Liver cancer
Liver cancer (hepatocellular carcinoma) is a cancer arising from the liver. It is also known as primary liver cancer or hepatoma. Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result of the cancer. The liver is made up of different cell types (for example, bile ducts, blood vessels, and fat-storing cells). However, liver cells make up 80% of the liver tissue. Thus, the cancers (over 90 to 95%) arises from liver cells is called primary liver cancers. When patients or physicians speak of liver cancer, however, they are often referring to cancer that has spread to the liver, having originated in other organs (such as the colon, stomach, pancreas, breast, and lung). More specifically, this type of liver cancer is called metastatic liver cancer or secondary liver cancer.
Liver cancer:
Primary liver cancer is cancer that forms in the tissues of the liver. Secondary carcinoma of the liver is cancer that spreads to the liver from another part of the body. Hepatocellular carcinoma, intrahepatic cholangiocarcinoma and mixed hepatocarcinoma are three kinds of primary liver cancer and most are hepatocellular carcinoma. Primary liver cancer is one of the most common malignent neoplasms in our country. The mortality rate takes the third position behind the stomach cancer and esophageal cancer in that of malignancy. According to the investigations by epidemiology, the mortality rate of liver cancer has a close relationship with geographic factors. In accordance with the statistic data by World Health Organization, the mortality of liver cancer ranks fifth in the worldwide range. It is worthy to notice that the rising trend of primary liver cancer incidence is significant in the entire world. There are 250 thousand patients died of this disease and most of them are 40 to 49 years old. The ratio of male to female is 3~5: 1.
|
 |
Etiology and pathogenesis:
1. Virus hepatitis. (hepatitis B infection and hepatitis C infection)
The role of hepatitis B virus (HBV) infection in causing liver cancer is well established. As noted earlier, the frequency of liver cancer relates to the frequency of chronic hepatitis B virus infection. In addition, the patients with hepatitis B virus who are at greatest risk for liver cancer are men with hepatitis B virus cirrhosis and a family history of liver cancer. In patients with both chronic hepatitis B virus and liver cancer, the genetic material of hepatitis B virus is frequently found to be part of the genetic material of the cancer cells. Therefore, those specific regions of the hepatitis B virus genome enter the genetic material of the liver cells. This hepatitis B virus genetic material may then disrupt the normal genetic material in the liver cells, thereby causing the liver cells to become cancerous. The vast majority of liver cancer that is associated with chronic hepatitis B virus occurs in individuals who have been infected most of their lives. In areas where hepatitis B virus is not always present in the community, liver cancer is relatively uncommon. The reason for this is that most of the people with chronic hepatitis B virus in these areas acquired the infection as adults.
Liver cancer can develop in individuals who acquired chronic hepatitis B virus in adulthood if there are other risk factors, such as co-infection with chronic hepatitis C virus infection.
Hepatitis C virus (HCV) infection is also associated with the development of liver cancer. The liver cancer occurred about eight to 10 years after the development of cirrhosis in the patients with hepatitis C. The way in which hepatitis C virus causes liver cancer is not well understood. Unlike hepatitis B virus, the genetic material of hepatitis C virus is not inserted directly into the genetic material of the liver cells.
2. Hepatocirrhosis
Individuals with most types of cirrhosis of the liver are at an increased risk of developing liver cancer. The incidence of primary hepatocellular carcinoma and cirrhosis is almost 50-90%, however, that in cirrhosis with liver cancer is about 30-50%. Liver cancer is strongly associated with hereditary tyrosinemia, a childhood biochemical abnormality that results in early cirrhosis. Liver cancer is rarely seen with the cirrhosis in the disease of abnormal copper metabolism or primary sclerosing cholangitis. It used to be thought that liver cancer is rarely found in primary biliary cirrhosis (PBC) as well. Recent studies, however, show that the frequency of liver cancer in PBC is comparable to that in other forms of cirrhosis.
3. Aflatoxin
Aflatoxin B1 is the most potent liver cancer-forming chemical. It is a product of a mold called Aspergillus flavus, which is found in food that has been stored in a hot and humid environment. This mold is found in such foods as peanuts, rice, soybeans, corn, and wheat. And according to the investigation by epidemiology, sometimes, those foods are all get a seriously contaminated in the areas with high incidence of liver cancer.
