Liver Cancer - Risk Factors, Symptoms, Stages & Treatment
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Liver Cancer - Risk Factors, Symptoms, Stages & Treatment

Liver cancer ranks fifth among cancers in men and eighth in women worldwide. It ranks fourth in total in cancer-related deaths. The incidence between regions varies in direct proportion to the frequency of hepatitis B virus infection. HCC is often seen with liver cirrhosis. It is seen 2.4-3.7 times more frequently in men than in women.

What are liver cancer risk factors?

  • Chronic hepatitis B virus (HBV) infection
  • Chronic hepatitis C virus (HCV) infection
  • Cirrhosis of the liver
  • Aflatoxin B1 taken with food (toxic and carcinogenic substances produced by a kind of fungus - Aspergillus flavus and parasiticus. It can be found in foods such as spices, corn - cereals, etc.) and in the milk of animals that consume these foods. The Ministry of Health has controls on this issue).
  • In addition, use of birth control pills, smoking, and some rare genetic or storage diseases (hemochromatosis, alpha1 antitrypsin deficiency, ataxia-telangiectasia, tyrosinemia, etc.) pose a risk for the development of HCC, although they are lower.

What are the symptoms?

Symptoms vary according to the size and extent of the tumor. It isn’t easy to detect in the early stages. To be palpable on physical examination, the tumor must be very large, which is usually possible in the late stages. A large part of the liver must be covered with a tumor for the symptoms of liver failure (such as jaundice, fluid collection in the abdomen) to develop, but this happens in the advanced stages of the tumor. For this reason, early detection of the tumor is usually done during routine controls (such as ultrasonographic examinations).

Since its coexistence is common in patients with liver cirrhosis, it comes to mind more frequently, and investigations are directed accordingly. Liver cancer should be considered in cases such as rapid deterioration in the patient’s general condition with cirrhosis, the appearance of jaundice, and accelerated accumulation of water in the abdomen.

HCC patients may be accompanied by a condition called paraneoplastic syndrome. In this syndrome, complaints such as decreases in blood sugar (hypoglycemia), increase in the number of red blood cells in the blood (polycythemia), increase in calcium (hypercalcemia), hypertension, diarrhea, etc. due to some hormones secreted by tumor cells can be seen.

Is it possible to diagnose early?

Because the symptoms are seen in the advanced stages of the disease, early diagnosis is often not possible. Tumor markers detected in the blood show promise for early diagnosis. It is recommended that individuals with high risk be monitored every 6 to 12 months.

How is the diagnosis made?

Definitive diagnosis is possible with biopsy, as in all other cancers. It is impossible to distinguish between tumor detection and traditional blood tests (liver function tests: ALT, AST, GGT, etc.). Alpha-fetoprotein (AFP), a protein overexpressed by tumor cells, is often used as a tumor marker. The increase in blood level is valuable data, especially in high-risk groups. Not all HCC tumors secrete AFP, so the level of AFP does not make a definitive diagnosis, but it can be a guide for diagnosis. There are also less used tumor markers such as “Fucosylated” AFP, “Des-gamma-carboxy prothrombin.”

Ultrasonography is a safe, easy-to-use, relatively inexpensive method, and most HCCs can be seen. However, it is indistinguishable whether the lesion seen is a tumor or a solid lesion.

Computed tomography is a relatively better diagnostic method than magnetic resonance (MR) ultrasonography. In addition, the extent of the spread of the tumor is better understood.

The definitive diagnostic method is biopsy and pathological examination. Taking a biopsy from the target mass with ultrasonography gives better results. If the tumor can be removed surgically, performing surgical intervention without biopsy may be more accurate.

What are the stages of the disease?

Hepatocellular carcinoma staging is done according to the American Cancer Society classification system. Accordingly, T defines tumor, N lymph involvement, and M distant organ spread. The numbers (0-4) added after T, N, and M indicate the degree of weight.

Stage I (T1, N0, M0): A single tumor (any size) without blood vessel invasion

Stage II (T2, N0, M0): A single tumor (any size) with blood vessel invasion or multiple tumors all <5cm

Stage IIIA (T3, N0, M0): Multiple tumors, at least one larger than 5 cm, or tumor with the portal or hepatic vein invasion

Stage IIIB (T4, N0, M0): Tumor invading adjacent organs (except the gallbladder) or presence of tumor located on the outer wall of the liver

Stage IIIC (any T, N1, M0): Tumor(s) of any size showing regional lymph node invasion

Stage IV (any T, any N, M1): lymph node that has spread to other parts of the body

How is it treated?

Treatment success depends on the size of the tumor, its spread, and the degree of accompanying cirrhosis liver failure. The best way to completely get rid of HCC may be to remove the tumor or liver transplant. It may be possible to destroy or reduce the tumor mass by injecting some substances into the tumor tissue with a needle and/or radiofrequency waves. Chemoembolization and chemotherapy are other treatment methods that can be applied.

Is it possible to be protected?

The use of vaccines against HBV is essential in reducing the incidence of liver cancer. In addition, interventions to prevent the development of cirrhosis, such as the treatment of chronic hepatitis C, early detection of hemochromatosis, and the treatment of alcoholism, are of great importance in preventing the development of liver cancer in these high-risk individuals.

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