Liver Cancer

Liver Cancer About Liver Cancer The liver is the largest organ inside the body, located on the right side of the abdomen under the rib cage. It performs many important functions, such as storing and breaking down nutrients they can be used by the body, and filtering and storing blood. A person cannot survive without his or her liver. As the statistics indicate, liver cancer is more common among men than women. But, overall, the cancer is relatively rare in North America and Europe. By contrast, in certain African and East Asian countries, it is the most common of all types of cancer. For reasons as yet unknown, it is becoming even more common in these countries and less common in the U.S. and Europe. Cancer FAQs What are the different types of liver cancer? There are many kinds of tumors than can originate in the liver. Of the four main types that are cancerous (angiosarcomas, cholangiocarcinomas, hepatoblastomas, and hepatocellular carcinomas), hepatocellular carcinoma (also called hepatoma or HCC), is by far the most common, accounting for about 84 percent of all liver cancer cases. HCC starts growing in the hepatocytes, the main type of cell found in the liver. What are the risk factors for liver cancer? A risk factor is anything that increases a person’s chance of getting a disease. There are several known risk factors for liver cancer: * Certain types of viral hepatitis, including chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV), are associated with increased liver cancer risk. Scientists estimate that about 10–20 percent of people infected with HBV will develop liver cancer. The precise relationship between HCV and liver cancer incidence is still under study. * Long-term exposure to aflatoxins – a group of carcinogenic chemicals produced by a fungus found in tropical and subtropical regions that often contaminates peanuts, wheat, soy beans, corn and rice – can raise the risk of liver cancer. * Long-term use of anabolic steroids (male hormones) can slightly increase the risk of liver cancer. Anabolic steroids are used for treating men with abnormally low testosterone levels and for treating men and women with certain types of severe anemia (low red blood cell counts). These hormones are also sometimes abused by athletes trying to build their strength. * In some parts of the world, contamination of drinking water with arsenic is a liver cancer risk factor. * Long-term exposure to the industrial chemicals vinyl chloride and thorium dioxide, which are now either strictly regulated or banned from use, has been tied to liver cancer. * Some studies suggest that tobacco use may be a liver cancer risk factor. * Birth control pills (oral contraceptives) have been shown to raise the risk of liver cancer, but the studies suggesting this link involved versions of oral contraceptives that are no longer used. These older formulations of “the Pill” contained different types of estrogens and progesterones at far higher doses than current formulations. It is not known whether or not today’s oral contraceptives are associated with liver cancer. * A history of other liver diseases, particularly cirrhosis of the liver, has been shown to raise the risk of liver cancer. Cirrhosis is a progressive disorder that causes formation of scar tissue in the liver, interfering with blood flow to the organ and with the ability of the liver to work properly. About 5–10 percent of people with cirrhosis of the liver develop liver cancer. Research also suggests that alcohol abuse and malnutrition can lead to both cirrhosis and liver cancer. Can anything be done to prevent liver cancer? Preventing infection with hepatitis B and C will reduce the risk of liver cancer. Strategies for lowering the likelihood of contracting hepatitis include following safe sex practices, not sharing needles, and getting vaccinated against hepatitis B. (All children should be vaccinated to prevent infection with hepatitis B.) To reduce the risk of cirrhosis of the liver, a known risk factor for liver cancer, avoid excessive alcohol consumption. What are the signs and symptoms of liver cancer? Unfortunately, the signs and symptoms of liver cancer do not become apparent until the disease has progressed to a late stage.What’s more, many of the symptoms are nonspecific, meaning they can be vague and caused by many conditions. If you experience any of the following symptoms, however, see a doctor as soon as possible: * unexplained weight loss; * persistent lack of appetite; * persistent abdominal pain; * persistent feeling of being very full after only a small meal; * swelling of the abdominal area with or without breathing difficulties; * sudden jaundice (yellow-green coloration of the skin and eyes); * a sudden change in your condition if you have chronic hepatitis or cirrhosis; * liver enlargement or a mass that can be felt in the liver area. What tests are used to diagnose liver cancer? If liver cancer is