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The liver's battle with cancer: How does chronic liver disease become a breeding ground for HCC?
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults and is currently the most common cause of death in patients with cirrhosis. According to the World Health Organization, HCC is the third leading cause of cancer-related deaths worldwide and is more common in people with pre-existing chronic liver disease, especially those with cirrhosis or fibrosis. What factors make chronic liver disease a breeding ground for hepatocellular carcinoma?
Chronic liver disease causes the liver to experience long-term damage and inflammation, providing an advantage for the development of cancer.
The association between chronic liver disease and hepatocellular carcinoma
A significantly increased risk of hepatocellular carcinoma is associated with a variety of chronic liver diseases, such as hepatitis infections (including hepatitis B, C, or D), nonalcoholic steatohepatitis (NASH), alcoholic liver disease, and exposure to environmental toxins. Certain diseases, such as siderosis and alpha-1 antitrypsin deficiency, also significantly increase the risk of HCC. Globally, chronic viral hepatitis is considered the main cause of hepatocellular carcinoma and is estimated to be responsible for approximately 80% of HCC cases worldwide.
Symptoms and diagnosis
Most cases of HCC usually occur in patients who already have symptoms of chronic liver disease, and when the cancer is detected, symptoms may worsen, or sometimes there may be no obvious symptoms. Common non-specific symptoms include abdominal pain, nausea, vomiting and persistent fatigue. Some symptoms more closely associated with liver disease include jaundice (yellowing of the skin or whites of the eyes), abdominal swelling, easy bruising, decreased appetite, and unintentional weight loss.
Main risk factors
Risk factors for hepatocellular carcinoma are mostly related to chronic liver disease factors that lead to cirrhosis. Heavy alcohol abuse, chronic hepatitis infections (hepatitis B and C), and environmental toxins are all important risk factors. Especially in areas where other health protection measures are insufficient, the incidence of HCC increases significantly in people with chronic hepatitis B infection.
Of the currently known risk factors, hepatitis B and hepatitis C infection are the most critical, especially in areas with poor health care systems.
Pathophysiology
The occurrence of HCC is related to a variety of epigenetic changes and cell mutations. Chronic hepatitis infection drives the immune system to repeatedly attack liver cells, causing significant DNA damage and oncogene mutations, leading to tumor formation. The most common mutations include mutations in the tumor suppressor gene TP53 and genes involved in cell proliferation. This cycle of continuous damage and repair is particularly applicable to the study of hepatitis C, while hepatitis B may directly lead to the development of hepatocellular carcinoma through the viral genome.
Screening and Diagnosis
Once diagnosed, HCC is often at an advanced stage, making early diagnosis key to improving chances of survival. Screening of patients with known chronic liver disease, especially those with cirrhosis, is critical. The American Association of Hepatology recommends ultrasound examinations every six months in these high-risk groups, which sometimes also measure levels of the tumor marker alpha-fetoprotein (AFP).
Treatment methods
The treatment of HCC depends on the stage of the disease, the patient's physical condition and whether he or she is suitable for surgical treatment. Treatment strategies may include surgical resection, liver transplantation, and local treatment of the tumor. For patients with early-stage HCC, surgical resection may be curative, and in some cases, liver transplantation has become an option.
Early intervention and treatment are important strategies to improve the survival rate of HCC patients.
Conclusion
Chronic liver disease creates a favorable environment for the development of hepatocellular carcinoma through persistent liver damage and inflammation. With the popularization of hepatitis vaccines and effective treatment options, can we reduce the prevalence of HCC in the future, even in the face of the challenges of multiple risk factors, it is still a question worth pondering?
