Hepatocellular Carcinoma and Cirrhosis of the Liver

 

 

Hepatocellular Carcinoma and Cirrhosis of the liver,tumour

There can be many serious consequences of cirrhosis of the liver. Hepatocellular carcinoma (HCC) is one serious complication that develops as a result of chronic cirrhosis. Some studies have shown that hepatocellular carcinoma is the main cause of death in those who develop a  chronic compensated cirrhosis. It is a common condition following cirrhosis and may occur 20 to 30 years after the initial damage  to the liver.

What is hepatocellular carcinoma?

Hepatocellular carcinoma is  primarily  a malignant condition of the liver cells. It is a very dangerous condition and may lead to death within 6 to 20 months after its onset. Although most cases occur in patients who have pre-existing cirrhosis, 25% of the patients may not even have a history or risk factors for the presence of cirrhosis.

The tumors that are present inside the liver are usually multi focal  (75%) hence it is difficult to remove them by surgery. As the disease progresses many metastases may form in the brain, lung, portal vein, bone or the lymph nodes around the portal region.

What causes hepatocellular carcinoma in cirrhosis of the liver?

There are a few causes and risk factors that may lead to the formation of liver cancer in patients in cirrhotic livers independent of the cause of cirrhosis. These include:

1. Hepatitis C virus (most common)
2. Hepatitis B virus
3. Older age
4. Race: it is more common in Asians of Japanese descent.
5. Male sex
6. Severity of compensated cirrhosis at presentation
7. Sustained activity of liver disease
8. Alcohol abuse especially in viral related cirrhosis
9. Hemochromatosis

Interventions such as  vaccinations against hepatitis and the slowing of alcoholic liver disease might decrease the incidence of hepatocellular carcinoma in the future. However because the latency period from the onset on injury to the development of cancer is so long, it may take many years till some substantial changes are observed in the patient.

Symptoms

The symptoms of patients suffering from liver cancer may resemble of an advancing case of cirrhosis of the liver. These include:

• Pruritis (body itching)
• Jaundice (yellow skin and sclera)
• Splenomegaly (enlargement of the spleen)
• Hepatomegaly (enlargement of the liver)
• Variceal bleeding
• Cachexia (body wasting)
• Abdominal enlargement
• Ascites (fluid in the abdominal cavity)
• Hepatic encephlopathy (mental disorientation, confusion or coma)
• Right upper abdominal pain (relatively uncommon symptom)
• Prominant veins
• Edema on the feet

Mortality/Morbidity

http://youtu.be/qsR92joabBg
Only 5% of  patients may be cured with  surgery. The median survival duration for HCC patientsliver cirrhosis,hepatocellular carcinoma,liver cancer is usually 6 months. The greater the extent of cirrhosis, the shorter is the patient survival time and the more limited  the therapeutic options . For example, if portal vein occlusion develops. the predicted survival may be even shorter.

Here is a list of a few complications which may arise from liver cancer:

• Hepatic failure
• Death from cachexia (body wasting)
• Variceal bleeding (stomach or esophagus)
• Tumor rupture
• Intra-peritoneal bleeding (within the body cavity)

Lab diagnosis

Hepatocellular carcinoma appears to be similar to cirrhosis of the liver with respect to its presentation of  symptoms and the risk factors involved. These laboratory tests may help recognize whether you are suffering from hepatocellular carcinoma:

• An elevated alpha fetoprotein (AFP) in the blood may hint at the presence of liver cancer in 75% of the patients. Prognosis of the condition is inversely linked to the level of AFP in the plasma. With co-existing signs such as  a growing liver mass, cirrhosis and an absence of acute hepatitis, a level of 1000ng/ml may be considered to be  presumptive evidence of cancer without confirming with a biopsy.

• Des-gamma-carboxy prothrombin (DCP) is another biomarker but it is not as effective as AFP.

• By using imaging studies such as liver ultrasound, CT or MRI, hepatocellular carcinoma can easily be seen.

