Etiology And Risk Factors In Hcc Development
The etiology of HCC depends on the geographic location. For example, in countries where HCC is endemic such as Africa, Asia and Alaska, the most common cause is HBV infection. In countries where the risk of HCC is low, cirrhosis is the main cause of HCC in spite of the etiology.
The main risk factors associated with developing HCC are as follows.
How Do Doctors Treat The Complications Of Hepatitis C
If hepatitis C leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, surgery, and other medical procedures. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order an ultrasound test to check for liver cancer.
If hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.
Hepatitis C Virus Proteins And Host
The proteins and RNA of HCV also interact with many host-cell factors besides their roles in the viral life -cycle. Interactions of HCV proteins with the translation machinery and post-translational modification systems have been described. In addition, HCV proteins have been proposed to be involved in a wide range of activities, including cell signaling, transcriptional modulation, transformation, apoptosis, membrane rearrangements, vesicular trafficking and translational regulation . Indeed, at least four of the HCV gene products have been shown to exhibit transformation potential in tissue culture . Owing to the enormous amount of information that has been generated regarding the properties of HCV structural and non-structural proteins and their interactions with cellular proteins and functions, only the findings that are potentially relevant for malignant transformation are summarized below.
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What Is Hepatitis C
Hepatitis C is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.
Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. The hepatitis C virus spreads through contact with an infected persons blood.
Hepatitis C can cause an acute or chronic infection.
Although no vaccine for hepatitis C is available, you can take steps to protect yourself from hepatitis C. If you have hepatitis C, talk with your doctor about treatment. Medicines can cure most cases of hepatitis C.
What Is The Prognosis Of Liver Cancer What Are The Survival Rates For Liver Cancer
The prognosis for liver cancer depends on multiple factors such as the size of the liver cancer, the number of lesions, the presence of spread beyond the liver, the health of the surrounding liver tissue, and the general health of the patient. Life expectancy depends on many factors that impact whether a cancer is curable.
The American Cancer Society states the overall 5-year survival rate for all stages of liver cancer is 15%. One of the reasons for this low survival rate is that many people with liver cancer also have other underlying medical conditions such as cirrhosis. However, the 5-year survival rate can vary depending on how much the liver cancer has spread.
If the liver cancer is localized , the 5-year survival rate is 28%. If the liver cancer is regional , the 5-year survival rate is 7%. Once the liver cancer is distant , the survival time is as low as 2 years.
Survival rate can also be affected by the available treatments. Liver cancers that can be surgically removed have an improved 5-year survival rate of over 50%. When caught in the earliest stages, and the liver is transplanted, the 5-year survival rate can be as high as 70%.
Primary liver cancer deaths are usually from liver failure, bleeding, or advanced cancer.
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Selective Internal Radiation Therapy
Also known as radioembolisation, this treatment targets liver tumours directly with high doses of internal radiation in tiny beads. It is used for both primary and secondary cancers in the liver when the tumours can’t be removed with surgery. It is not available in all areas, so talk to your doctor about availability and costs involved.
Computed Tomography And Magnetic Resonance Imaging
DWI is a functional magnetic resonance technique that consists of quantifying proton diffusion in tissues. There is cellular increase in HCC and this cellular proliferation restricts water proton diffusion. It is important to mention that DWI quantification demonstrates restricted specificity for HCC because some lesions can show restricted diffusion on DWI.
On the other hand, hepatobiliary contrast agents such as gadobenate dimeglubine and gadoxetate disodium can provide information about tumor vasculature and hepatocyte function in a single examination.
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Distribution Of Hcv Genotypes In Latin America
Studies on HCV genotypes related to different stages of liver disease have been reported even though the results are controversial. Nevertheless, cofactors such as age, sex, obesity, diabetes and alcohol consumption must be taken into consideration since they have an impact on the progress of chronic liver disease. Worldwide, genotype 1 is the most prevalent, causing 44% of all infections, followed by genotype 3 with 25% and then genotype 4 with 15%. HCV genotype 1 is also the most prevalent in Latin America and genotype 1b is predominant in the LAC.
Figure 3. Choropleth map of the fraction of liver cancer attributable to HCV in some Latin America and the Caribbean countries, 2012. Pie charts represent the genotypes present in some of those countries and the proportion of cases that are related to each genotype. Genotype distribution data are either taken from the literature or based on regional averages in the absence of country-specific data. HCV: hepatitis C virus AF: attributable fraction
According to Maucort-Boulch et al., HCV was the cause of HCC in 58.7% of cases in Mexico, 50.0% in Brazil and 35%-38.8% in the rest of the LAC countries that were analyzed.
What You Can Do To Help Manage The Symptoms Of Liver Cancer
Symptom management is an important aspect of coping with liver cancer. When symptoms are properly addressed and managed, it can significantly strengthen the capability of your loved one and their overall quality of life. Below are common symptoms experienced by those with liver cancer and suggestions that caregivers can use to help manage these symptoms. Always consult with your healthcare provider before trying any of the following suggestions:
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Who Is Most At Risk Of Contracting Hepatitis C
You have a high risk of contracting hepatitis C if you:
- use or have used injection drugs even if it was just once or many years ago
- have received blood or blood products or an organ transplant before July 1990 in Canada
- have been in jail or
- have been injected or scratched during vaccination, surgery, blood transfusion or a religious/ceremonial ritual in regions where hepatitis C is common.
