Today we are going to talk about the diagnosis of liver cancer.

The liver is the largest organ in the body, sits on the right side of the abdomen, next to the stomach. It manufactures bile and blood proteins, filters the blood, rids the body of harmful chemicals, and has other vital functions.

Liver cancer can either be primary or metastatic. Primary liver cancer is when a malignant tumour starts in the liver. Cancer which has spread from elsewhere to the liver, known as liver metastasis, is more common.

It is reported that primary liver cancer is globally the sixth most frequent cancer and the second leading cause of death from cancer. Diagnosis is most frequent among those 55 to 65 years old. Five-year survival rates are 18% in the United States.

China records show that every year more than 110,000 people died of liver cancer, accounting for over 45% of the world’s total. China has also 50% of HCC cases (Hepatocellular carcinoma is the most common type of primary liver cancer in adults). More than 80% of total cases in sub-Saharan Africa or in East-Asia are due to hepatitis B virus.

Symptoms of liver cancer may include a lump or pain in the right side below the rib cage, swelling of the abdomen, yellowish skin, easy bruising, weight loss, and weakness. Other related symptoms are loss of appetite, pain in the upper back (around the right shoulder blade), unusual tiredness, or a feeling of discomfort on the upper right side of the abdomen. The signs and symptoms depend on what type of cancer is present.

Viral infection with either hepatitis C virus (HCV) or Hepatitis B virus (HBV) is the chief cause of liver cancer in the world today. The most common way that hepatitis B is spread is during birth, from mother to baby.

If liver cancer is suspected, the diagnosis may be supported by physical examination, blood tests, scanning/imaging of the liver and nearby organs, and imaging with confirmation by tissue biopsy.

For HCC these methods include sonography (ultrasound), computed tomography (CT) and magnetic resonance imaging (MRI). If the cause of bile duct obstruction is suspected to be malignant, endoscopic retrograde cholangiopancreatography (ERCP), ultrasound, CT, MRI and magnetic resonance cholangiopancreatography (MRCP) are used.

Treatment options may include surgery, targeted therapy, and radiation therapy. In certain cases ablation therapy, embolization therapy, or liver transplantation may be used. Until today few of these options have proved to be effective in term of complete cure.

A more suggested way is of cause by early prevention. To reduce the spread of hepatitis B and the incidence of primary liver cancer, all at-risk people should be vaccinated against the virus.

When it comes to diagnosis, we differentiate the signs of liver cancer from those of jaundice. The word jaundice is from the French jaunisse, meaning “yellow disease”.It is a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels. Urine is dark in colour.

Jaundice itself is generally not considered a disease, but rather a sign of one of many possible underlying pathological processes in blood. Jaundice in babies occurs in over half in the first week following birth and in most cases is not a problem.

Most patients presenting with jaundice will have various predictable patterns of liver panel abnormalities, though significant variation does exist.

Swelling of the abdomen, or ascites, may be taken as a sign of liver cancer. That is the abnormal buildup of fluid in the abdomen. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath.

In the developed world, the most common cause is liver cirrhosis. Treatment often involves returning to a more healthier lifestyle, like a low salt diet.

If liver cancer is detected early, surgical removal is a suggested option, but unfortunately when most patients are diagnosed with the problem, it is already at a late stage and the time for surgery has passed. Chemotherapy has widely be adopted in modern western medicine, but side effects are apparent, and the treatment is not at all satisfactory.

We shall look into TCM treatments in later chapters.

Talk to you about diagnosis of bowel cancer next time.


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