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What Is
Hepatocellular Carcinoma?
Hepatocellular
carcinoma is a cancer that starts in your liver.
It's different from "secondary" liver cancers,
which have spread to the liver from other organs.
If
caught early, it can sometimes be cured with surgery or transplant. In
more advanced cases it can’t be cured, but treatment and support can help you
live longer and better.
It's
important to remember that you still have control over the decisions you make
about your treatment and your life. Make sure you have people you can talk to
about your plans, your fears, and your feelings. Ask your doctor about support
groups, where you can meet people who know what you're going through.
Your
doctor can help you understand your treatment options. Surgery, radiation,
and chemotherapy are
some of your choices.
Causes
Doctors
aren't sure exactly what causes all cases of hepatocellular carcinoma, but
they've identified some things that may increase your risk for getting it:
Hepatitis B or hepatitis C. Hepatocellular cancer can start many years after you've
had one of these liver infections. Both are passed through blood,
such as when drug users share needles. Blood tests can show whether you have
hepatitis B or C.
Cirrhosis. This serious disease happens when liver cells are
damaged and replaced with scar tissue. Many things can cause it: hepatitis B or
C infection, alcohol drinking, certain drugs, and too much iron stored in the
liver.
Heavy drinking. Having more than two alcoholic drinks a day for many years
raises your risk of hepatocellular cancer. The more you drink, the higher your
risk.
Obesity and diabetes. Both conditions raise your risk of liver cancer. Obesity can lead to nonalcoholic fatty liver
disease, which can lead to hepatocellular carcinoma. The higher risk
from diabetes may be due to high insulin levels in people with diabetes or
from liver damage caused by the disease.
Iron
storage disease. This
causes too much iron to be stored in the liver and other organs. People who
have it may develop hepatocellular carcinoma.
Aflatoxin. This harmful substance, which is made by certain
types of moldon peanuts, corn, and other nuts and
grains, can cause hepatocellular carcinoma.
The U.S. has safety measures that limit aflatoxin in the food supply.
Symptoms
You might not have any symptoms when
hepatocellular carcinoma is in an early stage. As the cancer grows, you may have one or more of
these:
- Pain in the upper right part of your belly
- A lump or feeling of heaviness in your upper belly
- Bloating or swelling in your
belly
- Loss of appetite and feelings of fullness
- Weight loss
- Weakness or deep fatigue
- Nausea and vomiting
- Yellow skin and eyes
- Pale, chalky bowel movements and dark urine
- Fever
Getting
a Diagnosis
Your doctor will give you a physical exam and may ask you questions
like:
- Have you had any pain in your belly?
- Are you feeling weak or tired?
- Is your appetite down?
- Have you lost weight?
Your doctor may use tests to help diagnose
hepatocellular carcinoma:
Blood test. Your doctor takes a sample of your blood and
checks to see if it has a protein called AFP. : Unborn babies have high
levels of AFP, but it decreases in most people right after birth. If your
blood has a high amount of AFP, it could be a sign of liver cancer.
Imaging tests. Your doctor may ask you to get an ultrasound, CT scan, or MRI to look for tumors in your liver. An
ultrasound creates images of your liver with sound waves. A CT scan is a
powerful X-ray that makes detailed pictures inside your body. An MRI uses
strong magnets and radio waves to make an image of your liver.
Liver biopsy . Your doctor may want to remove a sample of your liver
tissue and check it under a microscope for cancer cells.
This can be done several ways. In one method, your
doctor removes some liver tissue with a needle that he places through your skin
and into your liver. He numbs the area first so you won't feel pain.
Your doctor may also do a biopsy by
making a small cut in your belly and putting a needle into the liver to pull
out a sample of tissue. You'll get anesthesia first, so you won't be awake
while this is going on.
Questions
for Your Doctor
- Has my liver cancer spread?
- What treatment do you recommend?
- What are the side effects?
- What can help my pain and treatment side effects?
- What kind of follow-up care will I need?
Treatment
There are many treatments for hepatocellular
carcinoma. It's a big decision, so work closely with your doctor to make the
right plan for you.
Your choices may
include:
Radiation. This uses high-energy rays to kill your cancer
cells. Two types of radiation therapy can treat hepatocellular carcinoma:
- External: You'll lie on a table while a large machine
aims beams of radiation at specific spots on your chest or belly.
