A common cancer

[Guest guest]

http://thestar.com.my/health/story.asp?file=/2011/6/19/health/8924507 & sec=health

Sunday June 19, 2011

A common cancer

By PAUL YEO

starhealth@...

THE liver is the second largest organ in the body, and performs a variety of

functions that are vital to life. These include the filtering and processing of

blood; bile production; producing proteins, glucose and cholesterol; storing

fat-soluble vitamins, glycogen and iron; metabolising drugs, glucose and

haemoglobin; and even a role in immunity.

That’s an impressive resume, and it’s safe to say that when something adverse

happens to the liver, life as we know it will never be the same.

Unfortunately, many things can go wrong in the liver, and probably the worst of

the lot would be cancer.

In fact, liver cancer is the sixth most common cancer worldwide. Worse, it’s the

third most common cause of cancer-related death. This is probably due to the

fact that there are typically no symptoms of the disease until the cancer is in

its later stages.

Hepatocellular carcinoma (HCC) is the most common form of liver cancer, and is

responsible for about 90% of the primary malignant liver cancers seen in adults.

The current five-year survival rate for patients with liver cancer are as

follows: Europe, 8.6%; United States, less than 10%; and Asia, less than 10%,

for inoperable tumours. These are very depressing figures indeed.

According to consultant oncologist Dr Matin Mellor, approximately 75 to 80% of

all HCC occurs in Asia. “In some parts of Asia and Africa, HCC is the leading

cause of cancer mortality.”

Risk factors

It has been noted that liver cancer disproportionately affects men, with about

three times as many men developing the disease as women.

Although the overall cancer incidence and mortality are decreasing in the United

States, both the incidence and mortality of liver cancer are increasing

worldwide.

There are a few major risk factors for the development of the disease, but the

most significant one is chronic, cirrhotic liver disease. Cirrhosis is the

widespread disruption of normal liver structure by fibrosis and the formation of

regenerative nodules that is caused by various chronic progressive conditions

affecting the liver, such as alcohol abuse.

“Those living with hepatitis C (HCV), hepatitis B viral infection (HBV), as well

as those with alcohol-related cirrhosis, are at most risk of developing chronic,

cirrhotic liver disease. Hence, they are ultimately at higher risk for HCC.

“Worldwide, 75 to 80% of HCC cases are related to chronic HBV or HCV infection,”

noted Dr Mellor.

Other risk factors include:

·Obesity – non-alcoholic fatty liver disease (NAFLD) and non-alcoholic

steatohepatitis (NASH).

·Diabetes

·Long-term exposure to aflatoxins (naturally occurring toxins produced by many

species of fungus that can be found in tree nuts, peanuts and other oilseeds).

·Tobacco use

·Long-term use of anabolic steroids.

·In some parts of the world, water contaminated with arsenic.

Symptoms and complications

It is often said that the symptoms of liver cancer only appear late into the

disease. The signs and symptoms may include the following:

·Unexplainable weight loss

·Ongoing lack of appetite

·Feeling very full after a small meal

·A hard lump on the right side just below the rib cage

·Pain around the right shoulder blade

·Yellow-green colour to the skin and eyes (jaundice)

·Discomfort in the upper abdomen on the right side

·Unusual tiredness

·Nausea

Many of these symptoms can also be an indication of liver cirrhosis.

Liver cirrhosis leads to many complications. There can be fluid accumulation in

the abdomen (ascites), risk of infection to the lining of the abdomen (bacterial

peritonitis), enlarged spleen, distended and/or swollen veins, brain dysfunction

(hepatic encephalopathy), malnutrition, and of course, HCC.

According to Dr Mellor, HCC usually presents in patients aged 40 to 50 years

old, and about 40% of these patients do not show any symptoms during diagnosis.

“Diagnostic tests for HCC include a full history and examination, liver function

tests, ultrasound and other forms of radiology such as CT or MRI scan, and

tumour markers (in the case of HCC, it’s alpha-fetoprotein serology).

“Once a diagnosis is confirmed, the cancer is then staged. Staging is used to

determine prognosis and guide treatment,” said Dr Mellor.

“Staging HCC is difficult because most patients have underlying liver disease,

and key prognostic indicators are not clearly defined. In addition, there isn’t

a universal satging system that is used worldwide. There are a few around, and

it depends on the doctor’s personal choice as to which one is used.

“But in general, the guidelines recommend that HCC staging systems should

consider the tumour stage, liver function, health status, and impact of

treatment,” he added.

Prognosis and treatment

A person’s prognosis depends on both the extent of liver disease, as well as the

cancer. In general, a majority of patients present with intermediate or advanced

disease, which does not bode well for future prognosis.

Treatment options for liver cancer depend on the stage of the malignant disease,

underlying liver function and the patient’s overall condition.

Surgery offers the best chance to cure patients with liver cancer. If the cancer

is found at an early stage and the rest of the liver is healthy, surgery with or

without liver transplantation may be curative. However, only about 15% of

patients are operable.

“For early stage HCC, surgery (which could be partial or total removal of the

liver), or other techniques such as percutaneous ablation (a needle probe is

inserted into the liver tumour, usually under ultrasound, CT or MRI, and

radio-frequency oscillations used to kill liver cancer cells).

“For the intermediate stage, transarterial chemoembolisation (TACE) is used,” Dr

Mellor explained.

TACE exposes the tumour to high concentrations of chemotherapy and confine the

agents locally as they are not carried away by the bloodstream. At the same

time, this technique deprives the tumour of its needed blood supply, which can

result in the damage or death of the tumour cells.

Treatment options for advanced patients are limited. There is a drug, sorafenib,

which is the first approved systemic therapy for HCC, and

the only one shown to significantly improve overall survival in patients with

the disease.

