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HCC – Hepatocellular Carcinoma, Symptoms, Treatments

HCC – Hepatocellular Carcinoma, Symptoms, Treatments


What is HCC?
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which means it originates in the liver itself rather than spreading to the liver from another location. HCC typically develops in the hepatocytes, which are the main functional cells of the liver.
 
HCC usually develops as a result of chronic liver diseases, such as cirrhosis (scarring of the liver tissue) caused by factors like chronic hepatitis B or C infection, excessive alcohol consumption, non-alcoholic fatty liver disease (NAFLD), or other underlying conditions. Over time, the damaged liver cells may undergo changes that can lead to the development of cancerous cells.

 
Symptoms
 
In its early stages, HCC might not show significant symptoms. However, as the tumor grows, symptoms include.
 
• Abdominal Pain or Discomfort: People with HCC experience pain or discomfort in the upper right side of the abdomen, where the liver is located.
 
• Unexplained Weight Loss: To grow the cancer cell the body need more energy than usual. So there will be sudden weight loss.
 
• Loss of Appetite: Feeling full after small meals, not having or decrease in appetite.
 
• Nausea and Vomiting: Nausea and vomiting may result from the liver’s reduced ability to process toxins and perform its normal functions.
 
• Jaundice: Jaundice is characterized by yellowing of the skin and the whites of the eyes. It occurs when the liver is unable to process bilirubin properly, leading to its buildup in the body.
 
• Fatigue: Feeling tired even after doing minimal activity. Fatigue and weakness are common symptoms of HCC.
 
• Enlarged Liver: As HCC progresses, the liver can become enlarged, leading to a feeling of fullness or discomfort in the abdomen.
 
• Swelling (Edema) and Fluid Accumulation: HCC can lead to fluid accumulation in the abdomen (ascites) or legs (peripheral edema), causing swelling and discomfort.
 
• Easy Bruising and Bleeding: The liver produces proteins necessary for blood clotting. When liver function is compromised by HCC, it can lead to easy bruising and bleeding.
 
• Changes in Bowel Habits: Changes in bowel habits, such as diarrhea or constipation, may occur due to disruptions in the digestive process.
 
• Spider Angioma: These are small, red spider-like blood vessels that can appear on the skin due to changes in blood flow caused by liver dysfunction.
 
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Diagnosis
 
• Medical History and Physical Examination:
Checking medical history, including risk factors such as chronic liver diseases, hepatitis infections, alcohol consumption, and family history of liver cancer. They will also conduct a physical examination to assess any signs or symptoms of HCC.
 
•Blood Tests:
Blood tests are conducted to evaluate liver function and check for specific markers, such as alpha-fetoprotein (AFP), which may be elevated in individuals with HCC. Other blood tests can assess liver enzymes and overall health.
 
•Imaging Studies:
• Ultrasound: It can help identify tumors and assess their size and location.
• Computed Tomography (CT) Scan: helps to visualize tumors and their characteristics.
• Magnetic Resonance Imaging (MRI): Uses magnetic fields and radio waves to create detailed images of the liver, aiding in tumor detection and characterization.
• Angiography: A procedure that involves injecting a contrast dye into blood vessels to visualize blood flow in the liver and detect abnormalities.
 
•Biopsy:
In some cases, a small tissue sample (biopsy) may be taken from the liver to confirm the presence of cancer cells and determine the type of liver cancer. Biopsies can be obtained through various methods, such as fine-needle aspiration or core needle biopsy.
 
•Staging:
If HCC is confirmed, staging is done to determine the extent of cancer spread. This helps guide treatment decisions. Staging may involve additional imaging studies, such as CT or MRI, and evaluation of liver function.
A team of healthcare professionals, including oncologists, radiologists, surgeons, and pathologists, review all available information to determine the most appropriate treatment plan based on the stage of HCC, the patient’s overall health, and treatment goals.

 
Stages of HCC
 
Staging determines the extent and severity of the cancer. It helps guide treatment decisions and predict the prognosis.
 
Stage 0 (Very Early Stage):
 
Single tumor or up to three tumors, each measuring less than 3 cm in size.
No evidence of cancer spread to nearby blood vessels or lymph nodes.
Good liver function (Child-Pugh class A).
 
Stage 1 (Early Stage):
 
Single tumor or a few tumors, but slightly larger (typically up to 5 cm).
No evidence of cancer spread to nearby blood vessels or lymph nodes.
Good liver function (Child-Pugh class A).
 
Stage 2 (Intermediate Stage):
 
Tumors may have grown larger, or there may be more than one tumor.
May involve larger blood vessels, but cancer has not spread to other organs.
May still have relatively preserved liver function (Child-Pugh class A or B).
 
Stage 3 (Advanced Stage):
 
Cancer has spread to nearby blood vessels, lymph nodes, or other parts of the liver.
May involve impaired liver function (Child-Pugh class B or C).
 
Stage 4 (End-Stage):
 
Cancer has spread to other organs or parts of the body beyond the liver.
Often involves severe impairment of liver function (Child-Pugh class C).

 
Treatment
 
Treatment options depend on the stage of the cancer and the patient’s overall health.
 
• Surgery:
Resection: Surgical removal of the tumor and a portion of the surrounding healthy tissue.
Liver Transplantation: a liver transplant may be recommended, particularly for patients with early-stage HCC
 
• Ablation Therapies:
Radiofrequency Ablation (RFA): High-frequency electrical currents are used to heat and destroy the tumor.
Microwave Ablation: Microwaves are used to heat and ablate the tumor tissue.
Ethanol Ablation: Injection of ethanol (alcohol) into the tumor to destroy cancer cells.
 
• Embolization Therapies:
Trans arterial Chemoembolization (TACE): Chemotherapy drugs are directly delivered to the tumor’s blood supply followed by embolization to block blood flow.
Trans arterial Radio embolization (TARE): Radioactive microspheres are delivered to the tumor’s blood vessels to destroy cancer cells.
 
• Targeted Therapies:
Sorafenib (Nexavar): An oral targeted therapy that inhibits the growth of cancer cells and blocks blood vessel formation.
Lenvatinib (Lenvima): Another oral targeted therapy that can be used as a first-line treatment for advanced HCC.
 
• Immunotherapy:
Checkpoint Inhibitors: Some Drugs can enhance the immune system’s ability to recognize and attack cancer cells.
 
• Radiation Therapy:
External Beam Radiation: High-energy rays are directed at the tumor to destroy cancer cells.
Internal Radiation (Brachytherapy): Radioactive materials are placed directly inside or near the tumor.
 
• Supportive Care:
Supportive therapies, such as pain management, nutrition support, and management of complications, are important aspects of HCC treatment.
 
• Clinical Trials:
Participation in clinical trials may provide access to experimental treatments that are being investigated for their effectiveness against HCC.

 
Prevention:
 
Preventive measures include reducing the risk factors associated with chronic liver diseases, such as getting vaccinated against hepatitis B, avoiding excessive alcohol consumption, maintaining a healthy weight, and managing conditions like diabetes.
 
Hepatocellular carcinoma is a serious condition, and individuals at risk due to chronic liver disease should have regular medical check-ups and screenings. Early detection and timely intervention can have a positive impact on treatment outcomes.

 


 
 

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