suspected, the doctor will use several methods to diagnose the disease. First, the doctor will conduct a complete medical interview to look for risk factors and symptoms. Then he or she will perform a physical exam. The doctor will also order certain diagnostic tests, most of them imaging tests to produce pictures of the liver and the surrounding organs. These tests may include: ultrasonography (ultrasound), which uses sound waves to generate images of the targeted area; computed tomography (CT scan), which is a specialized x-ray procedure in which x-rays are put together by a computer to create detailed cross-sectional images of the body; and magnetic resonance imaging (MRI), in which images are produced using a magnetic field. In addition, angiography – an x-ray procedure for examining blood vessels – may be done to allow the doctor to examine the arteries that supply blood to a tumor. A laparoscopy is a method used to examine the liver directly through a thin, lighted tube inserted through a small incision in the front of the abdomen. The laparoscopy affords the doctor a clear view of the liver and surrounding organs, which can help the doctor plan for surgery or other treatments. It is also an opportunity for the doctor to remove a small sample of tissue, called a biopsy, for examination under a microscope. A biopsy is the only way to know for sure whether cancer is present. In addition, the doctor may order an alpha-fetoprotein (AFP) blood test, which is a tumor marker study. Tumor markers are substances that are found at elevated levels in the blood of people with certain cancers. AFP levels are routinely checked in patients with suspected liver cancer. Liver function tests – blood tests that take a detailed look at certain aspects of liver function – are also often ordered if cancer is suspected, particularly in people with known chronic liver disease. Abnormal results (such as alkaline phosphatase) can be a sign of cancer. Once liver cancer is diagnosed, more tests will be performed to determine the extent of the disease (for example, chest x-rays and bone scans). This is called staging. The stage of a cancer is the most significant factor when devising a treatment plan. What are the stages of liver cancer? For liver cancer, the system used to stage the disease is the TNM system (also known as the American Joint Committee on Cancer, or AJCC, system). This system is based on three main variables. The “T,” which stands for tumor, is followed by a number ranging from 1 to 4, and this indicates the extent to which the tumor has spread within the liver and to nearby organs. The “N,” which is followed by a 0 or 1, indicates whether the cancer has spread to regional (nearby) lymph nodes – small collections of immune system cells that help fight infections – and how large those lymph nodes are. And the “M,” followed by a 0 or 1, tells whether the cancer has spread to distant organs in the body or to lymph nodes not located near the liver. The TNM system is used to categorize the cancer in stages I through IV. The higher the stage number, the more the cancer has spread. Some doctors also divide the stages into letters (for example, IA or IB) to further clarify the extent of the cancer. How is liver cancer treated? Treatment of liver cancer depends on the type of tumor and the stage ofthe disease, the condition of the liver, and the patient’s age and overall health. The three main treatment methods include surgery, chemotherapy, and radiation therapy. Frequently, a combination of treatments is recommended. Surgery to remove a tumor, called surgical resection, is the only way to cure liver cancer. Unfortunately, in the majority of liver cancers, complete removal of the cancer is not possible, either because the cancer has already spread beyond the liver or because the tumor is too large, or several tumors are present in different parts of the liver. Moreover, about 30 percent of hepatocellular carcinoma (HCC) patients in the U.S. have cirrhosis. This makes removal of even a small amount of liver tissue at the perimeter of the cancer prohibitive, as it would not leave enough liver tissue to perform the essential functions of the organ. There are two other surgical methods for destroying liver tumors without removing them. The first is called cryosurgery, in which the tumor is destroyed by freezing it with a metal probe. The second is called ethanol ablation, which involves injecting alcohol directly into the tumor to destroy the cancer cells. Chemotherapy, the use of cancer-killing drugs, is also used to treat liver cancer. Chemotherapy can be administered systemically by injection into a vein (IV) or by mouth. In systemic chemotherapy, the anticancer drugs enter the bloodstream and travel throughout the whole body, attacking cancer cells found beyond the liver. A combination of anticancer drugs is usually used, typically given in cycles (a period of treatment followed by a period