Hepatocellular carcinoma (HCC)
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Overview
Hepatocellular carcinoma (HCC) is the most common type of liver cancer. It originates in the hepatocytes, the main cells of the liver. This condition is often associated with chronic liver disease, including cirrhosis and hepatitis B or C infections. Understanding the risk factors, symptoms, diagnosis, and treatment options is crucial for both prevention and management.
Risk Factors
Several factors increase the likelihood of developing hepatocellular carcinoma. These include:
- Cirrhosis (scar tissue in the liver), especially caused by hepatitis B or C infections, is the leading risk factor for HCC. In fact, about 80-90% of people diagnosed with HCC have cirrhosis.
- Alcohol abuse can cause liver damage, leading to cirrhosis and ultimately HCC
Chronic viral infections, especially hepatitis B and C, are major contributors to liver cancer risk. Both viruses cause ongoing liver inflammation that can lead to liver damage over time.
With the rise in obesity and metabolic syndrome, NAFLD has become a significant risk factor. Inflammation caused by fatty liver can progress to cirrhosis and liver cancer.
Individuals with a family history of liver cancer are at higher risk, suggesting a genetic predisposition to HCC.
Aflatoxins, which are toxins produced by certain fungi, can contaminate food products and are linked to liver cancer. These are particularly common in developing countries.
- Age (more common in people over 50 years old)
- Gender (more common in men)
- Smoking
- Diabetes and obesity
Reducing Your Risk
While certain risk factors for HCC, such as genetics and age, cannot be changed, there are lifestyle adjustments that can help reduce the risk:
- Vaccination against Hepatitis B:
Getting vaccinated against hepatitis B can prevent the infection and the associated liver damage.
- Manage Chronic Hepatitis B or C Infection:
For those with chronic hepatitis B, antiviral treatments can suppress the virus and reduce the risk of liver damage. New treatments for hepatitis C can cure the infection and significantly lower the risk of developing liver cancer.
- Limit Alcohol Consumption:
Excessive alcohol intake is a major cause of cirrhosis. Reducing or eliminating alcohol consumption can lower the risk of HCC.
- Weight Management and Physical Activity:
Maintaining a healthy weight, managing diabetes, and staying physically active can help prevent non-alcoholic fatty liver disease (NAFLD) and reduce the risk of liver cancer.
- Screening for High-Risk Individuals:
Regular screening for people with cirrhosis or chronic hepatitis infections can detect liver cancer at an early, more treatable stage. Screening typically includes ultrasound and blood tests for alpha-fetoprotein (AFP).
Symptoms of Hepatocellular Carcinoma
In the early stages, hepatocellular carcinoma may not cause any symptoms, but as the cancer progresses, the following signs and symptoms may appear:
- Abdominal Pain:
Persistent pain or discomfort in the upper right side of the abdomen, which may be related to liver enlargement.
- Jaundice:
Yellowing of the skin and eyes due to liver dysfunction.
- Unexplained Weight Loss:
Sudden and unintentional weight loss can occur as a result of the cancer’s progression.
- Loss of Appetite and Nausea:
A decreased appetite, feeling full quickly, or nausea can occur as the liver becomes overwhelmed by the cancer.
- Fatigue:
A general feeling of weakness and tiredness is common as the body struggles to cope with the cancer.
- Swelling or Bloating:
Fluid buildup in the abdomen (ascites) may occur, causing bloating or swelling.
- Enlarged Liver or Spleen:
The liver or spleen may become visibly enlarged, causing discomfort or a sense of fullness in the abdomen.
Diagnosis of Hepatocellular Carcinoma
Early diagnosis of HCC is key to improving outcomes. Several diagnostic tools are used to confirm the presence of liver cancer:
- Imaging Tests:
- Ultrasound: A first-line screening tool for those at risk (such as individuals with cirrhosis).
- CT Scan (Computed Tomography) or MRI (Magnetic Resonance Imaging): These provide detailed images of the liver and are used to identify tumors and assess their size and location.
2. Blood Tests:
- Alpha-fetoprotein (AFP): This protein is often elevated in individuals with HCC, though it is not specific to liver cancer. It can be used to monitor for recurrence in patients who have been treated for HCC.
- Liver Function Tests: These assess how well the liver is functioning and help determine the extent of liver damage.
3. Biopsy:
- A biopsy may be performed in certain cases to obtain a tissue sample for examination under a microscope to confirm the diagnosis of cancer.
Treatment of Hepatocellular Carcinoma
Treatment options depend on the stage of the cancer, the liver’s overall health, and whether cirrhosis is present. The main treatment modalities are:
- Surgical Options:
- Liver Resection: Surgical removal of the tumor may be an option if the cancer is localized and the liver is otherwise healthy.
- Liver Transplantation: For patients with tumors that cannot be surgically removed but who have cirrhosis, a liver transplant may be considered. The tumor must meet specific criteria to be eligible for transplantation.
2. Ablation and Embolization:
- Ablation Techniques: These include radiofrequency ablation (RFA) or microwave ablation (MWA), where heat is used to destroy the tumor tissue. This is suitable for small tumors.
- Transarterial Embolization (TACE): This procedure involves blocking the blood vessels that supply the tumor, starving it of nutrients and causing it to shrink.
3. Targeted Therapy:
- Targeted drugs like sorafenib and lenvatinib can help slow the growth of HCC by blocking the growth of blood vessels that supply the tumor.
4. Immunotherapy:
- Drugs like nivolumab and pembrolizumab, which work by stimulating the body’s immune system to attack the cancer cells, are increasingly used for advanced HCC.
5. Chemotherapy:
- Chemotherapy is generally not as effective in HCC, but it may be used in some cases to control the cancer’s growth.
6. Palliative Care:
- For advanced stages where curative treatment isn’t an option, palliative care focuses on improving the quality of life, managing pain, and alleviating symptoms.
Living with Primary Sclerosing Cholangitis
Living with PSC requires regular monitoring and proactive care to manage the disease and prevent complications:
- Follow-Up Appointments: Regular visits to a healthcare provider for liver function tests and imaging studies.
- Symptom Management: Medications to control itching, manage fatigue, and alleviate pain.
- Diet and Lifestyle: A healthy diet and lifestyle changes can support liver health and overall well-being.
- Mental and Emotional Support: Chronic illness can take a toll on mental health. Support groups or counseling can help in coping with the emotional aspects of PSC.