mRNA and protein in HCCLM3 cell were the highest. On the contrary, SMMC7721 cell showed the opposite outcome.
Expression levels of RUFY3 in HCC cell and the effect of RUFY3 expression on NF-B signaling-related markers. qRT-PCR detection of RUFY3 expression in five HCC cell lines and one normal liver cell line. Western blot analysis of RUFY3 expression in five HCC cell lines and one normal liver cell line. Western blot analysis of the effect of RUFY3 down-regulation or up-regulation on NF-B signaling-related markers. *P< 0.05.
Second, regarding to the effect of RUFY3 alteration on EMT in HCC cells, we demonstrated that RUFY3 knockdown in HCCLM3 cell decreased the expression levels of p-NF-B p65 and N-cadherin, and increased the expression level of E-cadherin. Conversely, RUFY3 overexpression in SMMC7721 cell led to the opposite outcome .
What Are Symptoms Of Hepatocellular Carcinoma
There are many conditions with the same symptoms as hepatocellular carcinoma. Having one or more of these symptoms doesnt mean you have hepatocellular carcinoma. But talk to your healthcare provider if you have these symptoms. Theyll identify and treat the condition that caused your symptoms. Potential hepatocellular symptoms include:
- Youre losing weight without trying.
- You feel very full after a small meal, or you dont have much appetite.
- Youre nauseous and vomiting.
- You notice a fullness or knot under your ribs on your right side. This might indicate your liver is enlarged.
- You notice fullness under your ribs on your left side. This might be a sign your spleen is enlarged.
- You have stomach pain or pain near your right shoulder blade.
- Your stomach feels swollen, as if its filling up with fluid.
- Your skin itches.
- Your eyes and skin are turning sallow or yellow. This might be a sign you have jaundice.
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Can I Have An Infection That Increases My Risk And Not Realize It
Having hepatitis C is a risk factor for hepatocellular carcinoma. You could have hepatitis C without having symptoms or knowing youve been infected. Some activities and medical conditions increase your risk of hepatitis C infection. Talk to your healthcare provider if:
- Youve had unprotected sex within the past six months, shared needles for drug use within the past six months or youve ever injected drugs.
- You have HIV.
- You were or are on long-term hemodialysis.
- You were born from 1945 through 1965. Most people in the United State who have hepatitis C were born in these years.
- You had a blood clotting problem before 1987 that was treated with medication.
- You received a blood transfusion or organ transplant before July 1992. This is when healthcare providers started screening blood and organ donations for hepatitis C.
Rufy3 Promotes The Growth Migration And Invasion Of Hcc Cell In Vitro
As shown in , the proliferation of HCCLM3 cell transfected with shRUFY3 was observably lower than shNC cell. Conversely, RUFY3 overexpression in SMMC7721 cell resulted in the opposite outcomes . Likewise, we further found that RUFY3 promoted the growth of HCC cell by EdU incorporation .
Effect of RUFY3 down-regulation or up-regulation on HCC cell growth in vitro. Effect of RUFY3 down-regulation or up-regulation on HCC cell growth by CCK-8 assay. Effect of RUFY3 down-regulation or up-regulation on HCC cell growth by EdU assay. *P< 0.05.
Second, RUFY3 knockdown significantly reduced the wound healing ability of HCCLM3 cell , whereas RUFY3 overexpression increased the wound healing ability of SMMC7721 cell. Additionally, transwell migration and invasion assay showed that the number of migration and invasion of HCCLM3 cell transfected with shRUFY3 was significantly lower than that of shNC cell. While the opposite outcomes were obtained from SMMC7721 cell, with significantly more cells passing through the Transwell membrane in the RUFY3 overexpression group than in the vector group.
Effect of RUFY3 down-regulation or up-regulation on HCC cell migration and invasion in vitro. Effect of RUFY3 down-regulation or up-regulation on HCC cell migration by wound-healing assay. Effect of RUFY3 down-regulation or up-regulation on HCC cell migration and invasion by Transwell migration and invasion assays. *P< 0.05.
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How Do I Take Care Of Myself
Its very hard to hear you have a life-threatening illness like hepatocellular carcinoma. It is completely normal to feel overwhelmed, anxious and even afraid. Give yourself and your loved ones some time to work through your initial emotions. Share your feelings with your healthcare provider. Theyll have suggestions to help you cope with your cancer diagnosis. Heres some steps you can take:
- Keep track of your questions and concerns about your condition and your treatment. Asking questions helps you understand what to expect and what you can do to help yourself.
- Cancer is stressful. You might find activities such as meditation, relaxation exercises or deep breathing help to ease your stress.
- Your treatments might affect your appetite. Try to eat a healthy diet, and talk to a nutritionist if youre having trouble eating.
- Get plenty of rest.
- Cancer can be lonely. Sometimes its hard talking to loved ones about your condition. Your healthcare provider can direct you to support groups and programs where you can share your thoughts and feelings with people who understand what youre going through.
Staging Of Hepatocellular Carcinoma
Department of General Surgery, Section of HPB Surgery and Organ Transplantation, Ankara Guven Hospital, Ankara 06540, Turkey.
Received: First Decision: Revised: Accepted: Science Editor: Copy Editor: Production Editor:
© The Author 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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