What Is Hepatocellular Carcinoma
Hepatocellular carcinoma is a cancer that starts in your liver. It’s different from “secondary” liver cancers, which have spread to the liver from other organs.
If caught early, it can sometimes be cured with surgery or transplant. In more advanced cases it canât be cured, but treatment and support can help you live longer and better.
It’s important to remember that you still have control over the decisions you make about your treatment and your life. Make sure you have people you can talk to about your plans, your fears, and your feelings. Ask your doctor about support groups, where you can meet people who know what you’re going through.
Your doctor can help you understand your treatment options. Surgery, radiation, chemotherapy, immunotherapy, and target therapy may be some of your choices.
Can Children Get Liver Cancer
Yes, in children the most common liver cancer is called hepatoblastoma. Hepatoblastomas are usually diagnosed within the first three years of life and are rarely found beyond the age of five. Hepatoblastomas are also reported to occur more frequently in males than in females. This cancer is caused by the rapid growth of immature or abnormal cells that no longer have the specialized function of normal liver cells
Loss Of Senescence Control
Senescence is a type of irreversible growth inhibition of cells in cell culture showing distinct morphological alterations . In hepatocytes, mechanism of senescence is not clearly understood. Replicative senescence controls partial proliferative ability of liver cells by a gradual decrease in the telomeric segment . Telomere-independent mechanisms have also been suggested for hepatocyte senescence monitored in severe chronic liver diseases and these include free radical and oncogene-dependent senescence The resulting DNA damage activates ATM/Chk/p53 pathway and arrests cells at G1 phase. Alternatively, the p16/pRb pathway also performs the same function. Anomalies in DNA damage checkpoint and cell cycle regulatory pathway paved a way for the unlimited proliferation of genetically altered hepatic cells at the senescent phase and subsequently to malignant transformation. .
The proposed model of hepatocellular carcinoma development.
In human HCC, the p53 pathway has an effect on many levels i.e., about 50% aflatoxin-mediated HCC cases exhibit p53 mutations while 2030% cases of non-aflatoxin mediated HCC show p53 mutations microdeletions of p14ARF rarely occurs in HCC with p53 mutation while it is reported in 15-20% of human HCC human HCC also shows elevated Mdm2 expression over expression of gankyrin, an oncoprotein, is commonly observed in human HCC, which imposes restriction on the pRb and p53 .
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What Is A 5
A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of liver cancer is 30%, it means that people who have that cancer are, on average, about 30% as likely as people who dont have that cancer to live for at least 5 years after being diagnosed.
Mass Spectrometry Imaging In Distinguishing Hepatocellular Carcinoma From Liver Cirrhosis
Hepatocellular carcinoma , the primary type of liver cancer is the fourth most cancer-causing death . HCC is the second leading death-causing cancer in East Asian countries. Morita has performed the analysis of 37 HCC samples by MSI for the identification of alterations in phospholipids composition caused due to lysophosphatidylcholine acyltransferase1 overexpression. Mass spectra obtained from hepatic cellular carcinoma liver cells showed different mass profiles from that of normal liver parenchyma. MS profile showed lipids, in particular, phospholipids of m/z 770.4 was abundant, and lysophosphatidylcholine level was reduced in cancerous tissue. MS profiles showed the elevated levels of the ratio of PC /LPC and PC /LPC in hepatitis C-virus related cancerous tissues in comparison to normal tissues. It was found that the elevated signal of PC is due to an increase in expression of the LPCAT1 protein in HCC tissues .
Table 8.4. Compilation of MSI techniques used for detection of analytes detected in different types of cancer.
|Positive and negative ion mode||Resected nonsmall cell lung cancers||m/z 693.65 m/z 741.64 m/z 750.63 m/z 760.65 m/z 778.56 m/z 782.66 m/z 798.62 m/z 822.63 m/z 824.63||20 pairs||Lee et al.|
Rishitha Gundala, … Kuldeep K. Roy, in, 2020
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Treatment Option Overview For Adult Primary Liver Cancer
There is no agreement on a single treatment strategy for patients with hepatocellular carcinoma . Selection of treatment is complex due to several factors, including:
- Underlying liver function.
- Extent and location of the tumor.
- General condition of the patient.
Several treatments for HCC are associated with long-term survival, including surgical resection, liver transplantation, and ablation. There are no large, robust, randomized studies that compare treatments considered effective for early-stage disease, nor are there studies comparing these treatments with best supportive care. Often, patients with HCC are evaluated by a multidisciplinary team including hepatologists, radiologists, interventional radiologists, radiation oncologists, transplant surgeons, surgical oncologists, pathologists, and medical oncologists.
Best survivals are achieved when the HCC can be removed either by surgical resection or liver transplantation. Surgical resection is usually performed in patients with localized HCC and enough functional hepatic reserve.
