Hepatocellular carcinoma
Last reviewed: 24.06.2018
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Hepatocellular carcinoma is formed in 5-15% of patients with alcoholic cirrhosis of the liver. The role of alcohol in carcinogenesis has not yet been elucidated. An increased incidence of cancer of the oral cavity (except for the lips), pharynx, larynx, esophagus in patients with chronic alcoholism. The total mortality from cancer of all localizations in people with chronic alcoholism is 25% higher than the average in the population. The experiment found that the main metabolite of ethanol acetaldehyde in the culture of human cells causes damage to chromosomes. In a number of alcoholic beverages can also be present carcinogens. In alcoholic beverages traces of nitrosamines, propanol, methylbutanol, polycyclic hydrocarbons were found. Ethanol is a good solvent and promotes the penetration of carcinogens into tissues. In addition, ethanol activates microsomal enzymes and can promote biotransformation of procarcinogens into obligate carcinogens, mutagens and teratogens.
Annually in the world of hepatocellular carcinoma die 1,250,000 people. Among tumors that affect a person, hepatocellular carcinoma is in seventh place. The prevalence of the tumor depends on the geographical area. The most common hepatocellular carcinoma occurs in people in countries in Africa and Asia, in which it almost always develops on the background of liver cirrhosis. In countries of South-East Asia hepatocellular carcinoma is the second most common malignant tumor. The incidence of cases is also increasing in Western countries, which is probably due to the prevalence of viral hepatitis B and C, which is the most common cause of hepatocellular carcinoma.
Causes of hepatocellular carcinoma
In Northern Europe and North America, the risk of developing primary hepatocellular carcinoma is four times higher among patients with alcoholism, especially the elderly. They always show signs of cirrhosis, and alcohol itself is not a hepatic carcinogen.
Pathogenesis of hepatocellular carcinoma
By the degree of malignancy, liver tumors can correspond to the entire range - from benign regeneration units to malignant tumors. Dysplasia of hepatocytes occupies an intermediate position. The probability of malignization is especially high in the presence of dysplastic hepatocytes of small size. An increase in the density of the nuclei of tumor cells is 1.3 times or more in comparison with the density of the nuclei of normal hepatocytes, indicating a highly differentiated hepatocellular carcinoma.
Symptoms of hepatocellular carcinoma
Symptoms of hepatocellular carcinoma are rather polymorphic. The course of the disease can be asymptomatic; while in patients only signs of cirrhosis are revealed. A tumor can be diagnosed accidentally. However, the clinical manifestations can be so vivid, and liver failure - so pronounced that the clinical picture resembles that of a liver abscess. The spectrum of manifestations fits between these two extreme clinical forms of the disease.
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Diagnosis of hepatocellular carcinoma
With computed tomography (CT), hepatocellular carcinoma appears as a foci of reduced density. CT often does not allow to determine the size and number of tumors, especially in the presence of cirrhosis. It is also important to conduct a study with contrasting. The picture in fcc is mosaic, multiple nodes with different degrees of signal attenuation and clearly defined partitions separating the tumor mass are visible. The tumor can be encapsulated. Often observed fatty degeneration of the liver. There may be infiltration of the portal vein and the presence of arterioportal shunts.
Diagnosis of hepatocellular carcinoma
[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]
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Treatment of hepatocellular carcinoma
It is necessary to determine the exact location of the tumor, especially when planning surgical intervention. The method of choice is CT, as well as its combination with angiography. CT can be combined with the contrast of the hepatic artery with iodolipol, which makes it possible to detect 96% of tumors. However, this method complicates the diagnosis and is not always necessary.
The only radical treatment for hepatocellular carcinoma is surgical, which consists of resection or liver transplantation.
Prognosis of hepatocellular carcinoma
The prognosis for hepatocellular carcinoma is usually extremely unfavorable. The time interval between infection with HBV or HCV and the development of the tumor varies from several years to many decades.