of recovery, then another treatment period, etc.). Systemic chemotherapy often does not work well for liver cancer. Another method, called hepatic artery infusion (a type of regional chemotherapy), may therefore be used. In this procedure, the anticancer drugs are injected directly into the artery that supplies the liver with blood. This allows high doses to reach the cancer. The procedure can be administered on an outpatient basis using a small pump placed just beneath the skin. Radiation therapy, in which high-energy rays are used to kill cancer cells, is not often used for liver cancer, as studies do not demonstrate a strong effect on survival rates. However, researchers are investigating new techniques for administering radiation, as well as new combinations of radiation therapy and chemotherapy. Signs/Symptoms * Abdominal swelling * Vague pain upper rightabdomen and back * Fatigue * Fever * Weight loss * Jaundice * Loss of appetite Risk Factors * Occupational exposure to chemicals, e.g. vinyl chloride * Cirrhosis * Alcohol abuse combined with heavy tobacco use * Hepatitis B or C * Poor nutrition Diagnostic Aids * Liver scans * CT/MRI * Blood tests * Biopsy Treatment Options * Surgery * Radiation therapy * Chemotherapy * Immunotherapy * Clinical trials Preventive Measures * Hepatitis B & C vaccination * Maximize protection against toxic chemicals * Reduce alcohol consumption * Don’t smoke Liver-Cancer-Stages Treatment of Hepatocellular Carcinoma Overview The following is a general overview of the treatment of hepatocellular carcinoma, the most common type of primary liver cancer. Choice of treatment will depend on the extent and location of the cancer, the health of the liver, and the overall health of the patient. Circumstances unique to each patient’s situation influence which treatment or treatments are utilized. The potential benefits of combination treatment, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this Web site is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician. Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials. Surgical Treatment of Hepatocellular Carcinoma For patients who are healthy enough to undergo surgery and who have early-stage cancer confined to the liver, treatment may involve surgical resection or liver transplantation. Resection: Resection refers to surgical removal of the cancer and some surrounding normal tissue. This is often the treatment of choice in patients without cirrhosis.[1] Although resection is potentially curative, an estimated 70% of patients will develop a cancer recurrence during the first five years after treatment. Furthermore, resection is only possible when the remaining part of the liver is healthy enough to function on its own after surgery. For many patients with cirrhosis or other liver disease, this will not be the case and other treatment options will need to be considered. Liver transplantation: For selected patients who have cancer that is confined to the liver but cannot be resected, liver transplantation may be an option. A benefit of liver transplantation is that it treats not only the cancer but also any underlying liver disease such as cirrhosis. Because the number of donor livers is limited, however, liver transplantation is generally reserved for those patients who are expected to have the best survival and the lowest risk of recurrence after transplantation. According to the commonly used “Milan criteria,” for example, transplant candidates should have a single liver nodule that measures no more than 5 cm or two or three nodules that measure no more than 3 cm each. These criteria are fairly restrictive, and the question of whether and how to expand the criteria to include more patients is currently being evaluated.[2] Non-surgical Treatment of Hepatocellular Carcinoma Even when the cancer is confined to the liver, not all patients will be candidates for surgery. Fortunately, there are several non-surgical treatment approaches available. Ablation: Ablation refers to the destruction of the tumor using techniques such as injection of alcohol into the tumor (percutaneous ethanol injection) or use of electrical energy and heat (radiofrequency ablation). Ablation tends to be most effective when tumors are small and limited in numbers.[3] Chemoembolization: Cancers rely on an adequate blood supply in order to grow and survive. The blood supply to liver tumors is provided primarily by the hepatic artery. In the process of transarterial chemoembolization (TACE), chemotherapy is injected into the branch of the hepatic artery that supplies the tumor. This allows the chemotherapy to concentrate in the area of the tumor. In addition, the hepatic artery is blocked (embolized) in order to reduce blood supply to the tumor. This procedure is not curative, but it can improve survival.[4] In general, patients must have adequate blood flow through the portal vein (the other main blood supply to the liver) in order to undergo TACE.