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Liver cancer
Liver cancer, also known as hepatocellular carcinoma (HCC), is a type of cancer that originates in the liver cells. It is the most common form of primary liver cancer, meaning it originates in the liver rather than spreading from another part of the body.
Causes and Risk Factors:
The development of liver cancer is influenced by several causes and risk factors.
Chronic viral infections: Hepatitis B virus (HBV) or hepatitis C virus (HCV) infection is a substantial risk factor for liver cancer. These viruses can induce long-term liver inflammation, which can result in the creation of malignant cells.
Cirrhosis is a disorder that causes scarring of the liver tissue. persistent alcohol misuse, persistent viral hepatitis, non-alcoholic fatty liver disease (NAFLD), autoimmune hepatitis, and some hereditary liver illnesses can all cause it. Cirrhosis increases the risk of developing liver cancer considerably.
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Excessive and persistent alcohol intake can result in liver cirrhosis, which raises the risk of liver cancer.
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NAFLD vs NASH: NAFLD is the buildup of extra fat in the liver, whereas NASH is a more severe variant of NAFLD characterized by liver inflammation and damage. Obesity, diabetes, metabolic syndrome, and high cholesterol levels are all connected with both disorders. They can lead to liver cirrhosis and raise the chance of developing liver cancer.
Aflatoxins are harmful chemicals generated by certain molds, specifically Aspergillus flavus and Aspergillus parasiticus. These molds have the potential to contaminate crops like peanuts, corn, soybeans, and cereals. Aflatoxin-contaminated foods can raise the risk of liver cancer if consumed for an extended period of time.
Obesity is a risk factor for a variety of cancers, including liver cancer. It is linked to the development of non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome, both of which can contribute to the development of liver cancer.
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Diabetes: People with diabetes, particularly type 2 diabetes, are more likely to develop liver cancer. The precise mechanisms causing this relationship are unknown, although it is thought to be related to underlying metabolic abnormalities and the link between diabetes and fatty liver disease.
Tobacco usage has been related to an increased risk of developing liver cancer. Tobacco carcinogens can reach the bloodstream and harm the liver, contributing to the development of cancer.
Hereditary liver illnesses, such as hereditary hemochromatosis, Wilson disease, and alpha-1 antitrypsin deficiency, can all increase the risk of developing liver cancer.
Signs and Symptoms:
The signs and symptoms of liver cancer may vary depending on the stage of the disease and other factors. In the early stages, liver cancer may not cause noticeable symptoms.
Abdominal pain or tenderness: The tumor may press against nerves or stretch the liver capsule, causing persistent pain or discomfort in the upper right side of the abdomen.
Unintentional weight loss: Significant and unexplained weight loss may occur as a result of a variety of reasons, including loss of appetite, the influence of cancer on metabolism, and the body's fight against the disease.
Loss of appetite: After consuming a modest amount of food, you may experience a decreased urge to eat or a feeling of fullness.
Nausea and vomiting: You may have persistent nausea, feeling unwell, or vomiting.
exhaustion and weakness: Even with minor physical exertion, persistent exhaustion, weakness, and an overall reduction in energy levels can occur.
Yellowing of the skin and eyes (jaundice): Bilirubin, a yellow pigment produced during the breakdown of red blood cells, can cause yellowing of the skin and eye whites. Jaundice can cause dark urine and pale feces.
Swelling of the abdomen or legs: Ascites, or fluid collection in the belly, can produce abdominal swelling, discomfort, and a feeling of fullness. Fluid retention can also cause swelling in the legs and ankles (edema).
Excessive itching, also known as pruritus, can be caused by a buildup of bile products in the bloodstream as a result of liver disease.
Easy bruising and bleeding: Liver cancer can interfere with the synthesis of clotting factors, increasing the risk of bruising and bleeding from mild injuries.
Changes in bowel habits: Bowel habits might shift, causing diarrhea or constipation.
Enlarged liver or palpable mass: The liver may swell in some situations, and a mass or lump may be felt in the upper abdomen.
Diagnosis:
The diagnosis of liver cancer typically involves a combination of medical history assessment, physical examination, imaging tests, and sometimes, a biopsy.
Medical history and physical exam: The doctor will inquire about your medical history, as well as any risk factors for liver cancer and your symptoms. They will also perform a physical exam to assess your overall health and look for signs of liver abnormalities such as an enlarged liver or abdominal edema.
Blood tests can provide valuable information about liver function as well as identify signs that may indicate the presence of liver cancer. These tests may include liver function tests, AFP levels (a tumor marker associated with liver cancer), and viral hepatitis testing (for HBV and HCV infections).
Imaging examinations:
Ultrasound: This non-invasive imaging technology creates a picture of the liver using sound waves. Ultrasound can assist in detecting the presence of liver tumors, determining their size and location, and determining if there are any irregularities in blood flow to the liver.
Computed Tomography (CT) scan: A CT scan creates detailed cross-sectional images of the liver using X-rays and computer technologies. It can detect any metastasis to surrounding lymph nodes or other organs and provide information on the size, quantity, and location of liver tumors.
