Liver Cancer (Hepatocellular carcinoma)

Liver is an internal organ located in the upper right portion of the abdomen, beneath your diaphragm and above your stomach.
Liver cancer is defined as a condition of out of controlled growth of hepatocellular cells in the liver. Since the organ is a soft tissue with less nerve, most liver cancer patient are diagnosed in the later stage of the cancer. According to the statistic, liver cancer remains the fifth most common malignancy in men and the eighth in women worldwide.
Hepatocellular carcinoma (HCC) is a common form of primary liver cancer.

Symptoms
1. Abdominal pain
Due to nerves in the surface was pressed onto by the tumors
2. Tenderness, discomfort in the upper-right part
Due to nerves in the surface was pressed onto by the tumors
3. Easy bruising or bleeding
Liver cancer reduces the function of platelet or numbers of platelets in the blood.
4. Enlarged abdomen
It may caused of enlarged liver or spleen due to cancer invasion
5. Yellow skin or eyes
Due to jaundice, as a result of too much bilirubin (yellow pigment) builds up in the body as a result of blocking off of major duct in the bile duct system, causing bile spill in the bloodstream.
6. Unintentional weight loss
Unintentional weight loss over 10% is a common system of all forms of cancer.
7. Loss of appetite
A common symptom for people with cancer
8. Severe pain
In the later stage of the cancer
9. Drowsiness and confusion
In the later stage of the cancer
10. Etc.

Causes and risk factors
1. Age
It is usually seen in people between the ages from 60 - 70 IN the State, but it can also develop in younger age group in some other parts of the world.
2. Gender
Hepatocellular carcinoma (HCC) occurs more often in men than women. It may be due to men are heavy drinkers than that of women.
3. Geography
The disease is more common in parts of Africa and Asia than in North or South America and Europe.
4. Cirrhosis (severe scarring in the liver)
a. Due to Hepatitis B ( As a result of contaminated blood products or used needles or sexual contact) or C (as a result of direct contact with infected blood, either from contaminated blood products or needles) virus infection that damage to the liver
b. As a result of the immune system attacks liver cells cause of inflammation of the liver.
c. As a result of prolonged period of alcohol abuse.
d. Hemochromatosis, as a result of too much iron in the body
e. Etc.
5. Aflatoxin B1
Aflatoxin B1 found in a fungus can cause mutations in the p53 gene in interfering with its function of tumor cells inhibition
6. Diabetes and obesity
Diabetes and obesity increases the risk of fatty liver, that can cause cirrhosis.
7. Etc.

Diagnosis and tests
If there are symptoms of about found, medical history may review that a patient is a heppatitis virus carrier or physical examination may show an enlarged, tender liver.
1. Ultrasound
Ultrasound allows your doctor to visualize the liver and around structures and to assess blood flow to the liver as well as looking for any abnormal cells growth mass, including cancer.
2. CT scan
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes. This test is helped to determine whether liver abnormality is a cyst or a tumor. Unfortunately, CT scan can only review the existence of cancer . but can not tell it is a primary or secondary cancer.
3. MRI (magnetic resonance imaging)
MRI (magnetic resonance imaging is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the metastasis of cancer in the liver and surrounding areas.
4. Alpha-fetoprotein (AFP) blood test
AFP is one of most common used blood test as its act as a marker of hepatocellular carcinoma found in about 65% of all cases.
5. Liver scan
Liver scam is performed first by injecting a inject a radioactive material called a radioisotope into one of your veins. After about 2 hours, as the liver is soaked up with the substance, images are taken and displayed on a computer to check how well the liver or spleen is working.
6. Liver function test
liver function tests, is a group of seven tests used to evaluate the liver for injury, infection, or inflammation including Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Total bilirubin and direct bilirubin, etc. The purpose of the test is to determine whether the liver has been damaged.
6. Liver biopsy
In liver biopsy, a sample of liver is taken by a thin, like-tube instrument to examine under microscopy to review the stage of the cancer.
7. Etc.

Grades of hepatocellular carcinoma
The Grade of hepatocellular carcinoma is depending to the tendency of spreading. Low grade cancers usually grow more slowly and are less likely to spread while high grade cancers indicate otherwise.

