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.
Can Hepatitis C Be Treated
Yes, since 2010 enormous progress has been made in the treatment of chronic hepatitis C. New therapies called direct-acting antivirals are pills that act on the virus itself to eradicate it from the body, unlike older medicines like interferon injections which work by stimulating an immune response. These new treatments are very effective and can achieve cure rates of over 90%. In most situations now, there is no need for interferon, which was responsible for many of the side effects previously associated with HCV treatment. The new treatment combinations require shorter treatment durations , have reduced side effects and appear to be effective at all stages of the disease.
Because these new therapies are very new, they remain very expensive. As such, drug coverage from both government and private companies may require that your liver disease has progressed to a certain stage before they are willing to cover the cost of these drugs.
Your primary care physician may refer you to a specialist to determine whether you are eligible for treatment. A specialist will help you decide which drug therapy is best for you based on the severity of your liver disease, your virus genotype and whether or not you have been treated in the past.
Relation Between Hepatitis C And Hepatocellular Carcinoma
Hepatocellular carcinoma accounts for 85 to 90% of the cases of primary liver cancer. Chronic hepatitis and cirrhosis constitute the major preneoplastic conditions in the majority of HCC. The risk of developing HCC for a patient with HCV-related cirrhosis is approximately 2-6% per year. HCC risk increases to 17-fold in HCV-infected patients compared to HCV-negative subjects. In general, HCC develops only after two or more decades of HCV infection and the increased risk is restricted largely to patients with cirrhosis or advanced fibrosis.
Multiple steps are required in the induction of all cancers it would be mandatory for hepatocarcinogenesis that genetic mutations accumulate in the hepatocytes. In HCV infection, however, some of these steps might be skipped in the development of HCC, in presence of the core protein. The overall effects achieved by the expression of the core protein would be the induction of HCC, even in the absence of a complete set of genetic aberrations, required for carcinogenesis. By considering such a non-Vogelstein type process for the induction of HCC, a plausible explanation might be given for many unusual events happening in HCV carriers.
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Hepatocellular Carcinoma And Hepatitis C Virus Infection In Latin America: Epidemiology Diagnosis And Treatment
Hugo Christian Monroy-Ramirez1 Jaime Sanchez-Meza1 Laura Sanchez-Orozco1 Juan Armendariz-Borunda1,2
1 University of Guadalajara, Institute of Molecular Biology in Medicine and Gene Therapy , Department of Molecular Biology and Genomics, Health Science University Center ,
Campus Guadalajara, Jalisco 45138, Mexico .
Received:First Decision:Revised:Accepted:Science Editor:Copy Editor:Production Editor:
© The Author 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Hepatitis C Virus Core
Hepatitis C virus core is involved in binding viral RNA, regulating HCV RNA translation, making homotypic interactions for particle assembly and interacting with the glycoproteins to generate a complete virion. In addition to these more predictable functions, the core gene product has been proposed to be also involved in cell signaling, transcriptional activation, apoptosis, lipid metabolism and transformation. An extensive list of cellular proteins has been shown to interact with HCV core, but, in most cases, it is still unclear whether these interactions occur in the course of a normal infection or reflect protein overexpression.
Additional proteins that interact with C include the LZIP protein , the hnRNP K , the RNA helicase DEAD box DDX3 protein and the 14-3-3 protein . The tumor necrosis factor receptor and the lymphotoxin receptor have been shown to interact with C and a role in inhibiting apoptosis has been proposed for HCV core through these interactions . Hepatitis C virus core also has been proposed to have immunosuppressive activities through its interaction with the complement receptor C1qR on T cells, thus contributing to chronic infection .
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Nonalcoholic Fatty Liver Disease/nonalcoholic Steatohepatitis
Due to the growing obesity epidemic, nonalcoholic fatty liver disease is the most common form of chronic liver disease which includes a clinic-pathologic spectrum of disease ranging from isolated hepatic steatosis to nonalcoholic steatohepatitis , which can progress to cirrhosis or HCC. Once cirrhosis has developed, NASH pathology may be difficult to evaluate because fatty deposition and inflammation often disappear. Between 40% to 60% of patients with NASH-induced cirrhosis may develop a complication such as HCC after a period of 5 to 7 years. A meta-analysis conducted by Singal et al., showed an association between the PNPLA3 variant and an increased risk for HCC, especially in patients with NAFLD-related cirrhosis. According to the Centers for Disease Control, the incidence of HCC was higher in Latinos than in non-Latinos. Latinos with HCC also have shorter survival rates than non-Latinos.