4. Drugs, medications, and chemicals
There are no medications that cause liver cancer, but female hormones (estrogens) and protein-building (anabolic) steroids are associated with the development of hepatic adenomas. These are benign liver tumors that may have the potential to become malignant or cancerous. Thus, in some patients, hepatic adenoma can evolve into cancer. Certain chemicals are associated with other types of cancers found in the liver. For example, vinyl chloride, a compound used in the plastics industry, can cause hepatic angiosarcomas that appear many years after the exposure.
5. Others
a) Genetic factor
Sometimes, there may be familial aggregation phenomenon in liver cancer. Most experts said that this phenomenon may be cause by maternal — fetal transmission of virus hepatitis.
b) Microelement
Soil, drinking water, foods and persons’ hair and blood from high incidence area are all with high copper and high zinc.So the relationships between copper and zinc with liver cancer should be gained more attention.
c) Malnutrition and lack of nutrition
Nutrition and tumour are significant topics of modern health. Persons should have less or have no foods with high fat and smoked food and eat more vegetables, fruits and coarse cereals.
Clinical features:
The initial symptoms of liver cancer are variable. In countries where liver cancer is very common, the cancer generally is discovered at a very advanced stage of disease for several reasons. For one thing, areas where there is a high frequency of liver cancer are generally developing countries where access to healthcare is limited. In addition, patients from these regions actually have more aggressive liver cancer disease. In other words, the tumor usually reaches an advanced stage and causes symptoms more rapidly. In contrast, patients in areas of low liver cancer frequency tend to have liver cancer tumors that progress more slowly and, therefore, remain without symptoms longer.
Abdominal pain is the most common symptom of liver cancer and it is often a sign for a very large tumor or widespread involvement of the liver. Additionally, unexplained weight loss or unexplained fevers are warning signs of liver cancer in patients with cirrhosis.
A very common initial presentation of liver cancer in a patient with compensated cirrhosis is the sudden onset of a complication. For example, the sudden appearance of ascites, jaundice, or muscle wasting without causative factors suggests the possibility of liver cancer. What's more, the cancer can invade and block the portal vein. This causes increased pressure in these veins, which results in esophageal varices. The patient then is at risk for hemorrhage from the rupture of the varices into the gastrointestinal tract. Rarely, a patient with liver cancer can become suddenly jaundiced when the tumor erodes into the bile duct. In advanced liver cancer, the tumor can spread locally to neighboring tissues or, through the blood vessels, to elsewhere in the body. Locally, liver cancer can invade the veins that drain the liver. The tumor can then block these veins, which results in congestion of the liver. In some patients, the tumor can invade the portal vein and lead to the rupture of esophageal varices.
Regarding the distant metastases, liver cancer frequently spreads to the lungs, presumably by way of the blood stream. Usually, patients do not have symptoms from the lung metastases, which are diagnosed by x-ray.
Complications:
1. Upper gastrointestinal bleeding. This accounts for about 15% of death causes. When the liver cells invades the bile duct, it can be led a hemobilia and patients always vomit blood. Erosion or ulceration of intestinal mucosal and blood coagulation dysfunction can result in a massive haemorrhage. And this can lead to shock and hepatic coma.
2. Hepatic coma (hepatic encephalopathy). It is a sign for end stage liver cancer and accounts for about 1/3 of death causes. Hepatic coma is often caused by gastrointestinal bleeding, massive use of urinative drugs, electrolyte disturbance and secondary infections.
3. Rupture and bleeding of liver cancer node. It can be considered as one of the most serious and urgent complications. People who aged over 40 had serious pains in upper abdomen, shock, anemia, stimulative symptom of peritoneum and bloody liquid drawn from abdominal cavity would presumably be considered as this disease.
4. Secondary infection. Patients with primary liver cancer often have weakened immunity for the long-term exhaustion and bed rest. Leukopenia after chemotherapy or radiotherapy of cancer makes them complicated by infection easily such as pneumonia, intestines infection, mildew infection and blood poisoning etc.
Treatments:
Patients with liver cancer should have an optimistic attitude and actively accept treatment and nursing. Treatment of liver cancer is based on several factors, including the type of cancer (primary or metastatic); stage (early or advanced); the location of other primary cancers or metastases in the patient's body; the patient's age; and other coexisting diseases, including cirrhosis.
1. Surgery
Few liver cancers in adults can be cured by surgery because they are usually too advanced by the time they are discovered. If the cancer is contained within one lobe of the liver, and if the patient does not have either cirrhosis, jaundice, or ascites, surgery is the best treatment option. Patients who can have their entire tumor removed have the best chance for survival. Unfortunately, only about 5% of patients with metastatic cancer fall into this group. If the entire visible tumor can be removed, about 25% of patients will be cured. The operation is called a partial hepatectomy or partial removal of the liver. The surgeon will remove either an entire lobe of the liver or cut out the area around the tumor.
