Healthpedia

Liver Cancer Lung Cancer

Liver Cirrhosis

 

Liver Cancer

 

Definition:

Malignant, or cancerous, liver tumors fall into two types: primary or secondary (e.g. spread from colon). Primary tumors originate in the liver itself. Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Primary liver cancer continues to be a major cause of mortality in Hong Kong. It accounts for over 7% of new cancer cases and is the second most common cancer in men and the seventh most common cancer in women.

 

Who is at risk?

• Men are more prone to liver cancer than women particularly those who indulge in heavy smoking and alcohol;
• People with Hepatitis B or Hepatitis C;
• Smokers;
• People with cirrhosis: Hepatitis B or C, heavy alcohol consumption, Alpha 1 anti-trypsin deficiency and hereditary Tyrosinemia are all strongly associated with cirrhosis and increase the risk of liver cancer;
• People with hereditary Hemochromatosis: It refers to too much iron in the liver. ~ 30% would develop into liver cancer, especially those who develop cirrhosis;
• People with Long-term exposure of Aflatoxins: poison from fungus that can grow on foods, such as grains and nuts that have not been stored properly can increase the risk;
• People with environmental exposure to Vinyl chloride and arsenic;
• People taking anabolic steroids: used by some athletes to increase their strength. Long-term use of these can slightly increase the risk of liver cancer.

 

Symptoms:

• Discomfort in the upper abdomen on the right side
• Might have a hard lump on the right side just below the rib cage
• Pain around the right shoulder blade
• Unexplained weight loss
• Jaundice (yellowing of the skin and whites of the eyes)
• Unusual tiredness
• Nausea
• Loss of appetite

 

Treatment:

• Partial hepatectomy: Removal of the part of the liver where cancer is found. The remaining liver tissue takes over the functions of the liver.
• Total hepatectomy and liver transplant: Removal of the entire liver and replacement with a healthy donated liver. If the patient has to wait for a donated liver, other treatment is given as needed.
• Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue. The doctor may use ultrasound to guide the instrument.
• Radio-frequency ablation: Use of a special probe with tiny electrodes that kill cancer cells. The probe is inserted directly through the skin or an incision in the abdomen.
• Alcohol injection. In this procedure, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol dries out the cells of the tumor and eventually the cells die.
• Radiation therapy. This treatment uses high-dose X-rays to destroy cancer cells and shrink tumors. Radiation may be used to treat localized unresectable cancer or following surgical removal of a tumor to help destroy any remaining malignant cells.
• Chemotherapy. This treatment uses powerful drugs to kill cancer cells. A special method called Chemoembolization, where the major artery supplying blood to your liver is blocked and chemotherapy drugs are injected between the blockage and the liver, can improve survival rates in people with unresectable liver tumors.

 

Prevention:

Protection from Hepatitis B and C, Cirrhosis and other liver diseases via:

1. Vaccination: Hepatitis B vaccination is available but for Hepatitis C yet.
2. Don't engage in unprotected sex; use a new latex condom every time you have vaginal or anal sex.
3. Use a clean needle if you inject drugs. Don't share the needles.
4. Avoid body piercing and tattooing.
5. Avoid alcohol and inappropriate use of medications (e.g. panadol) that may cause liver damage.
6. Avoid exposure to environmental toxins.

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Liver Cirrhosis

 

Definition:

In liver cirrhosis, the liver becomes tawny and knobby due to the presence of nodules. It is a response of the liver to injury where dead liver cells are replaced by excessive production of interlacing strands of scar tissue.

 

Who is at risk?

Alcoholism is a common cause of cirrhosis in all parts of the world. Cirrhosis usually develops after over a decade of heavy drinking. The amount of alcohol that can injure the liver varies greatly from person to person.

In Hong Kong, and Southeast Asia, the hepatitis B virus is another common cause of cirrhosis. The virus causes liver inflammation and injury that can last over decades. The hepatitis C virus is another major cause of cirrhosis and related chronic liver diseases.

Cirrhosis can also be caused by chronic obstruction to the flow of bile. Patients with heart failure may develop cirrhosis because of abnormal circulation.

 

Symptoms:

Many people with cirrhosis have no symptoms in the early stages. Some patients may experience exhaustion, fatigue, loss of appetite, nausea, weakness, weight loss and abdominal pain. Further down, complications may develop. They may have ankle and abdominal swellings as a result of water accumulating in the legs and abdomen. The patient may have skin bruising, gum bleeding, and develop jaundice (yellowing of the skin and eyes).