[5] Nexavar® (sorafenib): The targeted therapy Nexavar is the first systemic therapy to improve survival in hepatocellular carcinoma, and is now a standard approach to treatment among patients with advanced hepatocellular carcinoma. Nexavar inhibits biological pathways involved in cell proliferation and the development of new blood vessels. In a Phase III clinical trial among patients with advanced hepatocellular carcinoma and preserved liver function, median overall survival was 10.7 months among patients treated with Nexavar compared with 7.9 months among patients treated with placebo.[6] The most common side effects of Nexavar were diarrhea, weight loss, and hand-foot skin reaction. There is limited information about the safety and efficacy of Nexavar among patients with poor liver function.[7] Strategies to Improve Treatment The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of hepatocellular carcinoma will result from the continued evaluation of new treatments in clinical trials. Participation in a clinical trial may offer patients access to better treatments and advance the existing knowledge about treatment of this cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Adjuvant therapy: Recurrence rates after treatment with resection or ablation are high, highlighting the importance of finding effective adjuvant treatments (treatments given after the primary treatment to reduce the risk of recurrence). Although the search for effective adjuvant therapy for hepatocellular carcinoma has been frustrating, planned studies of newer agents such as Nexavar may hold promise. New targeted therapies: The approval of Nexavar for selected patients with hepatocellular carcinoma has prompted interest in the role of several other targeted therapies. Targeted therapies being evaluated in clinical trials among patients with hepatocellular carcinoma include Sutent® (sunitinib), Avastin® (bevacizumab), Tarceva® (erlotinib), and Tykerb® (lapatinib). Treatment prior to liver transplantation: Due to the limited availability of donor livers, wait times for a liver transplant can be long. During the wait the cancer may progress to the extent that the patient is no longer eligible for transplantation. In order to control cancer growth during the wait for a donor liver, patients may receive treatment such as ablation or chemoembolization.[8] The effect of these treatments on the survival of transplant candidates remains uncertain. Living donor liver transplantation: Liver transplantation from a living donor is one strategy to increase the availability of donor livers. In this procedure a living person donates part of their liver (usually the right hepatic lobe if the recipient is an adult).[9] The primary disadvantage of this procedure is the risk to the donor. Identifying candidates for liver transplantation: Identification of patients who are candidates for liver transplantation remains challenging. The goal is to identify those patients who are most likely to benefit. In part, this involves determining which patients are least likely to experience a cancer recurrence following transplantation. Traditional criteria consider factors such as the number and size of liver tumors, but it may be possible to improve upon these criteria by assessing specific biological characteristics of the tumor.[10] Research on this question is underway. Radiation therapy: Historically, radiation therapy has played a limited role in the treatment of hepatocellular carcinoma because of the damage it caused to normal liver tissue. Advances in radiation therapy, however, have allowed for more targeted delivery of effective doses of radiation. These advances include newer approaches to the delivery of external radiation therapy, [11] as well as techniques such as TheraSphere® that deliver radiation directly to the liver. TheraSphere involves the use of microscopic glass beads that contain a radioactive material. The beads are delivered through a catheter into the hepatic artery. The beads become trapped in the blood vessels that feed the tumor and deliver radiation to the tumor. References: [1] Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208-1236. [2] Mazzaferro V, Llovet JM, Miceli R et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncology. 2009;10:35-43. [3] Llovet JM, Bruix J. Novel advances in the management of hepatocellular carcinoma in 2008. Journal of Hepatology. 2008;48:S20-S37. [4] Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37:429-442. [5] Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208-1236. [6] Llovet JM, Ricci S, Mazzaferro V et al. Sorafenib in advanced hepatocellular carcinoma. New England Journal of Medicine. 2008;359:378-90. [7] Kelley RK, Venook AP. Sorafenib in hepatocellular carcinoma: separating the hype from the hope. Journal of Clinical Oncology. 2008;26:5845-5848. [8] Llovet JM, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinoma. Seminars in Liver Disease. 