You have a high moderate risk of contracting hepatitis C if you:
- have tattoos or body piercing
- have multiple sexual partners
- have a sexually transmitted infection , including HIV or lymphogranuloma venereum
- have experienced traumatic sex or rough sex or have used sex toys or fisting that can tear body tissue
- have vaginal sex during menstruation
- have received a kidney treatment
- have received an accidental injury from a needle or syringe
- have another infectious disease
- were born to a hepatitis C infected mother or
- have a sexual partner infected with hepatitis C.
Hepatitis C is NOT passed from person to person by:
- coughing, sneezing
- breastfeeding unless your nipples are cracked and bleeding or
- oral sex, unless blood is present.
The Impact Of The Revolution In Hepatitis C Treatment On Hepatocellular Carcinoma
- M.P. MannsCorrespondenceCorrespondence to: Dr Michael P. Manns, Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany. Tel: +49-511-532-3306 Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, HannoverGerman Center for Infectious Diseases , Hannover-Braunschweig, Germany
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Molecular Pathways In Human Hepatocarcinogenesis
The upregulation of growth factors expression and the activation of components of their signaling pathways also play an important role in hepatocarcinogenesis. Insulin-like growth factor II, insulin receptor substrate 1, hepatocyte growth factor and TGF- and have been involved in the development of HCC . Unexpectedly, HGF, a mitogen for normal hepatocytes, inhibits the growth of hepatoma cell lines in vitro and the development of HCC in transgenic mouse models of hepatocarcinogenesis . Overexpression of the angiogenic factors vascular endothelial growth factor and angiopoietin-2 has been documented in HCC. These findings are particularly relevant as the evolution from pre-neoplatic to HCC nodules is accompanied by neovascolarization and HCC is often a highly vascular tumor.
Loss of pRb and p53 pathways leads to genomic instability, which plays an important permissive role in malignant transformation. Defective DNA mismatch repair and microsatellite instability occur in a subset of HCCs , although the frequency of such defects is debated . Moreover, recent evidence suggests that telomere dysfunction, leading to telomere-based chromosomal instability, occurs during the early stages of hepatocarcinogenesis, whereas activation of telomerase, the ribonucleoprotein enzyme that prevents the shortening of telomeres and extends cell life span, occurs later during HCC progression .
Chronic Hepatitis Cirrhosis Adenoma Hepatocellular Carcinoma
Hepatocyte necrosis and mitosis of chronic hepatitis favor nodular regeneration, which in appropriate circumstances, is followed by hepatocyte dysplasia and carcinoma.
In many parts of the world HCC is among the leading causes of cancer-related mortality, and the third most common cause of cancer death in the world. Japan, for example, unlike other Asian countries, also has a high proportion of HCC caused by HCV infection accounting for 80 to 90% of all cases, while in the western world hepatocellular carcinoma is known to complicate cirrhosis secondary to hepatitis C in 2-6% per year.
There is currently no evidence that HCV by itself is oncogenic however, HCC may rarely develop in non-cirrhotic HCV-infected individuals, so a direct oncogenic effect cannot be excluded. However, in the pathogenesis of HCC associated with HCV, it remains controversial whether the virus plays a direct or indirect role. Recent studies using transgenic mouse models, in which the core protein of HCV has an oncogenic potential, indicate that HCV is directly involved in hepatocarcinogenesis, albeit other factors such as continued cell death and regeneration associated with inflammation would also play a role.
Almost all HCC occurs in the liver of patients with chronic hepatitis and liver cirrhosis, caused by HBV and HCV. Consequently, eradication of these hepatitis viruses with anti-viral agents and chemoprevention methods may decrease the risk of HCC.
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Risk Factors And Prevention Of Viral Hepatitis
- 1Gastroenterology Department, The First Affiliated Hospital of China Medical University, Shenyang, China
- 2The 3rd Clinical Department of China Medical University, Shenyang, China
Hepatocellular carcinoma is a common cancer in the world, and its incidence is increasing yearly. Hepatitis B virus infection and hepatitis C virus infection are important causes of HCC. Liver cirrhosis, age, sex, smoking and drinking, and metabolic risk factors will increase the risk of cancer in HBV/HCV patients. And viral load, APRI, FIB-4, and liver stiffness can all predict the risk of HCC in patients with viral infection. In addition, effective prevention strategies are essential in reducing the risk of HCC. The prevention of HCC involves mainly tertiary prevention strategies, while the primary prevention is based on standardized vaccine injections to prevent the occurrence of HBV/HCV. Eliminating the route of transmission and vaccination will lead to a decrease in the incidence of HCC. Secondary prevention involves effective antiviral treatment of HBV/HCV to prevent the disease from progressing to HCC, and tertiary prevention is actively treating HCC to prevent its recurrence.
