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Living with Hepatocellular Carcinoma

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Living with Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It is the 5th most common, and the 2nd most lethal malignancy worldwide with rising incidence in Western World. HCC is multi-resistant to conventional irradiation or chemotherapy. Less than 40 percent of HCC patients are eligible for curative treatment. Hepatocellular carcinoma occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection. The main risk factor for developing HCC is liver cirrhosis, for example, secondary to hepatitis B & C, alcohol, haemochromatosis, and primary biliary cholangitis.

Mainly there are two forms of liver cancers, viz.,

Primary liver cancer

  1. Hepatocellular carcinoma, a minority of them can be called as,.
  2. Cholangiocarcinoma.

Causes

  1. Hepatitis C virus.
  2. Hepatitis B virus.
  3. Long-term heavy alcohol use.

Secondary liver cancer – liver metastases, they metastasize from another original site,

  1. Colorectal cancer.
  2. Neuroendocrine tumors.
  3. Breast cancer.
  4. Menaloma.

Usually the features tends to present late. This is the highest popular liver cancer across humanity. This is responsible for death with Cirrhosis condition. This is mostly seen in male rather than female populace. This is really a very anxious condition which can be treated upon diagnosed in the right time with aid of surgery or transplant. Well, you can also diagnose such patients with the help of its symptoms.

Hepatocellular carcinoma symptoms usually show up in the form of,

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  1. Intense fever.
  2. Constant body pain.
  3. Loss of appetite.
  4. Unusually dark yellow urine.
  5. Unexplained gradual weight loss.

The most common cause to cause this type of disease is drinking. Drinking more than two drinks (every day) can cause this life-threatening disease. Hepatitis B & C are both responsible for hepatocellular carcinoma. It can either spread through physical relationship, or through a needle, (usually drugs). Diabetes mellitus and carcinogen of decaying plants can also cause this disease. Apart from these, there exist a few rare causes of hepatocellular carcinoma.

Treatment of such liver diseases will certainly be the liver transplant, but it is usually a very expensive affair where everybody may not be in a position to have it. Hence it is not recommended first as a treatment. Hepatocellular Carcinoma treatment includes Cryoablation, alcohol injection, surgery and liver transplant.

Hepatocellular carcinoma develops in association with specific risk factors, the most commonest of which is chronic liver disease or cirrhosis. Therefore the whole liver is at risk of recurrence or new tumor development although only one part or area may be affected to begin with. The only recognized curative options are liver resection or liver transplantation.

The only non-surgical comparable option with potential for cure is radio frequency ablation (rFA) but for only small tumors less than 2-3 cm.

Early HCC is typically clinically silent, and the disease is often well advanced at the first manifestation. Overall, survival for patients with un-resectable disease is based on tumor stage and size, liver function, and symptoms. It can be difficult for the human immune system to fight HCC. Hepatocellular carcinoma (HCC) is usually an aggressive tumor that arises in the setting of underlying chronic liver disease in most of the cases. Initially the preferred therapy is a surgical resection. Majority of patients are not eligible for this because of tumor extent or underlying liver dysfunction. Liver transplantation is the only other potentially curative option for such patients.

For other people who are not eligible for resection or liver transplantation, treatment options include local nonsurgical methods of tumor ablation, percutaneous ethanol injection, transarterial chemoembolization, radiation therapy, and systemic therapy. The selection of any of the above options of treatment is determined by the severity of underlying liver disease, the size and distribution of the intrahepatic tumors, the vascular supply, and the patient’s overall performance status. Features of liver cirrhosis or failure may be seen as jaundice, ascites, right upper quadrant pain, hepatomegaly, pruritus, splenomegaly. Screening with ultrasound should be considered for high risk groups such as:

MANAGEMENT

Hepatocellular carcinoma is challenging to treat. There are multiple different treatment options. These are relatively complex. The only proven potentially curative therapy for HCC remains surgical, either hepatic resection or liver transplantation. Hepatic resection should be considered as a primary therapy in any patient with HCC and non-cirrhotic liver. Liver transplantation should be in any patient with cirrhosis and a single small HCC ,<5 cm, or multiple up to 3 lesions <3 cm. Non-surgical therapy is only used when surgical therapy is not possible. Percutaneous ethanol injection has been shown to produce necrosis of small HCC and is best used in peripheral lesions. Transarterial chemoembolization (TACE) can produce tumor necrosis and has been shown to affect survival in highly selected patients with good liver reserve. Interferon has been used as the treatment of HCC rather than the underlying viral infection, but remains controversial.

How we decide treatment is largely based on the size of the tumor, tumor number, where the tumors are located. If the cancer spread outside the liver. The other medical conditions that someone may have, such as heart disease, lung disease, a stroke etc. But most importantly, this involves an in-depth conversation between the patient who has the cancer, to determine the best goals, and how aggressive, and how non-aggressive does the patient want to be.

There are also other various options for treatment, such as, thermal ablation, and transarterial Y90 radioembolization. In thermal ablation, the way this procedure is performed is under anesthesia. So, the patient is asleep during the procedure. A thin needle, it is about the size of a pen tip is inserted right through the skin into the tumor and we use an ultrasound or we use an x-ray to look where we are going, so it is completely minimally invasive in this case. From the tip of the needle there is heat that is emitted and the tumor essentially cooks to well above 150 to 200 degree for about 10 to 15 minutes. After the cooking is done the needle is removed, a band-aid is applied. Patient is woken up from anesthesia procedure and sent home.

So, overall, the procedure is relatively quick, and painless.

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