Stages of hepatocellular carcinoma
1. Stage 0
Hepatocellular carcinoma is classified as Stage 0, if the cancerous cell have not penetrated in deeper tissue but in the surface of the liver lining.
2. Stage I
In stage I, The cancerous cells are no longer in the surface but have invaded into deep liver lining, but still completely inside the liver.
a. Stage IA1
The cancer is not ≤ 3 mm (1/8 inch) deep and ≤ 7 mm (1/4 inch) wide.
a.1. Stage IA1: The spreading is < 3mm(1/8 inch) deep and & less than 7mm (1/4 inch) wide.
a.2. Stage IA2: The invasion area is ≥ 3 mm but ≤ 5 mm (about 1/5 inch) deep and & less than 7 mm (about 1/4 inch) wide.
b. Stage IB: The cancer in this stage have invaded the connective tissue, & less than 5mm (1/5 inch).
b.1. Stage IB1: Cancer is 4 cm large (1 3/4 inches).
b.2. Stage IB2: Cancer is ≥ 4 cm (1 3/4 inches) but & less than 5cm (1/5 inch)
3. Stage II
In stage II, the cancerous cells have spread to distant tissues, but is still within the liver.
4. Stage III
In this stage, cancerous cells has spread to the tissues immediately surrounding the liver.
5. Stage IV
In stage IV is the most advance stage of hepatocellular carcinoma as cancerous cells have spread to distant parts of the body

Prevention
A. How to avoid
1. Reduce intake of alcohol
Excessive drinking of alcohol and alcohol can causes cirrhosis, causing hepatocellular carcinoma.
2. Infection with hepatitis B, C
Hepatitis C can be infected by contaminated blood products or used needles, and hepatitis B can be infected by contaminated blood products or needles.
3. Practice Safe Sex
Hepatitis B. or C can be transmitted through unprotected sex.
4. Get the Hepatitis B Vaccine for children
hepatitis B vaccine helps to prevent the disease by producing hepatitis B antibody.
5. Do not overdose with iron
Over dose of iron can be toxic to the liver. Iron supplement can only be taken with the doctor prescription.
6. Etc.

B. Diet
Diet, rich in fruits and vegetables
The researchers found that Diet rich in fruits and vegetables held good for patients with hepatitis B and hepatitis C virus (HCV) infection. Dr/. RenatoTalamini advised that, to ward off liver cancer, one should "adopt a correct diet, rich in fruits and vegetables." Also important, he added, "is limiting consumption of alcohol beverages and avoiding HCV infection by practicing safe sex and eliminating needle sharing." International Journal of Cancer, 2006
1. Broccoli sprouts
In the study, three-day-old broccoli sprouts with known levels of sulforaphane glucosinolate were grown at the site in China and then turned into a liquid extract for purposes of ensuring standard dosages, researcher found that urine test showed that carcinogens were being detoxified and removed from the bodies of those who drank the extract. As the levels of sulforaphane derivatives in the urine increased, the amount of DNA damage decreased, which may indicate a reduction in cancer risk.

2. Green-yellow and green leafy vegetables
In a population-based prospective study of Japanese individuals, researchers found that consumption of vegetables, green-yellow and green leafy vegetables was inversely associated with the risk of liver cancer. British Journal Cancer. 200. In fact, traditional Chinese medicine view the green color vegetables are liver tonification.

3. Garlic
In some study, researchers found that protective effects from garlic may arise from its antibacterial properties or from its ability to block the formation of cancer-causing substances..., reduce cell proliferation, or induce cell death. (Source)

4. Green tea
In a study based on findings from the huge Ohsaki National Health Insurance Cohort Study in Japan which involved 41,761 Japanese adults between 40 and 79 years of age, researcher found that found that green tea consumption was inversely associated with the incidence of liver cancer. The study documented that the more green tea consumed, the more the risk plummeted -- five cups or more offered the most protection from liver malignancies.

5. Etc.

C. Nutritional supplements
1. Antioxidants
See the effects of antioxidant against cancer proliferation.

2. Cysteine
In studies, researchers found that cysteine inhibits tumor growth and improves liver function.

3. Beta Carotene
In some laboratory, animal, and human studies, researchers found that vitamin A certain retinoids may also inhibit cancer development.

