Hepatocellular Cancer

Hepatocellular cancer, also known as hepatocellular carcinoma (HCC), is the most common type of primary liver cancer. It originates from the hepatocytes, which are the main cells in the liver responsible for its normal functioning. This type of cancer typically develops in individuals with pre-existing liver conditions such as cirrhosis or chronic hepatitis B or C infection. Hepatocellular cancer is a serious and aggressive disease that can have significant impacts on a person's health and well-being. 

If you suspect you or someone else is experiencing Hepatocellular cancer, it is crucial to seek immediate medical attention by calling emergency services or consult with a Cancer Specialist.

Causes of Hepatocellular Cancer

• Chronic Hepatitis B Infection: Persistent infection with the hepatitis B virus (HBV) can lead to liver inflammation and cirrhosis, increasing the risk of HCC.

• Chronic Hepatitis C Infection: Similar to HBV, chronic hepatitis C virus (HCV) infection causes liver damage and can lead to cirrhosis and HCC over time.

• Cirrhosis of the Liver: Long-term liver damage from various causes (alcohol, viral hepatitis, fatty liver disease) leads to cirrhosis, a major risk factor for developing HCC.

• Alcohol Abuse: Chronic alcohol consumption can cause alcoholic liver disease, cirrhosis, and eventually increase the risk of developing HCC.

• Non-Alcoholic Fatty Liver Disease (NAFLD): Accumulation of fat in the liver due to metabolic syndrome, obesity, or diabetes can lead to NAFLD and progress to cirrhosis and HCC.

• Aflatoxin Exposure: Aflatoxins, produced by molds (Aspergillus species) on contaminated crops like peanuts, can cause liver damage and increase HCC risk, especially in regions with poor storage conditions.

• Hemochromatosis: This genetic disorder leads to excessive iron accumulation in the body, which can damage the liver and increase the risk of HCC.

• Alpha-1 Antitrypsin Deficiency: A genetic condition that can lead to liver damage and cirrhosis, raising the risk of HCC.

• Obesity and Diabetes: Both obesity and diabetes are linked to increased liver fat, insulin resistance, and inflammation, all of which can contribute to liver cancer.

• Family History of Liver Cancer: A family history of HCC may indicate a genetic predisposition to the disease.

• Age and Gender: HCC is more common in men and in individuals over the age of 50, especially those with pre-existing liver disease.

Risk Factors of Hepatocellular Cancer

• Chronic Hepatitis B or C infection (leading cause of liver cirrhosis)
• Cirrhosis of the liver (caused by alcohol abuse, fatty liver disease, or hepatitis)
• Non-alcoholic fatty liver disease (NAFLD) and NASH (Non-alcoholic steatohepatitis)
• Heavy alcohol consumption (leading to liver damage and cirrhosis)
• Aflatoxin exposure (toxins produced by certain molds found in contaminated crops like peanuts)
• Obesity and insulin resistance (increasing the risk of NAFLD and NASH)
• Diabetes mellitus (particularly type 2 diabetes)

Symptoms of Hepatocellular Cancer

• Unexplained Weight Loss: Significant, unintended weight loss without changes in diet or exercise.

• Loss of Appetite: A reduced desire to eat, which may lead to further weight loss.

• Abdominal Pain: Pain or discomfort in the upper right side of the abdomen, often due to liver enlargement or pressure from a tumor.

• Abdominal Swelling: Accumulation of fluid in the abdomen (ascites), causing bloating and discomfort.

• Fatigue: Persistent tiredness or weakness that doesn't improve with rest.

• Jaundice: Yellowing of the skin or eyes, indicating liver dysfunction.

• Nausea and Vomiting: Feeling nauseous or vomiting, often due to liver dysfunction or tumor growth.

• Fever: Low-grade fever can occur as a result of the body's immune response to the tumor.

• Itchy Skin (Pruritus): Generalized itching, often related to bile salt accumulation due to liver dysfunction.

Diagnosis for Hepatocellular Cancer

• Medical History and Physical Examination: The doctor will review symptoms, risk factors (like hepatitis or cirrhosis), and perform a physical exam to check for signs of liver disease, such as jaundice or an enlarged liver.

• Blood Tests:

  • Alpha-Fetoprotein (AFP): Elevated levels of AFP in the blood may indicate HCC, though it can also be elevated in other liver conditions.
  • Liver Function Tests: Assess liver function and damage (bilirubin, AST, ALT, albumin levels).
  • Hepatitis Virus Tests: Blood tests to detect chronic hepatitis B or C infections.

