Hepatocellular cancer

Description:

Pechenochnokletochny cancer - one of the most widespread malignant tumors. Especially often it meets in the Western, Equatorial and South Africa and Southeast Asia where about 500 cases on 100000 people annually are registered. In the USA and in Western Europe pechenochnokletochny cancer meets much less often and, according to autopsies, makes from 1 to 2% of all malignant new growths. Men are ill 4 times more often, and the tumor usually develops against the background of cirrhosis. In the USA and in Western Europe the peak of incidence falls on 40-60 years, in Asia and Africa this age is one-two decades less.

The main reason for high incidence of pechenochnokletochny cancer in Asia and Africa - considerable prevalence there chronic hepatitis B and hepatitis C. They lead to cirrhosis - one of major factors of risk of pechenochnokletochny cancer.

Symptoms of Hepatocellular cancer:

It is possible to distinguish a tumor at early stages not always as it often develops against the background of cirrhosis and symptoms of a tumor take for signs of progressing of cirrhosis. Most often the tumor has an effect an abdominal pain and the palpated volume education in right hypochondrium. Sometimes over a liver the friction murmur of a peritoneum and vascular noise are listened. In 20% of cases hemorrhagic ascites is observed. Jaundice is noted seldom, only at deep abnormal liver functions and at a prelum of bilious channels. In serum activity of ShchF and levels of alpha-fetoprotein and дес - a gamma carboxyprothrombin usually increase. At a small part of patients paraneoplastic syndromes develop: a hyperglobulia owing to products an erythropoetin tumor, a hypercalcemia owing to products of PTG-like peptide, a hypercholesterolemia, a hypoglycemia, a porphyria, a dysfibrinogenemia, a cryofibrinogenemia.

Apply ultrasonography, KT, MPT, the selection angiography and a stsintigrafiya with 99mTc to diagnosis of tumors of a liver. Ultrasonography is carried often out by the patient from risk group; it is necessary to begin inspection at suspicion of pechenochnokletochny cancer with this method. It is rather inexpensive and rather sensitive method of a research by means of which it is possible to reveal the majority of the tumors exceeding 3 cm. Along with ultrasonography even more often apply MRT. At 70-80% of patients alpha-fetoprotein level in serum exceeds 500 mg/l. Lower levels find at a carcinoma of the stomach and a colon cancer with large metastasises in a liver, sometimes - at acute and chronic hepatitis.

Permanent increase in level of alpha-fetoprotein (from 500 to 1000 mg/l) at the adult having a disease of a liver and not having a GIT tumor with high probability indicates pechenochnokletochny cancer. Growth of level of alpha-fetoprotein means growth of a tumor or its recurrence after a resection of a liver, chemotherapy, a himioembolization.

Transdermal biopsy of a liver - a valuable diagnostic method if it is carried out under control of ultrasonography or KT. It is necessary to carry out it carefully as a tumor usually richly in a vaskulyarizovan.

At a cytologic research of ascitic liquid tumor cells, as a rule, do not manage to be revealed.

Sometimes for a biopsy of a liver resort to a laparoscopy or a minilaparotomy. Such approach allows to reveal patients at the same time with the localized tumor who can execute a liver resection.

Reasons of Hepatocellular cancer:

The tumor develops in 60-90% of cases against the background of macronodular cirrhosis; the general risk it for patients with cirrhosis makes 3% a year.

The etiological role of a virus of hepatitis B is proved very convincingly. Epidemiological researches showed that in a number of the Asian countries incidence of pechenochnokletochny cancer among infected with a virus of hepatitis B is 100 times higher, than among not infected. In China, for example, at patients with chronic hepatitis In risk of pechenochnokletochny cancer throughout life reaches 40%.

The virus of hepatitis B is built in a genome of hepatocytes, it is found both in tumoral, and in the normal cells, next to a tumor. The virus changes an expression of cellular genes at the expense of an insertional mutagenesis, reorganization of chromosomes and activation of a transcription (the proteins having ability to activate a transcription are coded by a gene of X and a gene pre-S2).