Magnetic Resonance Imaging (MRI): MRI produces detailed images of the liver by using a strong magnet and radio waves. It can provide similar information to a CT scan but may be especially valuable for examining the blood arteries and bile ducts within the liver.
Positron Emission Tomography (PET) scan: A PET scan may be performed in some circumstances to identify if the cancer has progressed beyond the liver. A little amount of radioactive material is injected into the body, which is subsequently detected by a scanner to make images.
Biopsy: A biopsy may be required in some situations to confirm the diagnosis of liver cancer. A biopsy is a small sample of liver tissue that is examined under a microscope. This can be accomplished by a variety of methods, including percutaneous needle biopsy (guided by ultrasound or CT scan), laparoscopic biopsy, or surgery. The biopsy sample aids in determining the kind and stage of liver cancer and gives important information for therapy planning.
Treatment:
The treatment of liver cancer is determined by various factors, including the cancer's stage, the level of liver damage, the patient's overall health, and the available therapeutic options.
Surgery:
Tumour resection: When a tumour is tiny and localised to a specific location of the liver, surgical removal (resection) of the tumour may be achievable. This can be done as a partial hepatectomy, which involves removing a section of the liver containing the tumour.
Liver transplantation: Liver transplantation may be a possibility for some patients with early-stage liver cancer and underlying liver disease. This entails removing the entire diseased liver and replacing it with a healthy donor liver.
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Ablation treatment:
Radiofrequency ablation (RFA): This method involves inserting a needle-like electrode into the tumour and using high-frequency electrical currents to heat and destroy cancer cells.
MWA (microwave ablation): MWA, like RFA, employs microwaves to generate heat and eliminate cancer cells.
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TACE (transarterial chemoembolization):
TACE involves directly injecting chemotherapy medications into the blood arteries that supply the liver tumour. Embolic chemicals are also injected into the tumour to stop blood flow, effectively starving it of oxygen and nutrition.
Radiation treatment:
External beam radiation therapy involves directing high-energy radiation beams at the tumour in order to eliminate cancer cells. When surgery or other therapies are not an option, this method is frequently performed.
SBRT: This treatment delivers very precise and targeted radiation doses to the tumour while minimising damage to surrounding healthy tissue.
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Therapy with a specific goal:
Specific chemicals or processes involved in the growth and advancement of cancer cells are targeted by targeted treatment medicines. These drugs could be used to treat advanced-stage liver cancer that cannot be surgically removed. Sorafenib, lenvatinib, and regorafenib are examples of targeted treatment medications.
Immunotherapy:
Immunotherapy is the administration of drugs that boost the body's immune system to recognise and fight cancer cells. Checkpoint inhibitors, such as pembrolizumab and nivolumab, have been proven to be effective in treating a subset of individuals with liver cancer.
Chemotherapy: Systemic chemotherapy may be recommended for advanced-stage liver cancer in order to reduce tumours and delay disease progression. It is usually given intravenously or orally.
Palliative and supportive care: Supportive care focuses on symptom management and treatment side effects, as well as increasing quality of life and giving psychological support. When a cure is not possible, palliative care tries to ease symptoms and improve comfort in advanced-stage liver cancer patients. It focuses on pain reduction, symptom management, and emotional support for patients and their families.
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Prognosis:
The prognosis for liver cancer can vary greatly depending on a number of factors, including the stage of the disease at the time of diagnosis, the level of liver damage, underlying liver function, the patient's overall health, and the efficiency of the selected treatment. It is crucial to highlight that liver cancer is frequently identified at advanced stages, which makes treatment more difficult and may alter the prognosis.
Overall, the prognosis for liver cancer is worse than for many other forms of cancer. However, advances in treatment choices and improvements in outcomes have occurred, particularly for people diagnosed in the early stages or those suitable for surgical intervention such as liver transplantation.
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Some general factors that can influence prognosis include:
The cancer stage is defined by characteristics such as tumour size, number of tumours, involvement of adjacent blood arteries, and the occurrence of distant metastases. In general, the earlier a diagnosis is made, the better the prognosis.
The overall function of the liver is an important element in determining prognosis. If the liver has considerable damage or poor function as a result of cirrhosis or other liver illnesses, treatment choices may be limited and the overall prognosis may suffer.
Tumour traits, such as size, location, and the presence of certain molecular markers, might provide further information about the prognosis and guide treatment decisions.
Treatment reaction: Treatment response can have a substantial impact on prognosis. Some individuals may respond effectively to treatment, with tumour shrinking or even complete remission, improving their prognosis. However, not all types of liver cancer react well to treatment, and some may develop resistance over time.
Underlying liver illness: If liver cancer develops in the context of chronic liver disease, such as cirrhosis, the severity of the underlying liver condition may influence the prognosis.
Disclaimer: This article is meant for informational purposes only and must not be considered a substitute for advice provided by qualified medical professionals.