Hepatocellular carcinoma is a tumor disease of the liver. The tumor arises directly from liver cells.
What is hepatocellular carcinoma?
In medicine, hepatocellular carcinoma is also known as hepatocellular carcinoma or hepatocellular carcinoma. This refers to a malignant tumor in the liver. In most cases, it arises from chronic liver inflammation or liver cirrhosis. While there are no symptoms in the early stages, weight loss and pain in the upper abdomen occur in later stages. Hepatocellular carcinoma is more common in men than in women. In Germany, the severe disease is relatively rare. In contrast, hepatocellular carcinoma occurs more frequently in Africa and Asia. In western industrialized countries, liver disease is primarily caused by heavy alcohol consumption. In developing countries, however, infections with hepatitis B and hepatitis C as well as mold also have an influence on the development of liver cancer. Three different types of liver cancer are differentiated. In addition to hepatocellular carcinoma, these are cholangiocellular carcinoma, which develops from the cells of the bile ducts, and angiosarcoma, which develops from the liver blood vessels. Hepatocellular carcinoma forms the most common liver cancer variant, accounting for about 80 percent of all cases.
Causes
What causes hepatocellular carcinoma has not been able to be precisely clarified to date. However, there are some known risk factors that have a favorable effect on the disease. These include, first and foremost, alcohol consumption and obesity. Otherwise, the three different types of liver cancer also have different risk factors. In the case of hepatocellular carcinoma, this is primarily cirrhosis of the liver, also known as shrunken liver. In most cases, liver cirrhosis is caused by chronic viral infections, which include hepatitis B and C. Liver cirrhosis and chronic liver inflammation have in common that they cause the death of liver cells. By forming new liver cells and connective tissue, the liver makes an attempt to make up for the loss. However, if the cells are divided, there is a risk of errors in the genetic code. If there is an increased formation of new cells in the diseased liver, this leads to an increased risk of degeneration. This results in above-average growth and more frequent division of the diseased liver cells. In this way, a tumor is eventually formed. Mold toxins are also among the risk factors for hepatocellular carcinoma. Highly toxic aflatoxins with carcinogenic effects are produced by the mold (Aspergillus flavus). The fungus is usually found in cereals or nuts that have been grown under poor conditions and subjected to damp storage. In most cases, hepatocellular carcinoma occurs in Africa and Asia due to mold toxins. Another risk factor is congenital iron metabolism disorders. In these cases, an excess of iron is absorbed from the organism and deposited in the liver, eventually leading to its damage.
Symptoms, complaints, and signs
Symptoms appear relatively late in hepatocellular carcinoma. Most often, they are nonspecific complaints such as loss of appetite, nausea, and vomiting. In addition, there is pressure pain in the right upper abdomen, which is due to capsular tension in the liver. As hepatocellular carcinoma progresses, the tumor can also be palpated with the hand in the right upper abdomen. Emaciation and abdominal dropsy are considered typical accompanying symptoms.Other symptoms of hepatocellular carcinoma may include unexplained weight loss, a general feeling of weakness, and jaundice.
Diagnosis and disease progression
Usually, the symptoms lead the patient to the family doctor or to an internist. The physician looks at the patient’s medical history (anamnesis) and inquires whether there have been previous cases of chronic liver inflammation and cirrhosis in the family, whether foreign travel to Africa or Asia has been undertaken, and what quantities of alcohol are consumed. During the physical examination, the physician looks for enlargement of the liver under the right costal arch. In the case of cirrhosis, the surface of the liver proves to be irregular, which can be palpated.In addition, the physician taps the abdomen with his fingers to detect water retention in the abdominal cavity. A blood test can provide further information. For example, the AFP level in the blood serum is elevated in 50 percent of all patients with hepatocellular carcinoma. Imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) are also important, as they make the tumor visible and indicate liver cancer metastases. Also available is the collection and laboratory examination of a tissue sample. The course of hepatocellular carcinoma is usually poor, as it is often discovered late. Without treatment, the patient will die after approximately six months.
Complications
In many cases, hepatocellular carcinoma is diagnosed very late, so treatment is also late. In most cases, patents suffer from nausea or vomiting in the process. There is also a severe loss of appetite and thus not infrequently a significant loss of weight. There is also pain in the upper part of the abdomen, which can lead to restrictions in everyday life. In addition, patients suffer from significant accumulations of water in the abdomen and a general feeling of weakness. Furthermore, hepatocellular carcinoma also leads to jaundice and a greatly reduced ability to cope with stress in the affected person. As a rule, hepatocellular carcinoma can only be treated by surgery. Special complications do not occur in most cases. However, in severe cases, patients are dependent on a liver transplant to prevent death. The complications that may occur depend greatly on the patient’s health condition. It is also possible that the hepatocellular carcinoma significantly reduces the life expectancy of the affected person. Furthermore, chemotherapy is not infrequently necessary, which can further lead to various side effects.
