Multaq Warnings : Tumors that originate in other parts of the body often metastasize to the liver, but a primary malignant liver tumor begins in the liver itself. The most common type of liver cancer is hepatocellular carcinoma, often called hepatoma or HCC-—-one of the most common cancers we know.
As many as one million new HCC cases are reported in the world each year, a number that translates to about 6 percent of all cancers worldwide. It is the fifth most common cancer in men and the ninth most common in women, though in the United States it accounts for only about 2 percent of cancers, But this cancers numbers in this country are growing each year, possibly connected to the increase in cases of chronic hepatitis C.
Interestingly, hepatocellular carcinoma behaves differently in different countries: In Asia and Africa, where it is a more common cancer, HCC strikes at an early age and appears quite suddenly, In the United States, it is seen most often in mature adults and grows very gradually. This difference is because of the diseases link to hepatitis B and C. Hepatitis B is common in Asia and Africa and is usually acquired at birth or a very early age, whereas hepatitis C, which is more common in the United States, is acquired at a later age.
In an organ as vital as the liver—-which filters every fume, liquid, and morsel of food that enters the body-—-cancer may be triggered by many factors. Tbe clearest causative agent for liver cancer is cirrhosis, but it is also possible that lifestyle choices (particularly alcohol abuse), viruses, chemical exposure, genetics, hormones, aging, and even nutrition influence the onset of HCC. The connection between cirrhosis and liver cancer could not be clearer. Cirrhosis is found in up to 90 percent of HCC patients. Conversely, more than a quarter of cirrhosis patients had undiagnosed HCC, according to autopsy studies.
Patients with chronic hepatitis B (HBV) or hepatitis C (HCV) also have a high risk of developing liver cancer: HBV is a leading cause of HCC, accounting for as many as 75 percent of liver cancers. Even -when cirrhosis is not diagnosed, HCC can be found in HBV patients, possibly because of a gene that makes an individual more vulnerable to contracting HCC. Hepatitis B is a DNA virus, and it is possible that genetic mutations in patients with hepatitis B usher in HCC.
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If the patient carries both HBV and HCV, chances are even higher that he or she will contract liver cancer, a development that is exacerbated if the patient is a heavy alcohol drinker. Chronic hepatitis B and C patients who drink to excess face a startling fact: HCC appears an average of ten years earlier in patients who drink than it does in patients who do not drink alcohol. If the patient does not drink, 20 to 30 years can elapse before HCC manifests in an HBV patient. Clearly, anyone diagnosed with HBV should avoid alcohol to postpone the onset of cancer.
Hepatitis C, too, is strongly linked to liver cancer, and almost all HCC patients whose cancer derives from chronic hepatitis C also have cirrhosis. Hemochromatosis, a disease of iron overload, will not in itself cause hepatocellular carcinoma, but once cirrhosis has developed, the patients risk of contracting HCC jumps to 200 times that of the general population. For hemochromatosis patients whose livers are not yet cirrhotic, phlebotomy can help to head off HCC. Other liver diseases (including nonalcoholic fatty liver disease, autoimmune hepatitis, and primary biliary cirrhosis) also carry the potential of progressing to cirrhosis and, eventually, to HCC, but the correlation between HCC and hepatitis B, hepatitis C, and hemochromatosis is far stronger.
Not surprisingly, lifestyle can be a major contributing factor to hepatocellular carcinoma. Alcohol, which is toxic to the liver, does not cause HCC, but it does cause cirrhosis and other liver damage, and it renders the liver much more vulnerable to cancer. About 15 percent of patients with alcoholic cirrhosis will eventually develop HCC. Similarly, while the direct effects of tobacco on the liver are not yet known, some studies show a link between smoking and HCC in patients with liver disorders.
Another causative connection that surprises many people is the links between hepatocellular carcinoma and aflatoxin, a by-product of aspergillusflctvus (in simple terms, a mold), which is toxic to the liver. Aflatoxin contamination can occur in foods stored in hot, humid places for extended periods. It is possible that aflatoxin acts as a cocarcinogen—a substance that can lead to cancer development when combined with other cancer-causing agents. It is rare in the United States, but aflatoxin contamination is not uncommon in certain Asian and African regions, where it strikes stored corn, rice, peanuts, and soybeans.
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Diabetes may also put people at increased risk of developing liver cancer. Many studies have shown that diabetic patients who are obese are at an increased risk for developing a number of different types of cancer, including hepatocellular carcinoma. A link may also exist between HCC and nonalcoholic steatohepatitis (NASH), because many of the patients have diabetes, hyperinsu- linemia, or both.
Men develop hepatocellular carcinoma two to four times as often as women, so gender alone is a factor in the development of this malignant tumor, although increased cases of alcoholic cirrhosis and viral hepatitis in men may also contribute to the higher occurance. Ethnicity, too, is a factor: Asians, Hispanics, Native Americans, and African Americans contract HCC more often than Caucasians. The different rates may be attributed to lifestyle differences, including varying rates of alcohol consumption, tobacco use, diabetes, and hepatitis B and C among ethnic groups. More likely, however, is that the differences are the result of genetic differences in disease susceptibility (susceptible genes). Finally, although aging does not cause cancer, the cumulative effect of gene damage from all the above causes makes hepatocellular carcinoma in this country a disease of mature adults. It is rarely seen in men or women younger than 40 years of age.
In the United States, hepatocellular carcinoma is often diagnosed early, when the tumor is tiny, but the diagnosis often results from regular cirrhosis monitoring rather than the appearance of symptoms of the cancer itself. Some cases, however, start with the sudden appearance of symptoms, such as dramatic weight loss, fatigue, abdominal pain, or mild jaundice. There may also be clear signs of decompensated cirrhosis, such as ascites (accumulation of fluid in the abdomen).
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