 

Treatment:

Once cirrhosis develops the damage done cannot be reversed. Treatment can only stop or delay further progression and reduce complications. For example, cirrhosis caused by alcoholism is treated by cutting off alcohol. Hepatitis-related cirrhosis can be prevented with antiviral drugs.

 

Prevention:

• Take the vaccines against hepatitis A, B and C if you have not done so.
• Avoid intravenous drug use and excessive alcoholic drinking.
• Follow safe sex guidelines to protect against sexually transmitted hepatitis.
• Maintain good personal hygiene, such as washing hands after going to the bathroom.
• Lose weight, as recent studies have suggested that obesity is related to fatty liver, a condition in which the liver cells are accumulating fat abnormally and can result in liver damage.

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Lung Cancer

 

Definition:

Lung cancer is an uncontrolled growth of abnormal cells in one or both of the lungs. It is the most common cancer in men and the second most common in women, after cancer of the breast. It accounts for over 18% of new cancer cases in Hong Kong. There are two major types of primary lung cancer: Non-small cell (~80%) and small cell (~20%). Each affects different types of cells in the lung and grows and spreads in different ways. Mesothelioma is uncommon and has been associated with the previous exposure of asbetoses.

 

Who is at risk?

• Smokers: Stopping exposure to tobacco smoke at any age lowers the risk of lung cancer;
• Second hand smokers: Passive smokers also carry increased risk of cancer;
• People exposed to Radon: Radon is an odorless radioactive gas produced naturally in rocks and soil, Radon is found in homes and mines in some areas. Exposure to high indoor radon levels can cause damage to the lungs that may lead to cancer;
• People exposed to Asbestos: Asbestos particles can cause lung damage that may lead to lung cancer and mesothelioma;
• People with exposure to radiation, either through one's occupation or for medical reasons, such as repeated X-rays;
• People with gene mutation: Mutations in EGFR are not inherited but arised after birth, perhaps by exposure to some environmental factor. The mutation occurs in the epidermal growth factor receptor (EGFR) gene, which signals cancerous cells to divide and grow. This gene variant can appear in high concentrations in lung cancer cells, even in those of people who don't smoke;
• People with gene abnormality (deletion of short arm (p) of chromosome 3) have been associated with small cell lung cancer;
• Recent research has localized a region on the long (q) arm of the human chromosome number 6 that is likely to contain a gene that confers an increased susceptibility to the development of lung cancer in smokers.

 

Symptoms:

During the early stages of lung cancer there are not usually any symptoms. Later you may have one or more of the following signs or symptoms:

• Achy chest pain, often generalized
• Constant cough or coughing up a lot of sputum or bloody sputum
• Feeling tired, weak, or losing weight
• Having lots of flu and colds may be another sign
• Wheezing or trouble breathing, often not relieved by usual medicine

 

Treatment:

• Surgery: A wedge resection involves removing a small part of the lung in which the growth is located. Alternatively, a whole lobe of the lung (lobectomy) or the entire lung (pneumonectomy) may be removed.
• Chemotherapy: As the major treatment to kill the cancer cells once a tumor has been surgically removed. It also can be used to treat cancer that has spread to elsewhere in the body.
• Radiation therapy: It is also used after surgery to destroy any remaining cancer cells. Radiation therapy can be directed precisely to those areas in the body to where cancer has spread, such as the bones, brain, or spine.
• Photodynamic therapy: A newer treatment involving the use of a laser light targeted at the cancerous growth which activates a chemical that has been injected into the blood stream and is absorbed by cancer cells. The chemical activated by the laser would then kills the cancer cells.
• Other newer therapies: This includes immunotherapy (drugs to boost a person's immune system to fight cancer) and gene therapy (target at genetic mutations that are causing the cancer). Gefitinib (Iressa) is one of a new class of drugs known as signal transduction inhibitors, which work by blocking the signals that make cancer cells grow and spread.

 

Prevention:

• Smoking cessation is the most important measure that can prevent lung cancer.
• Minimizing exposure to passive smoking is also an effective preventive measure.
• A Helical low-dose CT scan may be of value in the identification of small cancer that can be cured by surgical resection and prevention of widespread, incurable metastatic cancer. However, it is controversial as whether to adopt this test as primary screening tool because of the associated radiation, however small the dose.

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