2005;25:181-200. [9] Trotter JF, Wachs M, Everson GT, Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor. New England Journal of Medicine. 2002;346:1074-1082. [10] Neuberger J. Liver-cell cancer and transplantation. Lancet Oncology. 2009;10:5-7. [11] Hawkins MA, Dawson LA. Radiation therapy for hepatocellular carcinoma: from palliation to cure. Cancer. 2006;106:1653-63. Copyright © 2012 Omni Health Media. All Rights Reserved. Liver Cancer Screening/Prevention Overview Information about the prevention of cancer and the science of screening appropriate individuals at high risk of developing cancer is gaining interest. Physicians and individuals alike recognize that the best ”treatment“ of cancer is preventing its occurrence in the first place or detecting it early when it may be most treatable. The chance of an individual developing cancer depends on both genetic and non-genetic factors. A genetic factor is an inherited, unchangeable trait, while a non-genetic factor is a variable in a person’s environment, which can often be changed. Non-genetic factors may include diet, exercise, or exposure to other substances present in our surroundings. These non-genetic factors are often referred to as environmental factors. Some non-genetic factors play a role in facilitating the process of healthy cells turning cancerous (for example, the correlation between smoking and lung cancer) while other cancers have no known environmental correlation but are known to have a genetic predisposition. A genetic predisposition means that a person may be at higher risk for a certain cancer if a family member has that type of cancer. Heredity or Genetic Factors A majority of cases of hepatocellular carcinoma can be attributed to environmental factors such as chronic viral infections and heavy alcohol use (discussed in greater detail below). Nevertheless, family history of liver cancer does appear to influence risk of the disease. Certain inherited conditions, such as hereditary hemochromatosis, also increase risk. Family history of liver cancer: In a study conducted in the United States, individuals with a first-degree family history of liver cancer (liver cancer in a parent, sibling, or child) were roughly four times more likely to develop liver cancer than individuals without such a family history. This increased risk was observed even in the subset of people without viral hepatitis.[1] This study suggests that either genetic factors or shared environmental factors influence the risk of liver cancer. Hereditary hemochromatosis: Hemochromatosis is a disease in which the body absorbs and stores too much iron. Some of this excess iron is stored in the liver. Hereditary hemochromatosis is one of the most common genetic disorders in the United States, and occurs when an individual inherits a specific genetic mutation from both parents.[2] People with hereditary hemochromatosis have an increased risk of developing liver cancer[3] as well as other health problems. Environmental or Non-genetic Factors Hepatocellular carcinoma is often (but not always) preceded by cirrhosis of the liver. In cirrhotic livers healthy liver tissue is replaced by scar tissue. Factors that contribute to liver cirrhosis and liver cancer are chronic infection with hepatitis C or hepatitis B viruses and chronic heavy alcohol use. Chronic infection with hepatitis B virus (HBV): Chronic infection with HBV is thought to account for more than half the cases of liver cancer that occur worldwide.[4] HBV can be transmitted through contact with infected blood or needles or sexual intercourse with an infected partner, or from an infected mother to her newborn. The likelihood that an HBV infection will become chronic varies by the age at infection. Chronic infection develops in roughly 90% people who are infected as infants and 2-6% of people who are infected as adults. Among those who develop chronic infections, an estimated 15-25% will die prematurely as a result of liver cirrhosis or liver cancer.[5] Chronic infection with hepatitis C virus (HCV): Chronic infection with HCV is another important risk factor for liver cancer, and is thought to account for some of the increase in liver cancer that has occurred in the United States in recent decades.[6] In North America HCV causes more cases of liver cancer than HBV.[7] HCV is transmitted through contact with infected blood or needles. Sexual transmission and transmission from mother to child during birth are less common routes of infection. Chronic infection develops in a majority of people (70-85%) who are infected with HCV.[8] Heavy alcohol use: Long-term, heavy alcohol use increases the risk of liver cancer. According to one estimate, consumption of 6-7 drinks per day for more than 10 years increases the risk of liver cancer more than fivefold.[9] The combination of heavy alcohol use with chronic HCV infection results in a particularly high risk. In the United States, heavy alcohol use is thought to account for roughly one-third of all cases of hepatocellular carcinoma.