4. Silymarin supplement
In a study of Silymarin retards the progression of alcohol-induced hepatic fibrosis in baboons. J Clin Gastroenterol. 2003 Oct;37(4):336-9, researcher found that silymarin retards the development of alcohol-induced hepatic fibrosis in baboons, consistent with several positive clinical trials.

5. Iodine
In a study of Sodium Iodide Symporter Is Expressed at the Preneoplastic Stages of Liver Carcinogenesis and in Human Cholangiocarcinoma, researcher found that in rat liver cancer, a functional sodium iodide symporter expression was triggered as from the early preneoplastic steps, and was amplified during clonal tumor cell expansion, allowing complete tumor suppression after (131)I radiotherapy.

6. Etc.

Treatments
A. In conventional medicine
1. Surgery
a. The aim of the treatment is to cure the cancer with surgery, if possible. Otherwise, treatments are focused to treat and control the symptoms as long as possible. Surgical resection is the best chance for a cure, because of it liver's ability to regenerate when part of it is removed.
b. Risks and side effects
Surgical and anesthesia risks

2. Transplantation
a. Liver is the second most commonly transplanted major organ, after kidney. Statistic from United Network for Organ Sharing (UNOS) showed there are over 17,000 people in the US alone in a waiting list. The procedure of the transplant is to remove the failed liver by replacing it with the healthy donor's liver.
b. Risks and side effects
b.1. Surgical and anesthesia risks
b.2. Rejection
New implant liver is rejected by the immune system
b.3. Nausea
b.4. Pain
b.5. Fever
Due to infection
b.6. Jaundice
As the result of new liver has not function well.
b.7. Weakened immune system
Due to drugs used to suppress the immune system for accepting the implanted liver.
b.8. Side effects of drugs use
b.9. Etc.

3. Hepatic arterial embolisation
a. It is a procedure with an aim to block the blood supply to the tumor in the liver if liver surgery is not possible. It is considered effective if the vessels which supply oxygen and nutrients to the tumor has been cut off, leading to shrinking of the tumor. In hepatic arterial embolization, a narrow tube is inserted into a blood vessel through a small cut in the groin then passed up to the artery blood vessel to block the blood flow to the liver's tumor.
b. Side effects
It is important to note that side effects will disappeared in a few days.
b.1. Nausea and vomiting
b.2. Back pain
b.3. Fever
b.4, Etc.

4. Ablative therapy
a. Ablative therapy has been quite sometime to treat hepatocellular carcinoma by destroying the tumor without removing it, including the uses of heating with radio waves and microwaves, alcohol and freezing (Crytherapy).
b. Risk and side effects
b.1. Belly pain
b.2. Infection
b.3. Bleeding in the chest or abdomen
b.4. Etc.

5. Radiotherapy
By using high-energy x-rays or other types of radiation, radiation therapy kills liver cancer cells and keep them from growing or regrowing. Depending to stage or grade there are two types of radiation therapy.
a. External radiation
By using a machine outside the body to send direct high-energy x-rays or other types of radiation toward the cancer.
b. Internal radiation
By placing a radioactive substance direct into or near the cancer by a medical instrument with the aim to kill nearby cancer cells.
c. Side effects
c.1.. Fatigue
c.2. Chest pain
c.3. Heart problem
c.4. Short of breath
c.5. Skin discoloration or pinkness, irritation.
c.6. Etc.

6. Chemotherapy
a. Chemotherapy is most use to treat with advance stage of hepatocellular carcinoma, as it has spread to a distant parts of the body by using drugs taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells.
b. Side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.

7. Etc.

B. Herbal medicine
1. Fenugreek
Fenugreek is used both as a herb (the leaves) and as a spice (the seed), genus Trigonella, belonging to family Fabaceae. Vitro studies have shown that fenugreek exhibits chemopreventive properties against certain cancers.

2. Cinnamon
Cinnamon is an evergreen tree, genus Cinnamomum, belonging to family Lauraceae, native to southern China, Bangladesh, India, and Vietnam. In a study in 2005. researcher found that Chemical aspects of coumarin compounds in cinnamon for the prevention of hepatocellular carcinomas.