- Internal: A doctor injects tiny radioactive
particles into the artery that sends blood to your
liver. These block or destroy the blood supply to the tumor in your liver.
Radiation therapy can cause side effects, including
nausea, vomiting, or tiredness, but these symptoms go away when treatment is
done.
Chemotherapy. To
treat cancer, doctors often place chemotherapy drugs directly into your liver.
It's a process called "chemoembolization."
Your doctor puts a thin, flexible tube into the artery
that supplies blood to your liver. The tube delivers a chemo drug combined with
another drug that helps to block the artery. The goal is to kill the tumor by
starving it of blood. Your liver still gets the blood it needs through another
blood vessel.
You usually get chemotherapy on an outpatient basis,
which means you don't need to stay overnight in a hospital. It can cause side
effects, such as nausea and vomiting, loss of appetite, fever and chills, headache, and weakness. You may also be more
likely to get infections, bruising, bleeding, and fatigue. Medicine can ease some of these side
effects.
Alcohol injection. This is also called "percutaneous ethanol
injection." An ultrasound, which uses sound waves to see structures in
your body, helps your doctor guide a thin needle into the tumor. Then he
injects ethanol (alcohol) to destroy the cancer.
You usually have this procedure under local anesthesia,
which means you won't feel pain but you're awake while this is going on.
Cryoablation and radiofrequency ablation. In cryoablation, your doctor destroys your tumor by freezing it with a thin metal probe. While you're under anesthesia, your doctor puts the probe into the tumor and delivers a cold gas that kills the cancer cells. A similar method, called radiofrequency ablation, uses an electric current to kill the cancer with heat.
Surgery to remove part of your liver. Your surgeon may take out the part of your liver
that has the cancer, an operation called "partial hepatectomy."
Healing time varies, but you might have pain and discomfort for the first few
days. Medicine can help control it. You may also feel weak or tired for a
while. Some people also have diarrhea and a sense of fullness in the stomach.
Liver transplant . If your doctor can't remove your cancer through a
partial hepatectomy, he may suggest a liver transplant.
A liver transplant is major surgery. First, you'll need
to get on a waiting list for a donor. Your new liver will come from someone who
recently died and has the same blood type and a similar body size as yours.
When donor livers are available, they go to the sickest people on the waiting
list. Since you may have to wait a long time for a new liver, your doctor may suggest
that you keep up with other treatments in the meantime.
You may need to stay in the hospital for up to 3 weeks
after your surgery. It could take you 6 months to a year before you can return
to your regular lifestyle. After your transplant, you'll need to take drugs
that prevent your body from rejecting the new liver.
If you're considering a transplant, you'll need a lot of
emotional support. Ask your doctor about support groups that have people facing
the same concerns as you. Also ask about educational workshops that can explain
what to expect before and after a transplant.
Taking
Care of Yourself
While you're getting treatment, there are lots
of things you can do to manage side effects and stay healthy.
Since chemotherapy can sometimes upset your stomach, you can try changing some of your eating habits. For instance, stay away from fried or spicy foods. You can also try eating five or six small meals a day rather than the traditional three meals.
If your treatment makes you tired, you can try to take
short naps. You also might find that short walks can help boost your energy.
If you're stressed about your treatment, sometimes deep
breathing and meditation might help you relax.
Reach out to family and friends who can give you
emotional support when you need it.
What
to Expect
For some people, treatment makes the cancer go
away. For others, the cancer may not go away completely or may return. If
that's the case, you may need regular treatment to keep it in check for as long
as possible.
Your treatment to fight liver cancer may stop working.
If that happens, you may want to focus on making sure you're as comfortable as
possible, known as palliative care.
You may not be able to control your cancer, but you control choices about how
you'll live your life.
You don't have to face things alone. Consider joining a
support group, where you can you share your feelings with others who understand
what it's like.
Getting
Support
For more information on hepatocellular cancer,
go to the web site of the American Cancer
Society. You can find out how to join support groups in your area.
You can also learn how to take part in a clinical trial, which tests new drugs to see if
they are safe and if they work. It's often a way for people to try new medicine
that isn't available to everyone.