Liver Cancer: Pathophysiology, Prevalence, Treatment Options and Interventions

This report discusses the pathophysiology, prevalence, treatment options and interventions for liver cancer. It covers the causes, symptoms and treatment regimes for this highly aggressive cancer. The report also includes information on the distribution pattern of HCC, treatment options, and the use of anti-angiogenesis drugs. The report concludes with a discussion of the development of a Hong Kong Liver Cancer Staging System with treatment stratification for patients with hepatocellular carcinoma.

Liver cancer, popularly known as
hepatic cancer can be defined as
the cancer that initiates in the liver
and spread to everywhere else.
The liver is the biggest organ in
the human body. It is comprised of
four lobes and is red in color.
Symptoms of hepatic cancer
includes excessive pai in the right
side just below the rib cage,
swelling of abdomen, sensation of
lump formation, easy bruising,
drastic weight loss and high
fatigue. Several causes behind
the occurrence of liver cancer has
been detected by healthcare
service users. One of the major
causes behind hepatic cancer is
cirrhosis due to hepatitis B,
hepatisis C and alchohol. Other
reason behind the occurrence of
hepatic cancer includes afflatoxin,
non-alchoholic fatty liver diseases
and liver fluxes. In this report, the
pathophysiology of the condition,
prevalence treatment options,
outcomes and interventions have
been discussed.
LIVER CANCER
Name of the Student
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Author Note
Hepatocellular carcinoma is defined as the primary malignancy of the liver that takes
place predominantly in the healthcare service users who are suffering from underlying
chronic liver disease as well as cirrhosis. According to a group of researchers, the cells
of origin are the hepatic stem cells (Forner et al., 2014). This disease takes place
equally in men as well as women. However, major people of the healthcare service
users who are being appointed to the healthcare home for hepatic cancer are of the
age 50 eras or above. The chief difference between metastatic liver cancer and
heptocelluler carinoa is that the later initiates within the liver and slowly spread into
other parts of the human body. Thus it can be understood that Hepatocelluler cirrhosis
is highly fatal and causes inflammation as well as hemochromatosis.
The distribution pattern of HCC demonstrate geographical variation and its
pathogenesis is multifactorial. Environmental, infectious, nutritional, metabolic, and
endocrine factors contribute directly or indirectly to hepatocarcinogenesis. The
occurrence of several additional risk factors further accentuates the risk. HCC is
commonly associated with chronic hepatitis as well as liver cirrhosis. As per
researchers, both environmental as well as external factors eventually lead to genetic
variation which in turn delays the appotosis as well as enhance the cellular proliferation
(Heimbach et al., 2017). The genes which gets altered during hepatocarcinogenesis is
PIKCA and beta–catenin genes. In health care service users suffering from HCC, there
prevails the chance of the genes getting mutated. The two major pathways that are
involved in cellular differentiation include Wnt-beta-catenin and Hedgeegog.
Treatment options and outcomes
In order to reduce the negative impact of Hepatic cancer
globally, several treatment options has been invented
over time.
Percutaneous ethanol injection
In this process, alcohol is directly injected into the liver of
the healthcare service users. It also has several side
effects that include intensive pain as well as fever (Dhir et
al., 2016). However, healthcare professional suggests this
method of treatment since it s highly safe and simple.
Radiation therapy
This treatment involves destruction of the affected cells
with the help of gamma rays radiated from the machine
(Bruix, Reig & Sherman, 2016). Only a radiation
oncologist who is specialized in treating health care
service users using radio therapy are allowed to use this
therapy. Any unprofessional act has the potential to cause
death of the patient
Radio Frequency Ablation (FA)
One of the multiple methods for the treatment of the
cancer, radio frequency ablation is the therapy where
compressed heat is generally used for targeting the
breakage of the cancer cells. With injection of the heat
therapy via the skin, the whensurgical incision or the
laparoscopy treatment takes place when the infected
victim or the patients are under the influence of sedatives.
The process of sedation involves the medications that
generally enable the patients to feel relaxed, sleepy and
calm. This process is also known as thermal ablation.
The Surgery
This treatment option is renowned and generally involves
the action or dissection of the human body targeting to
remove the infected tumor and the other connected
tissues. According to multiple researches and studies,
surgery or dissection is the most efficient treatment mode
of the liver cancer till decade. Surgery is mostly suitable
for the patient who’s functioning of liver is still good and
only a very small portion is infected and thus needs
removal. Surgery may not serve as the best option if the
infected tumor occupies a very large quantity of the liver
and if the majority of the liver is damaged throughout and
is not functioning effectively. Infected cancerous cells and
tumor that have already advanced and spread outside the
liver is not advised to be treated via surgery.