For patients with decompensated cirrhosis and a solitary lesion or early multifocal disease , the best option is liver transplantation, but the limited availability of liver donors restricts the use of this approach.
Among noncurative treatments for HCC, transarterial chemoembolization and multikinase inhibitors have been shown to improve survival.
Table 5 shows the standard treatment options for HCC.
Symptoms Of Stage 4 Liver Cancer
Considering the nature of the disease it is very important to understand the symptoms of the stage 4 liver cancer, these are not only helpful to determine the course of treatment but also helps to stabilize the patient. It is to be noted that the symptoms of the Liver Cancer generally becomes clear in the Stage 4. These are the following symptoms.
- Weight loss is the most common symptoms of the Stage 4 Liver Cancer. However, the diet of the patient does not change.
- Appetite seems decreasing all the time for patients. It has been observed patient suffering from Stage 4 Liver Cancer get the feeling of no hunger just after small meal.
- Persistent Nausea and Vomiting keep the patient troubling all the time.
- Presence of jaundice is quite obvious in this stage. However, the intensity of the jaundice may vary for individuals.
- The body becomes extremely weak, and fatigue is very common among the sufferers.
- Fever is very common symptom for the Stage 4 Liver Cancer.
- Unbearable pain in the lower abdomen and close to right shoulder blade is very common at this stage.
- Enlarged Liver becomes the common symptom in the Stage 4. It feels like that a mass is stuck in the right side of the ribs.
- Enlarged Spleen also very common and it gives the sensation of mass stuck in the left side of the ribs.
- Swellings in various places like abdomen are very common. These are also called Ascites.
Picture 3 morphology of cancer in liver
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How Can Hepatocellular Carcinoma Be Diagnosed
The first step to detect a hepatocellular carcinoma is to perform an abdominal ultrasound. This technique may also serve as a screening tool.
In case of finding a mass in the liver bigger than 1 cm, an imaging scan should be performed.
To confirm the diagnosis, a biopsy of the mass must be analyzed under a microscope to determine the presence of malignant cells.
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 .
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Localized Adult Primary Liver Cancer Treatment
Localized hepatocellular carcinomas that present as a solitary mass in a portion of the liver or as a limited number of tumors without major vascular invasion constitute approximately 30% of the HCC cases.
There are three potentially curative therapies that are acceptable treatment options for small, single-lesion HCC in patients with well-preserved liver function.
What Are The Different Types Of Primary Liver Cancer
The different types of primary liver cancer originate from the various cells that make up the liver. Primary liver cancer can start as a single lump growing in the liver, or it can start in many places within the liver at the same time.
People with severe liver damage are more likely to have multiple cancer growth sites. The main types of primary liver cancer are:
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Uncertainty Of Liver Findings Is Common
It is important to note that abnormal findings are quite common when scans are done of the liver, and sometimes it can be hard to determine if a spot or spots on the liver are due to the spread of cancer or another cause. If your healthcare provider is uncertain whether or not an abnormality in your liver is related to your cancer, and the treatment approach would vary depending upon the results, he or she may recommend a liver biopsy in order to look at the tissue to be certain of your diagnosis.
It can be frustrating if your healthcare provider is uncertain about findings in your liver, and this can make you feel anxious and unsure of your care. It may be helpful to know that this is common and that there is a lot of overlap between “normal” abnormalities in the liver and liver metastases.
Metabolic Syndrome And Hcc
Diabetes mellitus, a component of the metabolic syndrome has been shown to attribute about 7% of the HCC cases worldwide . Meta-analyses have shown that diabetes is associated with HCC independent of viral hepatitis in which diabetic patients show 2-3 fold greater risks in developing HCC compared with non-diabetic controls . The pathophysiological conditions such as hyperglycemia, hyperinsulinemia, insulin resistance, and activation of insulin-like growth factor signaling pathways provide a strong association for diabetes to be the risk factor in the pathogenesis of HCC . Obesity, a pathological state characterized by insulin resistance, hyperinsulinemia, and inflammation is also closely associated with HCC . It is demonstrated that increased reactive oxygen species, dysregulated adipokines, and adipose tissue remodeling, alteration of gut microbiota, and dysregulated microRNA increases the relative risk of HCC in obese patients . Accordingly, obesity is one of the common causes of NAFLD, which is also an underlying risk factor of HCC .
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What Are The Symptoms Of Liver Cancer
Thanks to the ultrasound screening of high-risk populations, liver cancer can be diagnosed in early stages when it has not yet produced any symptom.
However, when symptoms are present is because the tumor is already advanced. The most common symptoms are:
- Abdominal pain
- Mass in the right upper quadrant
- Yellowing of the skin
Another less frequent symptom is the accumulation bloody fluid in the abdomen .
In advanced liver cancer, curative treatments are not very promising.
