PREVENTION OF HEPATOCELLULAR CARCINOMA (HCC)

1. WHAT IS HEPACLOCAL CARCINOMA?

Liver cancer is divided into two types: primary and secondary liver cancer.

- Secondary liver cancer: is caused by cancer cells in other parts of the body entering the liver, causing metastatic tumors. Cancer cells grow, affecting adjacent normal tissue and can spread to other areas of the liver as well as organs outside the liver.

- Primary liver cancer: is a malignant disease of the liver that occurs when normal liver cells become abnormal in shape and function.

Primary liver cancer includes three main types: hepatocellular carcinoma (HCC) , cholangiocarcinoma, and hepatoblastoma.

In this article we will discuss hepatocellular carcinoma - the most common type of liver cancer.

Hepatocellular carcinoma is a silent disease with a high mortality rate, but it is preventable and treatable if detected early and risk factors are well controlled .

2. WHAT CAUSES HEPACHOTIC CELLULAR CANCER?

There are many causes and risk factors that can lead to hepatocellular carcinoma. Among them, hepatitis B virus infection, hepatitis C virus infection, aflatoxin, and alcohol are considered common risk factors. Nowadays, non-alcoholic fatty liver disease is also considered a risk factor for cirrhosis and liver cancer.

Hepatitis B virus is the most common cause of chronic liver disease, increasing the risk of complications such as cirrhosis and liver cancer. The rate of B virus infection in adults in Vietnam is about 8.2-19% according to data from the World Health Organization (WHO) in 2016.

Hepatitis C virus accounts for a lower percentage. After 10-20 years, 10-40% of patients with chronic hepatitis C virus infection will progress to cirrhosis and liver cancer.

Aflatoxin is a toxin caused by mold that can be found in grains such as corn, rice, peanuts, sunflower seeds, etc. that have not been properly preserved and have become moldy. Many people think that if they just remove the mold and cook it, they will be fine to eat. In fact, Aflatoxin remains intact and can cause liver cancer when it enters the body. It is worth noting that if a person infected with hepatitis B virus is also infected with aflatoxin, the risk of liver cancer is many times higher than that of a person infected with hepatitis B virus alone.

Alcohol is also considered one of the causes of cirrhosis and liver cancer. In particular, in people who drink a lot of alcohol and have a history of hepatitis caused by hepatitis B and C viruses, the risk and time of progression to liver cancer will be much faster.

Non- alcoholic fatty liver disease (NAFLD) is becoming the leading cause of chronic liver disease worldwide. Over the past two decades, NAFLD has progressed to non-alcoholic steatohepatitis (NASH), cirrhosis, and liver cancer.

3. HOW TO PREVENT LIVER CELLULAR CANCER ?

Hepatitis B and C viruses can be transmitted from person to person through blood transfusions, sexual intercourse, and newborns can be infected from their mothers. Therefore, vaccination against hepatitis B virus for children is necessary and pregnant women need to be checked and monitored if they are infected with hepatitis B virus.

Adults should be screened for hepatitis B virus , and if they do not have protective antibodies, they should be vaccinated.

Family members with liver cancer: family members should go to a medical facility to screen for hepatitis B and C.

Infection with virus B, C is stable: should limit beer, alcohol and limit fatty foods. Need blood test, abdominal ultrasound/ 6 months or when there is an abnormality.

Chronic hepatitis B: Take antiviral drugs continuously as prescribed by your doctor, have regular blood tests and abdominal ultrasounds every 3-6 months, and do not stop taking the medication on your own.

Chronic hepatitis C: treat as soon as possible with oral medication for 3-6 months, low cost, easy to store, few side effects.

Do not use moldy grains such as corn, rice, peanuts, sunflower seeds, etc., even if they have been washed and cooked, or products of unknown origin.

Limit your alcohol intake . Safe maximum levels of wine or beer:

Men: less than 3 cans of beer/day (330ml can), less than 3 glasses of wine/day (1 glass of wine 135ml), less than 5 glasses of rice wine/day (1 glass of rice wine 15-25ml).

Women: less than 2 cans of beer/day (330ml can), less than 2 glasses of wine/day (1 glass of wine 135ml), less than 3 glasses of rice wine/day (1 glass of rice wine 15-25ml).

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) should be treated because they increase the risk of liver cancer, especially when cirrhosis is present. Diabetes and obesity also increase the risk of liver cancer in patients with non-alcoholic steatohepatitis (NASH).

4. HOW TO SCREEN FOR HEPACHOTIC CELL CARCINOMA?

A. WHO NEEDS SCREENING?

All subjects need to be screened for liver cancer and liver diseases, especially those at risk such as cirrhosis, hepatitis B and C virus infection, alcoholism, and fatty liver.

B. HOW SHOULD SCREENING BE DONE?

Blood test, liver enzymes (AST, ALT), abdominal ultrasound every 6 months.

Patients with cirrhosis, hepatitis B and C virus infection, alcoholism, and fatty liver need to monitor the specific marker of liver cancer AFP every 6 months.

If AFP is increased but no liver tumor is detected by abdominal ultrasound, more frequent check-ups such as every 3 months are needed or abdominal CT scan with contrast or abdominal MRI  with contrast should be performed depending on the patient's condition.

If there is a lesion suspected of liver cancer and/or the AFP biological index value increases, an abdominal CT scan with contrast or abdominal MRI is necessary for confirmation.

5. CAN HEPACLOCAL CARCINOMA BE TREATABLE?

If liver cancer is in the early stages and the healthy liver is still good and has not yet developed cirrhosis, treatment is quite good and the patient can live for 5-7 years.

There are currently many methods of treating hepatocellular carcinoma, suitable for each stage of the disease. Patients should follow the doctor's advice and follow-up schedule.

• Resection of the part of the liver with the tumor or liver transplantation.
• Radiofrequency ablation (RFA), cryotherapy, alcohol (PEI) or radioactive material into the tumor.
• TACE ( Trans-Arterial Chemo-Embolization ) method : injecting drugs into the tumor.
• Radiotherapy.
• Systemic treatment – ​​chemotherapy.