[10] Diabetes: A combined analysis of previously published studies (most of which focused on type II diabetes) suggests that diabetes is linked with a more than twofold increased risk of hepatocellular carcinoma.[11] It remains possible, however, that diabetes was the result (rather than the cause) of the chronic underlying liver disease.[12] Additional studies are needed to better understand the link between diabetes and hepatocellular carcinoma. Obesity: Obesity increases the risk of several types of cancer, including endometrial cancer, postmenopausal breast cancer, and colon cancer. More recently, studies have suggested that obesity may also increase the risk of liver cancer.[13] [14] The development of nonalcoholic fatty liver disease may explain some of the link between obesity and hepatocellular carcinoma. Smoking: Tobacco smoking has been linked with a moderate increase in risk of liver cancer. In a large combined analysis of previously published studies, current smokers were 56% more likely than nonsmokers to develop liver cancer.[15] Coffee: Several studies have suggested that coffee consumption decreases the risk of liver cancer.[16] [17] It’s uncertain whether this effect is causal or simply the result of a reduction in coffee intake among those with liver disease. Other exposures: Occupational exposure to vinyl chloride increases the risk of angiosarcoma of the liver (a rare type of liver cancer). Aflatoxin—a toxin produced by fungi that can contaminate food—is an important risk factor for liver cancer in less developed countries.[18] Prevention Because many cases of hepatocellular carcinoma are linked with heavy alcohol use or chronic infection with HCV or HBV, control of these exposures is an important part of liver cancer prevention. Hepatitis B vaccination: Routine vaccination of infants against HBV is recommended in the U.S. and several other countries to prevent infection with HBV. Older children and adolescents who were not vaccinated previously, and adults at risk for HBV infection, may also be vaccinated.[19] Avoidance of HCV: The U.S. blood supply has been screened for HCV since 1992, greatly reducing the risk of infection through blood transfusion. Injection drug use remains an important route of transmission, and injection drug users are advised to avoid sharing needles.[20] Currently, there is no vaccine against HCV. Limited alcohol consumption: For those who drink, general dietary guidelines recommend no more than two drinks per day for men and no more than one drink per day for women.[21] People with hepatitis or other liver disease may need to avoid alcohol completely. Talk with your doctor about what’s best for you. Screening and Early Diagnosis For many types of cancer, progress in cancer screening has offered promise for earlier detection and higher cure rates. The term screening refers to the regular use of certain examinations or tests in persons who do not have symptoms of cancer. Thus far, there is no conclusive evidence that screening for liver cancer reduces the risk of death from the disease.[22] Nevertheless, some physicians recommend that individuals at high risk of liver cancer—such as those with cirrhosis of the liver—undergo regular screening with tests such as ultrasound of the liver and/or alpha-fetoprotein testing. Ultrasound: An ultrasound of the liver every 6-12 months may be recommended in order to detect liver cancer at the earliest possible stage in high-risk individuals.[23] If a liver nodule (growth) is detected on ultrasound, the patient may undergo additional testing or more frequent surveillance to establish the diagnosis.[24] Alpha-fetoprotein testing: Liver cancer can result in elevated blood levels of a protein known as alpha-fetoprotein (AFP), and AFP testing may be used as a screening tool for liver cancer. AFP is not a perfect marker for liver cancer, however, and some researchers have suggested that it should not be the only screening test used.24 Strategies to Improve Prevention and Screening The potential for earlier detection and higher cure rates increases with the advent of more refined screening techniques. In an effort to provide more screening options and perhaps more effective prevention strategies, researchers continue to explore new techniques for the screening and early detection of cancer. Researchers also continue to search for new ways to prevent liver cancer from developing in the first place. Predicting risk of liver cancer: Although important risk factors for liver cancer have been identified (such as chronic infection with HBV or HCV), many people with these risk factors will never develop liver cancer. Researchers are therefore trying to understand why some groups of patients with chronic liver disease develop liver cancer and others don’t. Answers to this question would improve our understanding of how liver cancer develops (and how it might be prevented), and could also help target screening efforts. As an example of this work, researchers in China developed a risk score to predict risk of liver cancer among individuals with chronic HBV infection.