Multidisciplinary Care For Patients
The Simmons Comprehensive Cancer Center and the Liver Transplant Program receive many referrals for the prevention and management of liver cancer treatment both incident and recurrent cases. Our cancer center is one of just 32 U.S. cancer research centers named by the National Cancer Institute as a National Clinical Trials Network Lead Academic Participating Site.
Only centers that meet rigorous standards for advanced cancer research can become NCI-designated. UT Southwestern is also home to one of the largest and most robust liver transplantation programs. Together, we care for patients awaiting liver transplants as well as those who have complex concurrent conditions such as decompensated cirrhosis from hepatitis C, alcohol-related liver disease, or non-alcoholic steatohepatitis.
As a multidisciplinary team, we approach patient care holistically with the goal of improving overall patient health along with their emergent liver condition. UT Southwestern continually pushes the boundaries of research in prevention and ongoing care. We anticipate that the profound findings from our research will usher in a new era in the care of patients with liver disease.
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Hepatitis C Virus Transgenic Mice
The transgenic mouse system has widely been used to study HCV proteins and carcinogenesis . Hepatitis C virus gene products have been expressed either alone or in combination in the liver of transgenic mice by using different liver-specific promoters. As already mentioned, three different HCV core transgenic lines develop liver steatosis and HCCs but other animals show only steatosis or different phenotypes , depending on the promoter used, the context of expression and the mouse strain background. NS5A transgenic mice, in spite of the pleiotropic functions of the protein in vitro, do not have any significant phenotype . The transgenic mice reported so far in HCV transgenes have always been expressed from constitutive promoters. Besides from not being amenable to any postnatal regulation, constitutive expression of HCV proteins in utero may easily induce adaptive or compensatory epigenetic that can profoundly affect the animal phenotype.
Table 1 Transgenic mice expressing HCV gene products
Testing Treating And Reducing Risk Of Hepatitis
If you think youre at risk for hepatitis infection, talk to your healthcare provider about getting tested. A blood test is usually done to see if you have been exposed to the virus. Women who are pregnant or trying to become pregnant should get tested for hepatitis.
Get treated for hepatitis infection
There are treatments for hepatitis. Treating long-lasting hepatitis B or C infection can reduce the amount of the virus in a person, which may lower the risk of liver cancer.
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Management Of Concomitant Hepatocellular Carcinoma And Chronic Hepatitis C: A Review
Elizabeth Harrod1,2,3 Carlos Moctezuma-Velazquez1 Ahmet Gurakar4 Aftab Ala2,3 Douglas Dieterich1 Behnam Saberi1
1 Icahn School of Medicine at Mount Sinai , Division of Liver Diseases, New York, NY 10029, USA .
Royal Surrey County Hospital NHS Foundation Trust , Dept of Gastroenterology and Hepatology, Guildford, Surrey 571122, UK
, Dept of Clinical and Experimental and Medicine, Guildford, Surrey GU2 7XH, UK .
Johns Hopkins University School of Medicine , Division of Gastroenterology and Hepatology-Transplant Hepatology, Baltimore, MD 21287, USA .
Received:First Decision:Revised:Accepted:Science Editor:Copy Editor:Production Editor:
© The Author 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author and the source, provide a link to the Creative Commons license, and indicate if changes were made.
The Hepatitis C Virus
Hepatitis C virus is a member of the Flaviviridae family of enveloped, positive-strand RNA viruses and is the only member of the genus Hepacivirus . The HCV genome consists of an RNA molecule, of approximately 9.6kb, that contains a large open-reading frame flanked by structured 5 and 3 non-translated regions . Viral proteins are translated as a polyprotein precursor from an internal ribosome entry site located in the 5 NTR . The polyprotein undergoes a complex series of co- and post-translational cleavage events catalysed by both host and viral proteinases to yield the individual HCV proteins . The structural proteins include the core protein and the envelope glycoproteins E1 and E2. The non-structural proteins include the P7 polypeptide, the NS2-3 autoprotease and the NS3 serine protease, an RNA helicase located in the C-terminal region of NS3, the NS4A polypeptide, the NS4B and NS5A proteins, and the NS5B RNA-dependent RNA polymerase . An additional HCV protein, F or ARFP , generated by an overlapping reading frame in the core protein coding sequence, has been proposed
Figure 2Figure 3
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Cancer Risk Two Times Higher For Hcv Patients After Excluding Liver Cancer
For their study, Dr. Nyberg and colleagues assessed all cancer diagnoses that had occurred at KPSC among HCV and non-HCV patients aged 18 and older between 2008 and 2012.