Primary Tumors Of The Liver
Hepatoma occurs primarily in patients with cirrhosis. The distorted anatomy and scarring of this disease make detection of dysplastic nodules difficult. Both dual-phase CT and MRI have proven successful in identifying these tumors, with MRI being more sensitive for small lesions. On CT scan, severely dysplastic nodules or hepatomas are often hyperintense on the arterial phase images, with rapid washout on the portal venous phase images. On T2-weighted MRI images, hepatoma may have a variety of appearances ranging from low-signal to high-signal images.64 Contrast-enhanced images demonstrate high-signal nodules on T1-weighted images, with rapid washin and formation of a ring-enhancing lesion.65 A common association is invasion of the portal vein.
Nagendra Sai Kumar Achanta, … Rakesh K. Tekade, in, 2020
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What Are The Treatment Options
The choice of therapy for liver cancer depends on the stage of your cancer, how well your liver is working, and your overall health. Your healthcare team members will work together to choose the treatment that is right for you.
- You may hear the term first-line treatment. It means the first treatment given for a disease. It is often part of a standard set of treatments, such as surgery followed by chemotherapy and radiation
- When that first-line treatment doesnt work or stops working, your doctor may start you on a second-line treatment
In addition to your doctor, your team may include some of the following healthcare professionals who treat people with liver cancer: hepatobiliary surgeons, surgical oncologists, gastroenterologists, radiation oncologists, nurses, and registered dietitians.
The team will consider the treatments that are available, including:
Surgery: removing the whole liver and replacing it with a healthy liver or removing the part with cancer.
Surgery is an option only with early stage cancer that has not spread to lymph nodes or other organs.
- Resectable means able to be removed by surgery
- Inoperable describes a condition that cannot be treated by surgery
Ablation: a procedure designed to destroy the cancer in your liver using heat, lasers, or microwaves.
Embolization: a procedure that blocks the flow of blood into the blood vessel that feeds the tumor to stop the cancer from growing.
Coping With Liver Cancer
A liver cancer diagnosis can be overwhelming. Its important to have a strong support network that can help you deal with any stress or anxiety you may be feeling.
You may want to see a counselor who can help you work through your emotions. You might also want to consider joining a cancer support group where you can discuss your concerns with others who can relate to what youre going through.
Ask your doctor about support groups in your area. You can also find information on support groups on the
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Prognosis Of Hepatocellular Carcinoma
Most people with hepatocellular carcinoma do not live for more than a few years because the cancer is detected at a late stage. Screening and early detection result in a better prognosis. If the cancer is small and has not spread and liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See… read more can be done, the person can often live a number of years.
What Are Liver Cancer Symptoms And Signs
The medical treatment chosen depends upon how much the cancer has spread and the general health of the liver. For example, the extent of cirrhosis of the liver can determine the treatment options for the cancer. Similarly, the spread and extent of spread of cancer beyond the liver tissue plays an important part in the types of liver cancer treatment options that may be most effective.
Surgery: Liver cancer can be treated sometimes with surgery to remove the part of liver with cancer. Surgical options are reserved for the smaller sizes of cancer tumors. Complications from surgery may include bleeding , infection, pneumonia, or side effects of anesthesia.
Liver transplant: The doctor replaces the cancerous liver with a healthy liver from another person. It is usually used in very small unresectable liver tumors in patients with advanced cirrhosis. Liver transplantation surgery may have the same complications as noted above for surgery. Also, complications from medications related to a liver transplant may include possible rejection of the liver transplant, infection due to suppression of the immune system, high blood pressure, high cholesterol, diabetes, weakening of the kidneys and bones, and an increase in body hair.
Targeted agent: Sorafenib is an oral medication that can prolong survival in patients with advanced liver cancer. Side effects of sorafenib include fatigue, rash, high blood pressure, sores on the hands and feet, and loss of appetite.
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What Are The Warning Signs Of Liver Cancer
Symptoms are hardly seen in the initial stages. As the tumor size increases, it may cause pain in the right side of the abdomen. Some patients may have worsening symptoms of chronic liver disease or cirrhosis, which often precedes the development of cancer of the liver.
Some of the early warning signs of liver cancer include:
- Pain in the abdomen or near the right shoulder blade
- Fluid build-up in the abdomen
Other common symptoms include:
- Fever unrelated to other conditions
- Enlarged veins in the abdomen
- Abnormal bruising or bleeding
- White, chalky stools
Tumors in the liver produce hormones that act on other organs, causing:
- Hypercalcemia , which presents with nausea, confusion, constipation, weakness, or muscle problems
- Shrinkage of testicles in man
- Erythrocytosis leading to redness and flushing
Inherited Diseases And Hcc
Certain metabolic disorders such as hereditary hemochromatosis, 1-antitrypsin deficiency, Wilsons disease, and hepatic porphyria are associated with high risk for the development of HCC. These hereditary diseases are known to promote hepatocarcinogenesis as a result of increased inflammation and hepatocellular damage .
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