Liver transplantation. If liver cancer progresses and becomes life-threatening, a liver transplant should be considered. It had achieved a great progress.
2. Interventional therapy.
3. Radiation therapy.
It is the use of high-energy rays or x rays to kill cancer cells or to shrink tumors. Its use in liver cancer, however, is only to give short-term relief from some of the symptoms. Liver cancers are not sensitive to radiation, and radiation therapy will not prolong the patient's life.
4. Chinese medicines.
This treatment can enhance immune functions and then improve the symptoms, reduce toxic effects of chemotherapy or radiotherapy, so the life quality can be improved and the illness exacerbation can be controlled.
How to deal with liver cancer?
Most persons are at a loss and have negative response to it when they are informed to get liver cancer. Patients may try anything when in this desperate situation, so it is important for doctors to enhance the ability of the diagnosis and differential diagnosis for liver cancer, to confirm diagnosis of liver cancer in time, avoid misdiagnosis and mistherapy.
1. Certain diagnosis.
The meaning of a certain diagnosis has two points, one is to check whether liver cancer is real existed or not, the other is to make clear the range of liver cancer. A confirmed diagnosis is important for curing, if one gets a misdiagnosis of liver cancer and is under the treatment of liver cancer, which should be a huge mistake. Based on a confirmed diagnosis, to know the type of cancer, stage, locations, metastasis or no metastasis and ranges clearly is also important for patients to get the best curing effects.
At the present time, misdiagnosis may be sometimes made by the diagnosis measures in common clinical use, so one should be got further examinations. For the liver cancers with typical clinic features, the measures include imaging examinations, single B-ultrasound, CT, nuclear magnetic resonance and hepatic artery angiography can give almost completely correct diagnosis.
The misdiagnosis and mistreatment of liver cancer sometimes appears in the imaging examination of hepatic space occupying lesion. Those lesions often have no significant clinical features, so the misdiagnosis frequently occurs. Clinical misdiagnosis and mistherapy have some situations as follow:
a). Diffuse liver lipoma misdiagnosed as liver cancer and treated by interventional embolization treatment.
b). Benign lesions (like adenomatous hyperplasia of liver nodules) misdiagnosed as liver cancer and treated by hepatectomy.
c). Small liver cancer misdiagnosed as haemangioma and the treatment time is delayed.
d). Operations without a certain diagnosis and the focus are missed
The surgeon only removes partial lobe of the liver or just cut out the main focus, so the postoperative effects is not good.
2. To make a suitable therapeutic strategy
At present, treatments of liver cancer in common use include, hepatectomy, interventional embolization treatment, chemotherapy, inner-neoplasitc dehydrated alcohol injection, multi-bullet radiofrequency therapy, biotherapy, Chinese traditional medicine and so on. These treatments have advantages and also disadvantages. Those treatments are based on several factors, including the type of cancer, stage, locations, the patient's age and economy affordability and so on. Doctors should make a perfect curing scheme with excellent curative effect, least side effects and low cost for every patient.
In a word, patients with liver cancer must calm down, take an optimistic attitude towards it and choose a good, well-conditioned and more professional hospital to accept therapy. A scientific and rational strategy may provide patients good therapeutic efficacies
Liver cancer VS YHK
A large number of clinical data on YHK’s ability of rapidly improving ALT (GPT) and AST (GOT) reveals that YHK plays a positive role in preventing liver cancer, its carcinomatosis and recrudescence.
TACHIOKAZUO—doctor from the Cancer Research Center in KANAGAWA-KEN Japan and his studying team have investigated the interrelationship between the status of ALT (GPT) and liver cancer for many years and accumulated mass of precious clinical data.
Investigation data shows:
1. With GPT value less than 80: the liver cancer rate can reduce significantly (lower than 1/3).
2. With GPT value less than 80: the time in the liver disease running to cancer can be extended in a large scale.
3. With GPT value less than 80: even though the cancerization takes place, the possibility of suffering from multiple carcinogenesis is very low. (Single carcinogenesis is easily controlled and treated).
4. With GPT value less than 80: the reproduction speed of cancer cells can be delayed.
5. With GPT value more than 80: the recrudescent rate after hepatic carcinectomy is two times more than that with GPT value less than 80.