One of the most common types of surgery is the
transplantation of the liver or hepatectomy. It is basically
the removal of the portal of the liver that is infected by
cancer. This involves the replacement and reconnection
of the part of the liver that is infected from another person’
liver part. This particular option of treatment is however
not possible in case the cirrhosis has spread and taken
up the majority of the functional liver. This particular
treatment is possible that includes in case of the
following:
•If the cancer has not spread out too much in the liver
•If any suitable donor is found for the transplantation
•If the cancer has not affected the other organs of the
body disrupting the function of the liver altogether
•If the size of the cancerous cell or the infected tumor
is not larger than 3cm
Some of the major symptoms of the side effects of liver
transplantation are temporary failure of the liver, pain,
weakness and restlessness. After the transplantation of
liver, the infected patient is then monitored for the major
and the vital signs that furthermore indicate the liver
rejection in case the cancer cells and the tumor are
coming back. Some of the medications include the
prescribed drugs that furthermore assist the patient for
the prevention of the rejection. The prescribed drugs
sometimes impose some major side effects like puffiness
in the face, high blood pressure, increased growth of the
body hair. This extremely common method sometimes
results in some of the serious outcomes like death.
Apart from the surgical intervention which is the
most wide spread treatment for the liver cancer,
percutaneous intervention is the best measure
for the small tumors. The injection of the
percutaneous ethanol injection is the most
widely used technique. Apart from these the
chemoembolization and transarterial
embolization are the most widely used
intervention. Some of the major drugs that are
used for the intervention and the follow ups for
the activities in case of the paramedics include
the following:
1.Epirubicin
2.Gemcitabine
3.Tamoxifen
4.Thymophysin
5.Fluorouracil
Hepatocellular carcinoma or the cancer of the
liver is one of the most common malignant
tumors. The treatment for the liver cancer is
generally based on the controlled trials, the
observational studies and the interventions that
includes the surgical, transarterial,
percutaneous, drugs, genes and some of the
revised immune therapies.
According to a survey conducted in the year 2017, it has been
found that Hepatic cancer is the third most prevalent type of
cancer and approximately 9.6 percent of all the deaths that takes
due to cancer is caused by the mentioned disease (Attwa,
2015). Even in this era of advanced technology, the mentioned
type of cancer is considered to b highly aggressive and the in
spite of medication and operation has poor survival rate, it is
currently a major concern of the health care professional and
researchers globally. As per a survey, 79 percent of the
individuals who are affected from hepatic cancer reside in
developing countries (Bruix, Gores & Mazzaferro, 2014). Almost,
98 percent of the sufferer of the mentioned cancer type is of the
age range 68 to 75 years. Amongst the different subtypes of the
Hepatocellular carcinoma, the intraheptic cholangiocarcinoma is
the one that accounts for the majority. Apart from hepatitis B and
hepatitis C, some of the other risk factors includes the fatty liver
diseases, exposure to aflatoxins, obesity, smoking and alcohol
induced cirrhosis. According to researchers, the above
mentioned risks factors are modifiable and if modified timely
posses the potential to reduce death rates that takes place due
to Hepatocellular carcinoma (Kozbial et al. 2016). Major
modification strategies include modification in the life style as
well as immunization from the virus of hepatitis. Considering the
fact that several technological advancement has made it
possible for the healthcare service user to screen different
causative agents of the HCC, I t is expected that the death rate
due to the mentioned type of cancer will get reduced in the
recent years.
The rate of liver cancer in Australia is considerably high
compared to other developed countries like USA and UK. The
rank of the nation, when it comes to number of individual who
have got affected in Liver cancer is 15th inn male and 20th in
Female. As per the survey, the rate of liver cancer is getting
increased in an alarming rate (Ayuso et al., 2018). Or instance,
the rate of hepatic cancer in men has got increased by 0.34
percent in the year 2016. When it comes to female the rate of
enhancement of hepatic cancer is approximately 0.23 percent.
As per researchers, men are more likely to get affected by
Hepatic cancer compared to women. The death ratio of men
versus women also signifies the same. One out of 198 males
who are of the age 75 ears are likely get affected by the
mentioned type of cancer while one out of 156 females are likely
to get affected by the same.
PREVALENCE/EPIDEMIOLOGY
INTERVENTIONS
Attwa, M. H. (2015). Guide for diagnosis and treatment of hepatocellular carcinoma. World Journal of Hepatology, 7(12), 1632. doi:10.4254/wjh.v7.i12.1632
Ayuso, C., Rimola, J., Vilana, R., Burrel, M., Darnell, A., García-Criado, Á., … Brú, C. (2018). Diagnosis and staging of hepatocellular carcinoma (HCC): current guidelines.
