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Written By Walter Leonard 12/5/2015
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Liver Cancer
By: Desharra Alexander-Self
            Liver cancer is a rare cancer that comes in multiple forms and is caused by different factors. Hence, trying to identify and spot early signs of the cancer can be difficult. “Liver cancer is much more common in countries in sub Saharan Africa and Southeast Asia than in the U.S……Liver cancer is also a leading cause of cancer deaths worldwide, accounting for more than 700,00 deaths each year.” This article will be discussing the types of liver cancer there are, symptoms, preventative measures and treatment.
            The liver is the largest internal organ inside of the human body. It is made of cells called hepatocytes. It functions includes sorting nutrients and filtering out waste and old cells from the body. It processes chemicals and compounds from the food, drinks, and medications ingested to prevent infections from spreading and poisoning the liver and surrounding organs. The liver’s other functions include managing metabolism, bile production, and storing nutrients. However, these functions are performed by the hepatocytes that makes up the liver. Because of the many processes it performs many other cells develop inside of the liver that can help it and severely damage it resulting in cancerous and non-cancerous tumors.
            Liver cancer comes in several forms. The different cancers can be divided into two groups: primary and secondary (or metastatic liver cancer).  The difference between the two is that for the primary group, cancer begins inside the liver, while for the secondary group, cancer has spread from another organ to the liver, infecting it.

Primary Liver Cancer

Hepatocellular carcinoma (HCC):
The most common cancer is HCC and it begins as a singular tumor that grows to a large size or begin as many small cancer nodules in multiple locations throughout the liver. The latter is often seen in patients with chronic liver damage.

Intrahepatic cholangiocarcinoma (Bile duct cancer):
It forms in the cells that line the smaller bile ducts of the liver.

Angiosarcoma, Hemangiosarcoma, and Hepatoblastoma:
These three cancers are the last of the primary cancers and the rarest.
 Angiosarcoma and Hemangiosarcoma are tumors that start in the cells lining the blood vessels of the liver and grow too quickly to be treated in early stages or removed surgically by the time the cancers are found. The causes involve exposure to arsenic, radium, vinyl chloride and thorium dioxide.

 Hepatoblastoma develops in children four and younger. Unlike the other two aforementioned rare cancers, early treatment is possible.

Fibrolamellar Carcinoma

Fibrolamellar carcinoma (FLC) is one of the rarest forms of cancer. This cancer is usually seen in children and young adults below the age of forty. There are no symptoms directly associated with FLC. The total amount of cases of patients known to have FLC is 1%. Unlike the aforementioned cancers, in the primary group, the cause of FLC is not related to diet, habits or environment. The exact cause of the cancer is unknown, however it is believed that an error or deletion occurs the DNA causing two genes (DNAJB1 and PRKACA) to fuse together. As there is limited information concerning this form of cancer, information for treatment is limited to surgical resection.


Secondary Liver Cancer:

This version of liver cancer is metastatic; as in a cancer already infecting another organ in the body (such as the breast, lungs, colon, etc.) has spread to the liver, causing it to become cancerous. In this case, because the cancer did not begin in the liver it is addressed as another type of cancer (breast cancer, lung cancer, colon cancer, etc.) but the liver is still given the same treatment as liver cancer.

Causes:
The causes of primary cancer range from hereditary medical conditions, diet, environment and unhealthy habits. Frequently it “tends to occur in livers damaged by birth defects, alcohol abuse, or chronic infection with diseases such as hepatitis B and C, hemochromatosis (a hereditary disease associated with too much iron in the liver, and cirrhosis.” In other cases, the liver can undergo a change in DNA which causes cells to mutate and stop functioning correctly, leading to overproduction of cells, tumors growing freely and other changes that resulting in cancerous cells.
Other causes include:
·       Exposure to arsenic, radium, vinyl chloride, thorium dioxide, second-hand smoke
·       Men have a higher risk of contracting liver cancer than women
·       Hormones and enhancers such as estrogen, androgen, steroids, and thrortrast

Symptoms:
Many of these symptoms are associated with other medical conditions. Since the cause and type of liver cancer can range from primary and secondary, it is highly recommended to see a doctor and report the symptoms instead of performing self-diagnosis.
·       Itching
·       Nausea or vomiting
·       Loss of appetite
·       Fever
·       Sudden weight loss
·       Yellowing present in the eyes and skin (usually a sign of Jaundice and a poor diet)
·       Swollen abdomen
·       Enlarged veins over stomach
·       Pain in the upper right of abdomen
·       Fatigue
·       Bruising
·       Hard lump on the right rib cage
·       Enlarged spleen detected to the left of ribs

Preventative Actions:
Not all of these actions will be able to prevent liver cancer as some causes of the cancer are linked to hereditary genes and mutations. However, for cancers that are caused by other means, these actions are recommended:
·       Don’t smoke and/or quit smoking
·       Keep alcohol consumption to a minimal
·       Maintain a healthy diet and weight
·       Get a HBV and HCV vaccine for yourself and children to prevent contradicting hepatitis B and C
·       Have protected sex and do not re-use condoms
·       Limit/avoid exposure to harmful chemicals that can cause liver cancer
·       Maintain regular check-ups with your doctor if your family has a history of cancer, hemochromatosis, birth defects, and chronic infections. The earlier treatment is given the less chance there is of contradicting liver cancer.

Treatment:
There are many treatment plans for liver cancer. While it is important to research different treatments to understand how it may treat and or cure cancer, it is imperative that a doctor specializing in cancer is consulted. The amount of information available online is limited and may not be completely up to date on recent developments concerning treatment and causes. According to the American Cancer Society, the type of treatment best suited to each individual is based on the following:
·       Age and estimated life span
·       Other health conditions
·       Stage of cancer
·       If surgery is possible
·       The probability of the cancer being curable
·       The probability of the cancer being hindered or treated in any way
·       Side effects from treatment

Another important factor to look into for treatment is the stage of the cancer. Liver cancer has what is know as an TNM system, with a ranking of 0-4 for stages. A summarized explanation of 
the stages can be read as the following:

T (Tumor): Defines the amount of and size of the original or root tumor.
N (Node): Shows whether the cancer is detected in or near lymph nodes.
M (Metastasis): Usually seen in secondary cancers, this indicates if the cancer has spread from the original organ to surrounding organs, infecting them with the cancer.
The numbers (0-4) is an indicator of the severity and treatability of the cancer; it is numbered from least to greatest on the scale. There are also classes of liver cancer to help give a definite reading of whether or not the cancer is treatable and what other factors to take into account for it. 

For more information on the stages of liver cancer, please refer to the Cancer Treatment Centers of America. For more, in depth information on liver cancer, please refer to a licensed doctor for all of your questions. Also check Up Cancer for more information on liver cancer and other cancers that may infect the liver.