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Hepatoma: Deadly

First Posted 09:55:00 09/21/2009

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HEPATOMA is a common and deadly cancer among Asians. I lost a close friend, a Fil-Am physician, a couple of years ago, and a few others before that, all to hepatoma. They all lived for only about 6 months from the time of diagnosis.

What is hepatoma?

Also known as hepatocellular carcinoma, hepatoma is the most common (70 percent to 85 percent) primary cancer of the liver. The rarer ones are cholangiocarninoma, hepatoblastoma and angiosarcoma. The word primary means the cancer originated in the liver, in contrast to secondary or metastatic liver cancer, which originated from another organ, like cancer of the lung, breast, pancreas, colon, or stomach spreading to the liver. Most cancer found in the liver are metastatic from other organs.

What is the incidence??

In the United States, the incidence is between 1 to 5 cases per 100,000 population per year. About 70 percent of cases of hepatoma worldwide are due to chronic hepatitis B infection, compared to only 20 percent in the United States, where 60 percent to 80 percent are alcoholic cirrhosis-related. Among those not caused by hepatitis B virus, 50 percent to 70 percent were due to chronic hepatitis C infection. Mean age of hepatoma patients is 55-62 years, and with a male to female sex ratio of 3-4?:1

What causes hepatoma?

Those with chronic hepatitis B or C infection are prone to develop liver cancer. Other causal agents include alcoholism and chronic liver cirrhosis.

Will hepatitis lead to hepatoma?

While those who have hepatitis B or C have increased risk of developing hepatoma, not all persons with a history of hepatitis B or C infection will automatically develop hepatocellular carcinoma. For these persons, a healthy lifestyle could help boost the immune system and conceivably lessen the risk.

What are the other risk factors??

Chronic use of oral contraceptives, unsterile intravenous drug abuse, primary biliary cirrhosis, hemochromatosis, some metabolic disorders (Niemann-Pick), chlonorchiasis, gallstones, and choledochal cyst, chronic exposure to vinyl chloride polymers.

What are the symptoms??

Some cases have no symptoms at all till the hepatoma has progressed, and different individuals may experience symptoms in variable ways. Some of the most common symptoms and signs are abdominal pain, weight loss, fever, nausea, vomiting, swollen abdomen, fatigue, jaundice (yellow discoloration of the skin and eyes), large mass in the right upper quadrant of the abdomen.

How is hepatoma diagnosed?

A complete medical history and physical examination by a physician is essential. Some tests are liver function test, abdominal ultrasound, computed tomography or CT scan, magnetic resonance imaging or MRI, hepatic arteriography, liver biopsy with a needle for specific microscopic pathological diagnosis, laparoscopy, and, if needed, exploratory laparotomy.

What is the prognosis?

Unless the diagnosis is made very early, which is not the usual case, life expectancy after the diagnosis of hepatoma is established generally ranges between 6-8 months.

How can one prevent hepatoma?

Vaccination against hepatitis B virus to prevent getting hepatitis B infection is an effective way to significantly reduce the risk of developing hepatoma. Hepatitis B is transmitted sexually, and through blood transfusion, like hepatitis C. So preventive mesures in this regard is fundamental. On top of this, abstinence from, or moderation in intake of, alcoholic beverages will help.

Any sign that vaccination helps??

Yes, since universal immunization against hepatitis B was implemented among children, statitsics show that the incidence of hepatoma has been reduced to 1/4 to 1/3, compared to the period before the use of the vaccine. Global immunization against hepatitis B among all infants will surely help in minimizing, if not eradicating hep-b caused hepatoma.

What are the treatments available??

The attending physician, who has all the data available including the stage of the liver cancer, will determine and recommend the appropriate treatment strategy and options. The patient, as always, especially in cases of hepatoma, has the final say.

The management could include surgery to remove the entire liver (and liver transplant for specific candidates that qualify) or partial resection of the liver with cancer, depending on the extent of involvement, external beam radiation therapy to kill the cancer cells, or, in advanced cases, to shrink the size of the tumor for pain relief, chemotherapy intravenously, or intra-arterial chemo given directly thru a catheter in the liver artery, chemo-embolization to clog the artery and cut the blood supply to the liver and anti-cancer drugs delivered to the liver directly. Radio-frequency ablation, using a special probe to kill the cancer cells with heat. Laser and microwave therapy also use heat to kill the cancer cells. A a few patients who qualify, liver transplantation may be an option, provided the cancer has not spread to other organs.

The team of physicians and surgeon, led by the oncologist, will formulate a treatment plan for each individual patient.

We all look to the day when deadly diseases like hepatoma and all other cancers could be prevented with the use of vaccines, or effectively treated with oral medications, like in the case of tuberculosis, which used to spread and ravage all the organs of the body like cancer, until French scientists Calmette and Guerin discovered the BCG vaccine against TB in 1906, and later, streptomycin was isolated on October 19, 1943 by Albert Schatz, a graduate student, and first randomized trial of the drug used against TB in 1947.

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