The injured and regenerating hepatocytes, apparently, are the most vulnerable targets.

After discovery of a virus of hepatitis C many data testimonial of its role in development of pechenochnokletochny cancer collected. So, in Europe and in Japan among developed pechenochnokletochny cancer prevail having hepatitis C, but not hepatitis B.

Find both viruses in some patients, however no features during pechenochnokletochny cancer at them are noted. The only distinction between patients with the pechenochnokletochny cancer arising against the background of hepatitises B and C - age of the beginning of a disease. So, in Asia infection with hepatitis B occurs in the perinatal period while catch hepatitis C preferential adult at hemotransfusion. Respectively, and pechenochnokletochny cancer at patients with hepatitis B develops on average for 10-20 years earlier, than at patients with hepatitis C.

Retrospective researches show that pechenochnokletochny cancer develops on average in 30 years after infection with hepatitis C and is almost exclusive against the background of cirrhosis.

Any chronic influence causing damage and regeneration of hepatocytes promotes changes of their genome. Chronic diseases of a liver, irrespective of their nature (alcoholic damage of a liver, insufficiency of alfa1-antitrypsin, hemochromatosis, a tirozinemiya of type I), are risk factor of pechenochnokletochny cancer.

In Africa and in the Southern China a serious threat for health of the population is posed by B1 aflatoxin. This toxin produced by mushrooms causes a specific mutation in a codon of the 249th gene suppressor of tumoral growth of TP53. In turn, loss, an inactivation and mutations of a gene of TP53 - the most frequent changes of a genome from what is found in cells of malignant tumors of the person.

Dominance of men among patients with pechenochnokletochny cancer suggests an idea of a role of hormones in its pathogeny. The disease can arise at prolonged treatment by anabolic steroids, under the influence of thorium dioxide and vinyl chloride, and also, apparently, at reception of the oral contraceptives containing estrogen.

Treatment of Hepatocellular cancer:

pechenochnokletochny cancer quickly progressing current is characteristic. Without treatment most of patients die in 3-6 months after diagnosis. At early detection of a tumor (by regular determination of level of alpha-fetoprotein and ultrasonography) life expectancy of patients can be increased up to 1-2 years, and some to execute a liver resection.

The only chance of treatment the liver resection, however because of cirrhosis gives, defeats of both shares and remote metastasises (in a brain, bones, adrenal glands) she is possible only at the few patients. Five-year survival after a liver resection low.

For patients from risk group, in particular for HBsAg carriers and patients with cirrhosis (including the caused chronic hepatitis C), developed programs of mass inspections for the purpose of early detection of pechenochnokletochny cancer.

As at early stages of a disease at 20-30% of patients alpha-fetoprotein level in serum is not increased, along with its definition at mass inspections carry out also ultrasonography.

According to the research conducted in the Far East, five-year survival of patients - HBsAg carriers after a liver resection at a preclinical stage of pechenochnokletochny cancer made 70%, and ten-year-old - 50%. However at these patients of change in a liver were minimum or at all were absent, and tumors were single or encapsulated.

These results do not correspond to the data obtained at the research of big group of patients with cirrhosis conducted in Italy. A considerable part of patients had chronic hepatitis B or hepatitis C; examination was conducted by each 3-12 months; pechenochnokletochny cancer was revealed annually at 3%. Nevertheless most of patients had an inoperable tumor.

Use of transplantation of a liver as a method of treatment is limited in connection with the high frequency of recurrent tumors.

From other methods are perspective:

- a himioembolization (embolization of a hepatic artery with simultaneous introduction of antineoplastic means);

- transdermal destruction of a tumor ethanol under ultrasonography control;

- a cryolysis under ultrasonography control;

- an immunotherapy the monoclones conjugated with cytostatics;

- a gene therapy the retrovirus vectors bearing genes of suicide of cells.

The leading role is assigned to prevention.

Vaccination against hepatitis B allows to warn both an infection, and its effects.

Treatment by interferon the alpha reduces risk of pechenochnokletochny cancer at patients with chronic active hepatitis C.