WHAT CAUSES HCC (HEPATOCELLULAR CARCINOMA)?
HCC
- BY DR. AK RANA
Incidence of HCC (Hepatocellular carcinoma) is increasing. It occurs more in males than females. Improper lifestyle, lack of balanced diet and regular exercises can be seen as a factor in general, along with various other important causes.
RISK FACTORS OF HCC
- Hepatitis B virus (chronic hepatitis)
- Hepatitis C virus
- Alcohol – it can cause Alcoholic liver disease (ALD), which can cause cirrhosis. Intake of 60 ml of alcohol per day for 10 years can lead to ALD.
- Obesity
- Aflatoxin exposure – Aflatoxin is produced by fungi Aspergillus and found on certain crops like maize, peanuts etc.
- NASH (Non- alcoholic steatohepatitis)
- NAFLD (Non- alcoholic fatty liver disease)
STAGES OF DISEASE PROGRESSION
In Alcoholic liver disease there is history of alcohol intake.
In NASH/NAFLD, there is history of obesity, Diabetes mellitus, hypercholesterolemia.
In both of the above the cases (in general) –
STAGE 1 – Fatty change is seen in hepatocytes/ liver cells.
(This stage is reversible)
STAGE 2 – Hepatitis stage
Inflammation of liver parenchyma.
(Infiltration of neutrophils/ monocytes)
Cirrhosis stage – starting from mild fibrosis to bridging fibrosis that connects different portal tracts.
From cirrhosis, various directions can be taken by the disease –
- Liver failure
- Portal hypertension (HTN)
- HCC (Hepatocellular carcinoma)
CLINICAL FEATURES OF HCC
- Hepatomegaly
Liver is increased in size; patient complains about presence of an abdominal lump.
- Jaundice due to abnormal liver function.
It usually presents late.
- Weight loss and weakness is seen.
- Hypoglycaemia (Low blood sugar level) is seen.
- Hypercholesterolemia – Increased level of cholesterol is seen.
DIAGNOSIS
- LFT (Liver function test)
- ALT (Alanine aminotransferase) and AST (Aspartate aminotransferase) generally their values <30 units/l is considered normal.
- Normal bilirubin up to 1.2 mg/dl
- Alkaline phosphatase
Normal = 40-140 IU/l
Abnormal = >4 times normal
- USG (Ultrasonography)
- Triple phase CT scan is IOC (Investigation of choice)
- Non- contrast phase
- Arterial phase
- Washout/ venous phase
It is done to differentiate between HCC & metastasis (e.g., From colorectal carcinoma)
- Tru cut/ core needle biopsy
It can be done to confirm the diagnosis.
- Various tumour markers are –
- Alfa feto protein
- Glycipan
- HepPar-1
- Neurotensin B
- Fibro scan
If it shows increased stiffness then cirrhosis is likely to be present.
WHAT WE CAN DO?
After knowing HCC, the most important question is how to prevent its occurrence or how to protect ourselves and our family from it.
The answer lies in the risk factors and the mechanism that follows it.
- Stop drinking alcohol
At least when your LFT (liver function test) is abnormal or when your doctor writes in your report ‘FATTY LIVER’.
Fatty liver in the report is a ‘warning’ that liver is weak and you need to heal it.
It is a reversible situation and with less fats, more exercise, no alcohol you can change it with the time.
- Proper immunization of Hepatitis
As through National Immunization schedule, it is being strictly followed; hence, cases arising through chronic hepatitis is decreasing.
Still, if you are not immune, you should consult your doctor for proper guidance.
- Obesity and high cholesterol level
Our food habits are to be blamed for this. Eating instant, high sugar, oily or food with ‘extra cheese’ or saturated fats are not good for your liver or your heart.
Eat a balanced diet.
Take timely and proper meals. Once on a weekend, or on a special occasion, your favourite dishes are not a bad choice; but you must keep a check on it.
Look whether your meal plan is good or not.
Plan a good meal plan for a week, and follow it.
- ‘Dieting’ is a fashionable word, but ‘Healthy dieting’ is what you can follow –
- Eat at a proper time, avoid eating all the time or when you are bored.
- Keep a check on your calories.
- Eat food rich in fibres and all other essential nutrients.
- Only once, or twice a week you are allowed to break this rule and not on any other days.
- When you will achieve control on yourself, you will see the results.
- Doing yoga and exercises daily.
Even for 1 hour or 30 minutes daily, if you take this time out for your health, its what your body needs.
Daily exercises are always more beneficial than doing all the exercises on a day.
Starting from jogging/ walking, aerobics followed by some yoga and pranayama – in this way you can make your own set of exercises with the assigned time, so that you can wrap it up accordingly.
If you have a liver disease or someone in your family have it, then you need to take extra care.
Follow regular health checkups and keep in touch with your doctor.
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also read HOW TO PREVENT EYE FLU?
also read HIGH BLOOD PRESSURE- A SILENT KILLER