European Journal of Radiology, 101, 72-81. doi:10.1016/j.ejrad.2018.01.025
Bruix, J., Gores, G. J., & Mazzaferro, V. (2014). Hepatocellular carcinoma: clinical frontiers and perspectives. Gut, 63(5), 844-855. doi:10.1136/gutjnl-2013-306627
Bruix, J., Reig, M., & Sherman, M. (2016). Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology, 150(4), 835-
853. doi:10.1053/j.gastro.2015.12.041
Dhir, M., Melin, A. A., Douaiher, J., Lin, C., Zhen, W. (., Hussain, S. M., … Are, C. (2016). A Review and Update of Treatment Options and Controversies in the
Management of Hepatocellular Carcinoma. Annals of Surgery, 263(6), 1112-1125. doi:10.1097/sla.0000000000001556
Forner, A., Gilabert, M., Bruix, J., & Raoul, J. (2014). Treatment of intermediate-stage hepatocellular carcinoma. Nature Reviews Clinical Oncology, 11(9), 525-535.
doi:10.1038/nrclinonc.2014.122
Heimbach, J. K., Kulik, L. M., Finn, R. S., Sirlin, C. B., Abecassis, M. M., Roberts, L. R., … Marrero, J. A. (2017). AASLD guidelines for the treatment of hepatocellular
carcinoma. Hepatology, 67(1), 358-380. doi:10.1002/hep.29086
Kozbial, K., Moser, S., Schwarzer, R., Laferl, H., Al-Zoairy, R., Stauber, R., … Ferenci, P. (2016). Unexpected high incidence of hepatocellular carcinoma in cirrhotic
patients with sustained virologic response following interferon-free direct-acting antiviral treatment. Journal of Hepatology, 65(4), 856-858. doi:10.1016/j.jhep.2016.06.009
Torres, H. A., Vauthey, J., Economides, M. P., Mahale, P., &Kaseb, A. (2016). Hepatocellular carcinoma recurrence after treatment with direct-acting antivirals: First, do no
harm by withdrawing treatment. Journal of Hepatology, 65(4), 862-864. doi:10.1016/j.jhep.2016.05.034
Weinmann, A., Koch, S., Niederle, I. M., Schulze-Bergkamen, H., König, J., Hoppe-Lotichius, M., …Wörns, M. A. (2014). Trends in Epidemiology, Treatment, and Survival
of Hepatocellular Carcinoma Patients Between 1998 and 2009. Journal of Clinical Gastroenterology, 48(3), 279-289. doi:10.1097/mcg.0b013e3182a8a793
Xiao, L., Li, J., & Zheng, S. (2014). Totally laparoscopic ALPPS in the treatment of cirrhotic hepatocellular carcinoma. Surgical Endoscopy, 29(9), 2800-2801.
doi:10.1007/s00464-014-4000-1
Yau, T., Tang, V. Y., Yao, T., Fan, S., Lo, C., & Poon, R. T. (2014). Development of Hong Kong Liver Cancer Staging System With Treatment Stratification for Patients With
Hepatocellular Carcinoma. Gastroenterology, 146(7), 1691-1700.e3. doi:10.1053/j.gastro.2014.02.032
Younossi, Z. M., Otgonsuren, M., Henry, L., Venkatesan, C., Mishra, A., Erario, M., & Hunt, S. (2015). Association of nonalcoholic fatty liver disease (NAFLD) with
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CONCLUSIONS
TREATMENT OPTIONS AND OUTCOME
PATHOPHYSIOLOGY OF THE CONDITION
REFERENCES
INTRODUCTION
In case of incurable cancer and tumors in the liver, it
is the responsibility of the doctor to offer treatment for the
improvement of the quality of the rest of the life span of the
patient. Treatment regimes are targeted for slowing and
shrinking the growth of the tumor in the liver. According the
researches, elimination of the cancer cell and the tumor
from the liver might not be possible in all the cases but it
definitely improves the quality of the life of the patient.
Some of the recommended treatment options in this
category include targeted therapy and chemoembolization.
Targeted Therapy
The targeted therapy includes genes, proteins and some of
the other factors towards the proliferation of the destruction
of the tumor and the cancerous cell. The therapy
furthermore involves the growth restriction of the tumor and
minimal damage of the connected tissues. According the
researches, the majority of the tumor expands with time
and its is the responsibility of the health care professionals
to carry out certain test to identify the proteins, genes and
other factors of the infected tumor.
Use of anti angiogenesis drugs for the treatment of the liver
cancer has been a new approach. Some of the factors
including the anti angiogenesis therapy includes the
following:
•Formation of new blood vessels
•Application of the correct treatments and the nutrients
•Effective prevention of the angiogenesis resulting in the
shrinkage of the infected cancerous cell in the liver
•Improved liver functions
Some of the notable angiogenesis drugs includes
Sorafenib and Nexavar. These also have some of the
major side effects including – complications in the skin and
diarrhea.
Radio Embolization and Chemoembolization
Drugs used in this treatment are used to kill the cancerous
cells. The therapy involves the limiting of the ability of the
multiplication and growth of the cancer cells. Some of the
factors of the treatment include the following.
Drugs are pushed in the hepatic artery that is obstructed so
that the drug stays in the tumor and kill the cancerous cell
and enable the liver to function properly
Radio active beads are used in the process of radio
embolization through the artery for the supply of the blood
in the tumor of the liver.
TREATMENT REGIMES
Figure 1; Source: (Xiao, Li&
Zheng, 2014)
Figure 2; Source: (Torres et al.,
2016)