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Liver cancer

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I. The etiology and prevalence

  • Morbidity.

In many countries, hepatocellular carcinoma is one of the first places on the morbidity and mortality. Annually in the world up to 1 million people die from hepatocellular carcinoma.

  • Risk factors for hepatocellular carcinoma
    • Hepatitis B.
    • Cirrhosis of the liver.
    • Hepatitis C.
    • Aflatoxins are distinguished by fungi Aspergillus flavus and Aspergil lus parasiticus, which are prevalent in any climate (except the far north), and often parasitic on nuts, grains, cassava.
    • Mutations in TP53.
    • Steroid hormones. The risk of liver adenomas and hepatocellular carcinoma increased in women taking oral contraceptives for 8 years or longer.
    • Smoking, alcoholism, diabetes, and insulin, but the survey in the Los Angeles study, significantly increased the risk of hepatocellular cancer in non-Asian origin people.

I I. Pathological anatomy and flow

  • Histological types of
    • Adenoma of the liver carries a low risk of cancer. True adenomas are rare and usually in women taking oral contraceptives. In most cases, a tumor, but sometimes develops liver adenomatosis, when adenomas are many - 10 or more. Adenoma has a smooth surface, surrounded by a capsule and does not contain Kupffer cells. Usually there are certain complaints, 25% of cases is bleeding into the abdominal cavity.
    • Focal nodular hyperplasia of the liver is not able to degenerate into cancer. It is twice as common in women bowl, clear communication with oral contraceptives (both adenomas) are not shown, they take only half of the patients. Hyperplastic node devoid of a capsule, but has Kupffer cells. Characterized by asymptomatic, low risk of hemorrhage.
    • Hepatocellular carcinoma may grow in the form of one or more nodes, it is also a diffuse disease of the liver (respectively, have identified a massive, nodal and diffuse forms).
    • Bile duct adenoma in 80% of single and may superficially resemble a metastasis. Typically, the tumor is less than 1 cm and is located under the capsule of the liver.
    • Tsistadenoma tsistadenokartsinoma and bile ducts. Good-quality and malignant cystic tumors frequently originate from the intrahepatic bile ducts than from extrahepatic.
    • Cholangiocarcinoma is less common than hepatocellular carcinoma, and is not associated with liver cirrhosis.
  • The natural course.

The main cause of death - no distant metastases, and hepatic failure, although the tumor is limited to the liver only 20% of cases.

  • The clinical picture.

Pain in the right upper quadrant or right shoulder girdle (due to irritation of the phrenic nerve), 95% of patients complain. Are often severe weakness (30%). loss of appetite (25%), weight loss (35%), unexplained fever (30 40%). Many patients before diagnosis (up to 2 years) complained of abdominal discomfort, fever and poor appetite. Sometimes there is bleeding into the abdominal cavity, which can lead to death. Ascites and marked for the patient volume formation in the hypochondrium - the extremely adverse symptoms. Any sudden deterioration in liver diseases, especially hepatitis B and C, requires the exclusion of cancer. Physical examination found hepatomegaly (90% of cases), splenomegaly (65%), asiit (50%), fever (40%), jaundice (40%), vascular sounds over the liver (30%), cachexia (15%) .

I I I. Prevention and early diagnosis

  • Prophylaxis.

Risk factors for hepatocellular carcinoma in poor countries with high incidence of hepatitis B elusive. The wide hepatitis B vaccination can reduce the incidence of hepatocellular carcinoma, but only a few decades later.

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