• A liver biopsy is however, frequently necessary to confirm the diagnosis. There is a small risk of the tumor spread along the tract of the needle with this procedure. It may be omitted in the case of a growing cirrhotic mass (more than 2 cm) which has been positive on two consecutive imaging studies .

Treatment of Hepatocellular Carcinoma

The treatment options available vary depending on the size, location or the number of lesions. It may also be linked to the severity of underlying cirrhosis, presence of metastases or portal vein infiltration. Surgical resection or liver transplantation may offer some hope of a cure. Chemotherapy may offer hopes of palliation for untreatable cases of liver cancer developing in an individual with cirrhosis of the liver.

Comments

  1. Each and every night, I research Cirrhosis of the Liver and Hepatocellular Carcinoma.

    You see, I have a son who just turned 48 years old, a son whom will soon die.

    I recall the very day that he was born, blond hair, big beautiful blue eyes, a child full of life, pep, fun and vigor. Through the years, I stood by in the shadows to witness many of his life-long achievements come into fruition, that is, until he was diagnosed in 2004 with a severe mental illness. The VA subsequently granted same a Service-Connected Disability. For those of you not aware that the majority of mental illness is accompanied by alcoholism or some other form of drug, it daily becomes a goulish nightmare for the mentally ill person and leaves behind a family who is at all times, left in Limbo as to how to help, what to do, how to deal with it, and how to cope with the many laws which prevent the family from such things as knowing what hospital your son has been taken to, how long he will be there, what was the diagnosis, what is the prognosis, is same dead, and if so, where have you taken him? I’m talking about the Mental Health Disabilities Code for Mentally Ill Persons, the Hippa Act and other laws unknown to me at this time which prevents the family from helping their son, and preventing the family from knowing their sons’ whereabouts. Unless the Mentally Ill Person has had enough mental fortitude to elect a Power of Attorney for the family, there is nothing the family can do to help.

    In times such as this, only living three or four houses away from my son, all I can do is get into the car when hearing an ambulance and drive through town 50 miles an hour to see where the ambulance is taking my son, or else simply sit at home waiting for the day my son will die. Regardless of whom I have talked to this year, where I have gone, what court papers I have initiated desperately trying to get help for my son, the law is that unless he presents himself, signs paperwork through his own volition, neither I, nor anyone else within the family, can do absolutely nothing to help him.

    Believe it or not, mentally ill people can be very intelligent. This was the case with my son. Prior to 2004, he was making about $50 per hour as a computer programmer and had a distinguished future ahead of him until he broke down. Then..it was all over. Even though he always drank and partied, he became a severe alcoholic, never once seeking treatment. Quite by accident, I found out in June of this year that he has Cirrhosis of the Liver and Probable Hepatocellular Carcinoma. He has all of the above symptoms cited. For whatever reason, in his young life, he has not been aggressive and has not attended any AAA meetings, nor has tried to seek help for neither his psychiatric, nor physical health. Now…there is so very much on the plate, I do not know where to go with all of it. One minute I am seeking whatever help possible only to find out my son must initiate same, and the next minute, I dwell on his pre-planned funeral. All I can do is watch him suffer, waste away, and die. Tell me, What good are all of these laws doing other than destroying the entire family?

  2. Hello Violet,
    I have just been reading your email and oh my goodness I feel for you and I can hear your pain and being so frustrated at a system which seems to hinder you at every step. Mental illness is so difficult in itself to deal with and is incredibly hard, let alone dealing with a diagnosis of cirrhosis as well. Many mentally ill people are extremely intelligent, sometimes I wonder if this intelligence is part of the reason why they have mental illness issues because they find it so hard to cope with this world.
    Sometimes, being a parent is the most difficult and emotional thing. Children reach us in ways that the ordinary person cannot!
    I’m so sorry for you and your dear son, our hearts go out to you, we were getting teary reading your heartfelt email as we have two young boys and can just imagine how it awful would be.

    Sending you a big hug ,

    kind regards,
    Claire and Don

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