What Is Liver Cancer
Primary liver canceris a malignant tumour that begins in the liver. There are different types:
- hepatocellular carcinoma or hepatoma, is the most common type of primary liver cancer and it starts in the main cell type in the liver, the hepatocytes
- cholangiocarcinoma, or bile duct cancer, starts in the cells lining the bile ducts
- angiosarcoma, which starts in the blood vessels. This is a rare type of liver cancer that is more likely to occur in people over 70.
Secondary cancer in the liver is cancer that started in another part of the body but has spread to the liver. If you have secondary cancer in the liver, it may be useful to read information about the primary cancer in conjunction with this information or aboutcancer of unknown primary.
A secondary cancer is named after the primary site where it began, for example bowel cancer with liver secondaries. In this information, we use the term “secondary cancer in the liver” to refer to any cancer type that has spread to the liver.
It is estimated that 2832 people will be diagnosed with liver cancer in Australia in 2021. Men are three times as likely to be diagnosed as women.
The five year survival rate for liver cancer is 19%.
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What Causes Liver Cancer
Many factors play a role in the development of cancer. Because the liver filters blood from all parts of the body, cancer cells from elsewhere can lodge in the liver and start to grow. Cancers that begin in the gastrointestinal tract often spread to the liver. Liver cells can regenerate after injury . Sometimes the regeneration of liver cells is associated with changes that have been linked to the development of liver cancers.
What Are The Types Of Hepatitis C Infection
There are two types of hepatitis C infection:
- Acute: a short-term infection that occurs within 6 months after a person is exposed to the virus. However, about 75 to 85 percent of people with the acute form go on to develop the chronic form.
- Chronic: a long-term illness that can continue throughout a persons life. It can lead to cirrhosis of the liver and other serious problems, such as liver failure or cancer. About 15,000 people a year die from liver disease associated with hepatitis C.
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What Are The Symptoms Of Hepatitis C
Most people infected with hepatitis C have no symptoms. Some people with an acute hepatitis C infection may have symptoms within 1 to 3 months after they are exposed to the virus. These symptoms may include
If you have chronic hepatitis C, you most likely will have no symptoms until complications develop, which could be decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.
Causes And Risk Factors
HCV causes hepatitis C. People contract the virus through blood-to-blood contact with contaminated blood. For transmission to occur, blood containing HCV must enter the body of a person without HCV.
A speck of blood, invisible to the naked eye, can carry hundreds of hepatitis C virus particles, and the virus is not easy to kill.
The report the following risk factors for developing hepatitis C:
- using or having used injectable drugs, which is currently the most common route in the U.S.
- receiving transfusions or organ transplants before 1992, which is before blood screening became available
- having exposure to a needle stick, which is most common in people who work in healthcare
- being born to a mother who has hepatitis C
The CDC offer advice on cleaning syringes if it is not possible to use clean and sterile ones. Although bleach can kill the HCV in syringes, it may not have the same effect on other equipment. Boiling, burning and using alcohol, peroxide, or other common cleaning fluids to wash equipment can reduce the amount of HCV but might not stop a person from contracting the infection.
It is extremely dangerous to inject bleach, disinfectant, or other cleaning products, so people should make sure they rinse the syringe thoroughly. A person should only ever use bleach to clean equipment if new, sterile syringes and equipment are not available.
People who are at risk due to these factors can have screening to rule out HCV.
- peginterferon alfa-2a
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Can Primary Liver Cancer Be Prevented
Prevention is the best defence against primary liver cancer. Worldwide, the most common risk factors for primary liver cancer are chronic hepatitis B and C infections. Therefore, the prevention of these forms of liver disease is essential. The Canadian Liver Foundation recommends that all children, as well as adults at high risk of being exposed to the virus, should be vaccinated against hepatitis B.
Since there is no vaccine against hepatitis C, it is crucial to prevent the spread of this disease and to identify and assess all those who are already infected with the hepatitis C virus for treatment. The Canadian Liver Foundation recommends that all people with risk factors and adults born between 1945 and 1975 should get tested for hepatitis C.
Alcohol intake should be limited to no more than one to two standard drinks per day. Drinking alcohol every day, as well as binge drinking, can be harmful to your liver. If you already have a liver disease, the safest amount of alcohol is no alcohol at all.
As mentioned earlier, non-alcoholic fatty liver disease and its most severe form, non-alcoholic steatohepatitis is a big risk factor for liver cancer. It is important to maintain a healthy body weight, eat a well-balanced diet, and introduce physical activity into your daily routine.
What Does The Future Hold
The Canadian Liver Foundation funds research into the causes, diagnosis, prevention and treatment of all forms of liver disease including liver cancer. Scientists are looking for the causes of liver cancer, ways to prevent it and methods to improve treatments. Prevention of new viral hepatitis infections and better treatments for chronic hepatitis could prevent about half of liver cancer cases worldwide. New methods that combine treatments with surgery or other types of treatment are being studied.
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