• Imaging Tests:

  • Ultrasound: A non-invasive imaging test used to detect liver abnormalities, including tumors.
  • CT Scan (Computed Tomography): Provides detailed cross-sectional images of the liver, helping to identify and stage liver tumors.
  • MRI (Magnetic Resonance Imaging): Offers detailed images of the liver and can help in the accurate detection and characterization of tumors.
  • Contrast-Enhanced Imaging: Contrast agents are used in CT or MRI scans to enhance the visibility of liver tumors and blood vessels.

• Liver Biopsy: A small sample of liver tissue is removed for examination under a microscope to confirm the presence of cancer cells and assess the extent of the disease.

• Arterial Phase Imaging (CT or MRI): Special imaging techniques that evaluate blood flow to the liver tumors, as HCC typically has a rich blood supply.

Treatments for Hepatocellular Cancer

• Surgical Resection: Surgical removal of the tumor if the cancer is confined to one area of the liver and the liver function is relatively well-preserved.

• Liver Transplantation: For patients with early-stage HCC and cirrhosis, a liver transplant may be considered if the tumor is unresectable but meets specific criteria (such as Milan criteria).

• Ablation Therapy:

  • Radiofrequency Ablation (RFA): Uses heat to destroy cancer cells by passing high-frequency electrical currents through a needle into the tumor.
  • Microwave Ablation (MWA): Similar to RFA, but uses microwave energy to destroy the tumor.
  • Percutaneous Ethanol Injection (PEI): Alcohol is injected directly into the tumor to cause cell death.

• Transarterial Chemoembolization (TACE): A procedure where chemotherapy is delivered directly to the tumor through the hepatic artery, followed by embolization to block the blood supply to the tumor.

• Transarterial Radioembolization (TARE): Uses tiny radioactive beads (Yttrium-90) delivered to the tumor through the hepatic artery to target and kill cancer cells.

• Systemic Therapy (Targeted Therapy):

  • Sorafenib: A targeted drug that inhibits tumor growth and angiogenesis (formation of new blood vessels).
  • Lenvatinib: Another targeted therapy that can be used as an alternative to sorafenib for certain patients.
  • Regorafenib: For patients who have not responded to sorafenib, this drug can be used as a second-line treatment.

• Immunotherapy:

  • Checkpoint Inhibitors: Drugs like nivolumab or pembrolizumab that help the immune system recognize and attack cancer cells.
  • Atezolizumab and Bevacizumab Combination: This combination therapy can help treat advanced HCC by inhibiting both cancer cell growth and blood vessel formation.

• Radiation Therapy: External beam radiation may be used to shrink tumors or alleviate symptoms, especially in patients who are not candidates for surgery or other local treatments.

• Chemotherapy: Although not commonly effective in HCC, chemotherapy may be used in advanced cases or as part of a clinical trial.

Preventive Measures for Hepatocellular Cancer

• Vaccination Against Hepatitis B: Getting vaccinated against hepatitis B virus (HBV) can significantly reduce the risk of developing HCC, especially in regions with high HBV prevalence.

• Screening for Hepatitis B and C: Regular screening for hepatitis B and C in high-risk individuals (e.g., those with a family history, or exposure to contaminated blood) can help detect infections early and reduce the risk of liver damage leading to HCC.

• Antiviral Treatment for Hepatitis B and C: Effective antiviral therapies can control chronic hepatitis B and C infections, lowering the risk of cirrhosis and HCC.

• Avoiding Excessive Alcohol Consumption: Limiting alcohol intake helps prevent alcoholic liver disease, cirrhosis, and reduces the risk of liver cancer.

• Maintaining a Healthy Weight: Preventing obesity and maintaining a healthy weight can reduce the risk of non-alcoholic fatty liver disease (NAFLD), which can lead to cirrhosis and HCC.

• Managing Diabetes and Metabolic Syndrome: Proper control of diabetes, blood pressure, and cholesterol levels can reduce the risk of liver disease and HCC.

• Avoiding Exposure to Aflatoxins: Reducing exposure to aflatoxins (toxins from moldy grains or nuts) by ensuring proper food storage and handling can lower the risk of liver cancer.

• Regular Liver Health Monitoring: For individuals with liver cirrhosis, chronic hepatitis, or other liver diseases, regular monitoring with blood tests (e.g., alpha-fetoprotein, liver function tests) and imaging can help detect early signs of HCC.

• Genetic Counseling and Screening: For those with a family history of liver disease or liver cancer, genetic counseling and early screening may help identify risks and prevent cancer development.

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Do's & Don’t's

When it comes to Hepatocellular Cancer, there are certain do's and don'ts that can help individuals navigate their journey towards better health. By following these guidelines, patients can optimize their treatment outcomes and improve their overall well-being.

If you suspect you or someone else is experiencing Hepatocellular cancer, it is crucial to seek immediate medical attention by calling emergency services or consult with a Cancer Specialist.