The researchers found that, compared with patients without HCV, patients with HCV are not only at increased risk of liver cancer but of other cancers, including non-Hodgkin lymphoma and prostate and renal cancers.
The team identified 2,213 cancer diagnoses among patients with HCV during the 5-year study period. When liver cancer was excluded, 1,654 cancer diagnoses remained. Among patients without HCV, 84,419 cancer diagnoses were identified, with 83,795 cancer diagnoses remaining after the exclusion of liver cancer.
Based on their findings, the researchers calculated that patients with HCV were 2.5 times more likely than non-HCV patients to be diagnosed with cancer, including liver cancer. When liver cancer was excluded, cancer risk was still almost two times higher for patients with HCV, according to the study.
The results suggest that cancer rates are increased in the cohort of hepatitis C patients versus the non-hepatitis C patients, both including and excluding liver cancers. These findings certainly point to the suggestion that hepatitis C may be associated with an increased risk of cancer.
Still, the team believes their findings warrant further investigation into the association between hepatitis C and cancer risk.
Treatment For Liver Cancer
There have been many reports of effective drug therapies for hepatocellular carcinoma , but so far most have only been tested in small samples of patients. At present, no drug or combination drugs have resulted in an effective cure.
Currently treatments such as chemoembolisation, injecting alcohol into the tumour or radiofrequency ablation may be helpful as palliative treatments. Palliative treatments are those that provide relief or remission from the cancer but are not cures.
Curative Treatments
Surgical removal of the tumour
Liver resection aims to remove the tumour and the surrounding liver tissue without leaving any tumour behind. As this option is usually limited to those people with excellent liver function, ideally without cirrhosis, there are very few people eligible for it. This is usually because the remaining portion of the liver is incapable of providing the necessary support for life. For patients whose tumours are successfully removed the five year survival rate is between 21% and 57% .
Liver transplants
For people who have cirrhosis and HCC, an early liver transplant may be effective. If a transplant is available it is probably the best option. This is particularly true for people with tumours less than 5cm in size who also show signs of liver failure.
A transplant may be suggested if: a single liver tumour is less than 5cm across up to three tumours are all less than 3cm across a single tumour 5-7cm in size has not grown for at least six months.
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Daas And Liver Transplantation
There is also much speculation regarding timing of HCV treatment in patients with HCC, particularly in those for which liver transplantation is being considered. Where no guidelines exist that prevent the transplantation of HCV-viraemic organs into HCV-negative recipients, limited data is available into this practice and so it is not generally accepted. In liver transplantation specifically, outcomes of HCV-viraemic organs into HCV-positive recipients do not appear to negatively impact patient or graft survival, therefore many centres have adopted this practice. Treatment of HCV prior to transplantation may therefore pose a disadvantage in terms of wait-list time, thus allowing potential for tumour progression. This is particularly relevant in locations with high volumes of HCV-positive liver donors.
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.
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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.
Cirrhosis Of The Liver
When permanent scar tissue replaces healthy liver cells and your liver loses the ability to function, its called cirrhosis. In this condition, your liver can no longer heal itself. This can cause a variety of health concerns, including a buildup of fluid in your abdomen and bleeding from veins in the esophagus.
When the liver fails to filter toxins, they can build up in your bloodstream and impair brain function. Cirrhosis of the liver can sometimes develop into liver cancer. This risk is greater in people who drink excess alcohol. Treatment of cirrhosis depends on the progression of the condition.
Chronic hepatitis C can cause serious long-term health consequences. End-stage hepatitis C occurs when the liver is severely damaged and can no longer function properly.
Symptoms may include:
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Hepatitis In The Western Pacific
Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis , cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances , and autoimmune diseases can also cause hepatitis.
There are five main hepatitis viruses, referred to as types A, B, C, D and E. These 5 five types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.
Hepatitis B and C infections lead to chronic liver disease in hundreds of millions of people. They are the most common causes of liver cirrhosis and liver cancer.
Technical links
The Link Between Hepatitis And Liver Cancer
In medical terms, liver cancer is also known as hepatocellular carcinoma. The liver cells called hepatocytes make up 80 percent of your liver.
Scarring of your liver is usually caused by cirrhosis, which is recognized as the main risk factor for liver cancer. Cirrhosis can be caused by hepatitis B, hepatitis C, and viral hepatitis, alcohol abuse, autoimmune diseases, hemochromatosis, and other diseases that lead to chronic inflammation of the liver. Chronic hepatitis B or C infections may also lead to liver cancer.
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