Primary Hepatocellular Carcinoma: An Evergrowing Heath Care Burden

Most patients who are diagnosed with cancer in the liver suffer from metastatic disease, which is a tumor that started somewhere else in the body and then spread to the liver (metastatic disease). When we discuss a primary hepatocellular cancer however, we mean a malignancy which arose from the liver itself.
Liver cancer generally is seen today as hepatocellular carcinoma (primary liver cancer/ HCC) or cholangiocarcinoma (bile duct cancer) versus metastatic disease. Today, HCC is the third leading cancer cause of death worldwide. HCC rarely arises in a normal liver. The underlying triggers are usually cirrhosis from any cause, or chronic hepatitis B. Worldwide, HCC is the third leading cause of death from malignancy. This is due to the high prevalence of chronic hepatitis B in many countries. Here in America the incidence is rising, due to the incidence of cirrhosis from all causes, but primarily hepatitis C and fatty liver.

Cirrhosis from any cause, as well as chronic hepatitis B itself, are the two most common risk factors associated with HCC. Screening in both these patient types should occur every 6 months via right upper quadrant ultrasound or CT / MRI dedicated to the liver. A lab test called alpha-fetoprotein is also commonly used to monitor for HCC. Pain on the right side along the ribs may be the only presenting symptom, but incidental detection on imaging studies is the most common means of diagnosis.

HCC is potentially curable with liver transplantation. A 5-year survival of nearly 75% in selected patients is possible. Otherwise, in carefully selected patients (< 15-30%), resection of the cancer is possible with a 5–year survival of about 74%. All other patients undergo a variety of other treatment modalities depending on the presentation including chemoembolization and ablation procedures as well as chemotherapy. More than one treatment strategy is commonly used. Unfortunately for patients with advanced disease, they can expect a life expectancy of less than one year generally.

The most effective means of treatment against HCC is via prevention through vaccination against hepatitis B, avoiding alcohol consumption, avoiding obesity which may predispose you to fatty liver with scarring, and treatment for potentially curable or treatable diseases to include chronic hepatitis B or C, hemochromatosis, Wilson’s disease, or autoimmune hepatitis. New CDC guidelines recommend all individuals born between 1945 and 1965 or those with risk factors for viral hepatitis (blood transfusion prior to 1992, tattoos, IV drug use, and anal sex) should be screened with a one-time blood test for hepatitis C.
The physicians at Texarkana Gastroenterology Consultants are specialist familiar with HCC and those patients at risk. We welcome the opportunity to discuss your liver health at an appointment. A physician referral is not required for an office appointment.

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