[25] The score incorporated information about age, gender, HBV DNA levels, HBV gene mutations, and cirrhosis. Although it’s unclear whether this score will be applicable outside of this particular population, it represents the progress that is being made. References: [1] Hassan MM, Spitz MR, Thomas MB et al. The association of family history of liver cancer with hepatocellular carcinoma: a case-control study in the United States. Journal of Hepatology. Early online publication October 16, 2008. [2] National Institute of Diabetes and Digestive and Kidney Diseases. Hemochromatosis. Available at: National Digestive Diseases Information Clearinghouse (Accessed January 12, 2008). [3] Elmberg M, Hultcrantz R, Ekbom A et al. Cancer risk in patients with hereditary hemochromatosis and in their first-degree relatives. Gastroenterology. 2003;125:1733-41. [4] Parkin DM. The global burden of infection-associated cancers in the year 2002. International Journal of Cancer. 2006;118:3030-3044. [5] Centers for Disease Control and Prevention, Division of Viral Hepatitis. Hepatitis B. Available at: http://www.cdc.gov/hepatitis/HBV.htm (Accessed January 9, 2009). [6] El-Serg HB, Davila JA, Petersen NJ, McGlynn KA. The continuing increase in the incidence of hepatocellular carcinoma in the United States. Annals of Internal Medicine. 2003;139:817-823. [7] Raza SA, Clifford GM, Franceschi S. Worldwide variation in the relative importance of hepatitis B and hepatitis C viruses in hepatocellular carcinoma: a systematic review. British Journal of Cancer. 2007;96:1127-34. [8] Centers for Disease Control and Prevention, Division of Viral Hepatitis. Hepatitis C. Available at: http://www.cdc.gov/hepatitis/HCV.htm (Accessed January 9, 2009). [9] Morgan TR, Mandayam S, Jamal MM. Alcohol and hepatocellular carcinoma. Gastroenterology. 2004;127:S87-S96. [10] Hassan MM, Hwang L-Y, Hatten CJ et al. Risk factors for hepatocellular carcinoma: synergism of alcohol with viral hepatitis and diabetes mellitus. Hepatology. 2002;36:1206-1213. [11] El-Serag HB, Hampel H, Javadi F. The association between diabetes and hepatocellular carcinoma: a systematic review of epidemiologic evidence. Clinical Gastroenterology and Hepatology. 2006;4:369-380. [12] Chuang S-C, La Vecchia C, Boffetta P. Liver cancer: descriptive epidemiology and risk factors other than HBV and HCV infection. Cancer Letters. Early online publication 2008. doi:10.1016/j.canlet.2008.10.040. [13] Polesel J, Zucchetto A, Montella M et al. The impact of obesity and diabetes mellitus on the risk of hepatocellular carcinoma. Annals of Oncology. Early online publication August 22, 2008. [14] Ohki T, Tateishi R, Sato T et al. Obesity is an independent risk factor for hepatocellular carcinoma development in chronic hepatitis C patients. Clinical Gastroenterology and Hepatology. 2008;6:459-464. [15] Gandini S, Botteri E, Iodice S et al. Tobacco smoking and cancer: a meta-analysis. International Journal of Cancer. 2007;122:155-164. [16] Hu G, Tuomilehto J, Pukkala E et al. Joint effects of coffee consumption and serum gamma-glutamyltransferase on the risk of liver cancer. Hepatology. 2008;48:129-136. [17] Inoue M, Yoshimi I, Sobue T, Tsugane S. Influence of coffee drinking on subsequent risk of hepatocellular carcinoma: a prospective study in Japan. Journal of the National Cancer Institute. 2005;97:293-300. [18] Chuang S-C, La Vecchia C, Boffetta P. Liver cancer: descriptive epidemiology and risk factors other than HBV and HCV infection. Cancer Letters. Early online publication 2008. doi:10.1016/j.canlet.2008.10.040. [19] Centers for Disease Control and Prevention. Viral Hepatitis. Available at: http://www.cdc.gov/hepatitis/index.htm (Accessed January 14, 2008). [20] Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease. MMWR. 1998;47(RR-19):1-39. [21] U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th Edition, Washington, DC: U.S. Government Printing Office, January 2005. Available at: www.healthierus.gov/dietaryguidelines. (Accessed January 8, 2008). [22] National Cancer Institute. Liver (Hepatocellular) Cancer Screening (PDQ®). Available at Liver (Hepatocellular) Cancer Screening (PDQ®) Accessed January 13, 2008. [23] Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208-1236. [24] Parikh S, Hyman D. Hepatocellular cancer: a guide for the internist. The American Journal of Medicine. 2007;120:194-202. [25] Yuen M-F, Tanaka Y, Fong D Y-T et al. Independent risk factors and predictive score for the development of hepatocellular carcinoma in chronic hepatitis B. Journal of Hepatology. 2009;50:80-88. Copyright © 2012 Omni Health Media Liver Cancer Information Center. All Rights Reserved.