References: <CUT>

[Guest guest]

http://thestar.com.my/health/story.asp?file=/2011/6/19/health/8924507 & sec=health

Sunday June 19, 2011

A common cancer

By PAUL YEO

starhealth@...

THE liver is the second largest organ in the body, and performs a variety of

functions that are vital to life. These include the filtering and processing of

blood; bile production; producing proteins, glucose and cholesterol; storing

fat-soluble vitamins, glycogen and iron; metabolising drugs, glucose and

haemoglobin; and even a role in immunity.

That’s an impressive resume, and it’s safe to say that when something adverse

happens to the liver, life as we know it will never be the same.

Unfortunately, many things can go wrong in the liver, and probably the worst of

the lot would be cancer.

In fact, liver cancer is the sixth most common cancer worldwide. Worse, it’s the

third most common cause of cancer-related death. This is probably due to the

fact that there are typically no symptoms of the disease until the cancer is in

its later stages.

Hepatocellular carcinoma (HCC) is the most common form of liver cancer, and is

responsible for about 90% of the primary malignant liver cancers seen in adults.

The current five-year survival rate for patients with liver cancer are as

follows: Europe, 8.6%; United States, less than 10%; and Asia, less than 10%,

for inoperable tumours. These are very depressing figures indeed.

According to consultant oncologist Dr Matin Mellor, approximately 75 to 80% of

all HCC occurs in Asia. “In some parts of Asia and Africa, HCC is the leading

cause of cancer mortality.”

Risk factors

It has been noted that liver cancer disproportionately affects men, with about

three times as many men developing the disease as women.

Although the overall cancer incidence and mortality are decreasing in the United

States, both the incidence and mortality of liver cancer are increasing

worldwide.

There are a few major risk factors for the development of the disease, but the

most significant one is chronic, cirrhotic liver disease. Cirrhosis is the

widespread disruption of normal liver structure by fibrosis and the formation of

regenerative nodules that is caused by various chronic progressive conditions

affecting the liver, such as alcohol abuse.

“Those living with hepatitis C (HCV), hepatitis B viral infection (HBV), as well

as those with alcohol-related cirrhosis, are at most risk of developing chronic,

cirrhotic liver disease. Hence, they are ultimately at higher risk for HCC.

“Worldwide, 75 to 80% of HCC cases are related to chronic HBV or HCV infection,”

noted Dr Mellor.

Other risk factors include:

·Obesity – non-alcoholic fatty liver disease (NAFLD) and non-alcoholic

steatohepatitis (NASH).

·Diabetes

·Long-term exposure to aflatoxins (naturally occurring toxins produced by many

species of fungus that can be found in tree nuts, peanuts and other oilseeds).

·Tobacco use

·Long-term use of anabolic steroids.

·In some parts of the world, water contaminated with arsenic.

Symptoms and complications

It is often said that the symptoms of liver cancer only appear late into the

disease. The signs and symptoms may include the following:

·Unexplainable weight loss

·Ongoing lack of appetite

·Feeling very full after a small meal

·A hard lump on the right side just below the rib cage

·Pain around the right shoulder blade

·Yellow-green colour to the skin and eyes (jaundice)

·Discomfort in the upper abdomen on the right side

·Unusual tiredness

·Nausea

Many of these symptoms can also be an indication of liver cirrhosis.

Liver cirrhosis leads to many complications. There can be fluid accumulation in

the abdomen (ascites), risk of infection to the lining of the abdomen (bacterial

peritonitis), enlarged spleen, distended and/or swollen veins, brain dysfunction

(hepatic encephalopathy), malnutrition, and of course, HCC.

According to Dr Mellor, HCC usually presents in patients aged 40 to 50 years

old, and about 40% of these patients do not show any symptoms during diagnosis.

“Diagnostic tests for HCC include a full history and examination, liver function

tests, ultrasound and other forms of radiology such as CT or MRI scan, and

tumour markers (in the case of HCC, it’s alpha-fetoprotein serology).

“Once a diagnosis is confirmed, the cancer is then staged. Staging is used to

determine prognosis and guide treatment,” said Dr Mellor.

“Staging HCC is difficult because most patients have underlying liver disease,

and key prognostic indicators are not clearly defined. In addition, there isn’t

a universal satging system that is used worldwide. There are a few around, and

it depends on the doctor’s personal choice as to which one is used.

“But in general, the guidelines recommend that HCC staging systems should

consider the tumour stage, liver function, health status, and impact of

treatment,” he added.

Prognosis and treatment

A person’s prognosis depends on both the extent of liver disease, as well as the

cancer. In general, a majority of patients present with intermediate or advanced

disease, which does not bode well for future prognosis.

Treatment options for liver cancer depend on the stage of the malignant disease,

underlying liver function and the patient’s overall condition.

Surgery offers the best chance to cure patients with liver cancer. If the cancer

is found at an early stage and the rest of the liver is healthy, surgery with or

without liver transplantation may be curative. However, only about 15% of

patients are operable.

“For early stage HCC, surgery (which could be partial or total removal of the

liver), or other techniques such as percutaneous ablation (a needle probe is

inserted into the liver tumour, usually under ultrasound, CT or MRI, and

radio-frequency oscillations used to kill liver cancer cells).

“For the intermediate stage, transarterial chemoembolisation (TACE) is used,” Dr

Mellor explained.

TACE exposes the tumour to high concentrations of chemotherapy and confine the

agents locally as they are not carried away by the bloodstream. At the same

time, this technique deprives the tumour of its needed blood supply, which can

result in the damage or death of the tumour cells.

Treatment options for advanced patients are limited. There is a drug, sorafenib,

which is the first approved systemic therapy for HCC, and

the only one shown to significantly improve overall survival in patients with

the disease.

References: <CUT>