3. Scutellaria
Scutellaria is also known as skullcaps, a genus of flowering plants, genus Scutellaria, belonging to family Lamiaceae. In a study of Inhibition of Cancer Cell Proliferation and Prostaglandin E₂ Synthesis by Scutellaria Baicalensis, researchers found that Scutellaria baicalensis selectively and effectively inhibits cancer cell growth in vitro and in vivo and can be an effective chemotherapeutic agent for HNSCC. Inhibition of PGE2 synthesis via suppression of COX-2 expression may be responsible for its anticancer activity.

4. Japanese cornelian cherry
Japanese cornelian cherry is a genus Cornus, belonging to family Cornaceae, native in China, Japan and Koren. In a study of Chemoprevention against hepatocellular carcinoma ( liver cancer ) of Cornus officinalis in vitro by Am J Chin Med. 2004, researcher found that extracts of Cornus officinalis possessed the anti-oxidant activity through free radicals scavenging activity at a concentration of 50 microg/ml. In summary, our experiment implied that C. officinalis might be a candidate for chemopreventive agent against hepatocellular carcinoma through the antioxidant and anti-neoplastic effects

5. Etc.

C. Traditional Chinese medicine
1. Rou Qui
Rou Qui is also known as Cinnamon Bark. The sweet, acrid and very warm herb has been used in TCM to treat cold limbs, cold limbs, diarrhea, muscle spasm, headache, back pain, sweating and impotent and promote urination as it tonifies fire, enhances yang, disperses cold and promotes circulation in the channels by enhancing the functions of heart, ling and gallbladder channels. In a study in 2005. researcher found that Chemical aspects of coumarin compounds in cinnamon for the prevention of hepatocellular carcinomas.

2. Nu Zhen Zi
Nu zhen Zi is also known as privet fruit. The bitter, sweet and neutral herb has been used in TCM as anti inflammatory, anti cancer and anti oxidization medicine and to regulate immune system, lower blood sugar as it tonifies the liver and kidney, benefits the liver and kidney and clears heat by enhancing the function of liver and kidney channels.

3. Bai Zhi Lian
Ban Zhi Lian is also known as scutellaria. The bitter and cool herb has been used in TCM as diuretic and to treat tumors and cancer as it clears heat, expels toxins, eliminates stagnation, stops bleeding and calms pain by enhancing the functions of lung, liver, spleen, stomach and large intestine channels. In vitro study, essential oil extract of 200mg/ml of the herb possesses the effect of inhibiting the tissues of rectum cancer or colon cancer.
In lab tests of animals and breast-cancer cells, BZL101 caused apoptosis or cell death, researchers found.

4. Long Kui
Long Kui is also known as wonderberry. The bitter, cold, slightly sweet and toxic herb has been used in TCM as diuretic and antipyretic and to treat acute kidney inflammation, chronic bronchitis, throat cancer, larynx Cancer, uterus cancer as it clears heat, eliminates toxin, improve urination by enhancing the function of liver, kidney and stomach channels. A study was done at the College of Environmental and Chemical Engineering at the Yanshan University in Hebei, China, researcher found that the tumor growth inhibition of long kui polysaccarides might correlate with the reduction of TNF-alpha level of blood serum, which resulted in a massive necrosis (accidental death of cells) in tumor tissues and the up-regulation of Bax and down-regulation of Bcl-2 and mutant p53 gene expression, which triggered apoptosis in tumor cells.

5. Bai Hua She She Cao
Bai Hua She She Cao is also known as spreading hedyotis, The bitter, sweet and cold herb has been used in TCM as anti-bacteria, anti-inflammation, anti-tumor, anti-virus agent and to treat snakebite and enhances immune system as it clears heat, drains dampness, expels toxins and resolves abscesses by enhancing the functions of liver, stomach, large intestine channels.
The Sanjiv Kumar YADAV, Shao Chin LEE(Yong Loo Lin School of Medicine, National University of Singapore researcher results showed that the ethanol extract from Bai Hua She She Cao effectively evokes cancer cell apoptosis, possibly through burst-mediated caspase activation.

5. Etc.
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