When should one go to the doctor?
Nonspecific symptoms such as lack of appetite and nausea may indicate hepatocellular carcinoma. The affected person should therefore have the symptoms clarified quickly by a medical professional so that appropriate treatment can be initiated without delay. If the symptoms suddenly become more severe, an immediate visit to the doctor is indicated. The same applies if other accompanying symptoms of hepatocellular carcinoma occur, such as emaciation and abdominal dropsy. Other warning signs that should be clarified are jaundice, weakness and recurrent attacks of dizziness. Individuals suffering from liver disease should contact the responsible medical specialist if they experience loss of appetite or other unusual symptoms. Other at-risk groups, such as hepatitis B and C patients and people with a congenital iron metabolism disorder, also need to see a doctor immediately if they experience warning signs. If the carcinoma is not treated, chronic symptoms may develop. In addition, untreated hepatocellular carcinoma significantly reduces life expectancy. For this reason, the family doctor, a hepatologist or a gastroenterologist should be consulted if there is any suspicion. In chronic disease, a therapist may be involved in treatment in consultation with the physician.
Treatment and therapy
Treatment of hepatocellular carcinoma depends on the stage of the disease. In most cases, surgery must be performed to remove sections of the liver. In some cases, liver transplantation is also possible, in which the diseased liver is exchanged for a donor organ. The patient’s state of health and age also play an important role in treatment. Destruction of liver cancer tissue is feasible with laser therapy or radiofrequency therapy. Cytostatic drugs, on the other hand, respond poorly to hepatocellular carcinoma. Only the tyrosine kinase inhibitor sorafenib is effective. For palliative treatment, tumor embolization can be performed. Furthermore, local chemotherapy with agents that have a necrotizing effect can take place.
Prospect and prognosis
The prognosis for hepatocellular carcinoma depends on the progress of the disease. The earlier a diagnosis is made and thus an early start of treatment can take place, the better the prospects for relief of existing symptoms. Nevertheless, it should be borne in mind that hepatocellular carcinoma is often detected at an advanced stage of the disease.This makes treatment options much more difficult and can contribute to the spread of cancer cells. In young people, with a stable immune system and no other diseases present, recovery can occur. However, complications and further formation of metastases often occur. These worsen the prospect of recovery and can result in the premature death of the affected person. Since this disease is not expected to heal spontaneously, refusal of medical help inevitably leads to the death of the affected person. If a donor organ can be found, the prognosis improves. Although liver transplantation is associated with various risks and side effects, it is a good way to achieve recovery. If the operation proceeds without further disturbances and the organism accepts the donor organ well, the carcinoma can be cured. The affected person is nevertheless bound to lifelong medical care and experiences a limitation of physical resilience.
Prevention
To prevent hepatocellular carcinoma, abstaining from alcohol is advisable. In addition, molds should be avoided.
Aftercare
In most cases, the measures of aftercare for hepatocellular carcinoma prove to be reactively difficult or are not available to the affected person at all. In this case, the disease must be detected and treated by a physician at a very early stage to avoid further complications in the daily life of the affected person. If hepatocellular carcinoma is not treated properly, most cases result in the premature death of the affected person. In some cases, various medications can be used to alleviate the symptoms of hepatocellular carcinoma. In this case, the affected person should always ensure that the medication is taken correctly and also that the dosage is correct. If there is any uncertainty or if there are any questions, a doctor should be consulted first, and the doctor’s instructions should always be followed. However, in many cases hepatocellular carcinoma can be cured only by complete transplantation of a liver. Strict bed rest is required after such a procedure. The affected person should not perform any physical or stressful activities in order not to put unnecessary strain on the body. In this regard, the help and support of friends and family can have a very positive effect on the course of the disease. However, hepatocellular carcinoma significantly reduces the life expectancy of the affected person.
Here’s what you can do yourself
Treatment of hepatocellular carcinoma is based on the stage of the disease. If the tumor is detected at an early stage, the patient only needs to pay attention to a healthy and active lifestyle. In combination with drug therapy, this is often already sufficient to prevent further growth of the carcinoma. In the case of larger tumors, surgical intervention is necessary. The patient can support recovery by taking it easy after the operation and following the doctor’s instructions regarding diet and hygiene measures. If any discomfort or complications arise, the physician must be informed. In addition, it should be ensured that the wound heals well. Accompanying this, the physician will refer the patient to a counseling center for tumor diseases. Especially in cases of severe disease progression, it is useful to talk to a therapist and other people affected by the disease. Liver cell carcinoma can usually be treated well, but there is a relatively high risk of recurrence. The diet should therefore be maintained even after treatment has been completed. In particular, stimulants such as alcohol, nicotine and coffee must be avoided. Regular check-ups must be adhered to.
