Hepatic cancer, a malignant tumour that poses a serious threat to human health, has a high global morbidity and mortality rate. According to the latest global cancer burden data for 2020 published by the International Agency for Research on Cancer (IARC) of the World Health Organization, the number of new cases of liver cancer reached 90.66 million and deaths reached 830,000 [1]. Better knowledge about liver cancer is essential for prevention, early diagnosis and treatment.
Definition and classification of liver cancer
Hepatic cancer refers to malignant neoplasms occurring in the liver, mainly from primary and secondary liver cancers. Primary liver cancer originates in the cells of the liver itself, of which hepatic cell cancer is most common, accounting for about 90 per cent of primary liver cancer, while cholesterol cell cancer and hybrid cell cancer are less common. The subsequent liver cancer is the result of the transfer of malignant tumours from other parts of the body to the liver.
II. Causes and risk factors for liver cancer
(i) Hepatitis virus infection
Hepatitis B virus and hepatitis C virus infection are among the leading causes of liver cancer. If chronic hepatitis B and C patients are not treated in a timely and effective manner, long-term viral infections can lead to repeated damage to and repair of liver cells, increasing the risk of cancer [2].
(ii) Hepatic cirrhosis
The cirrhosis of the liver is a pathological change following long-term liver damage, with common causes including chronic alcohol abuse, fat liver and pharmaceutical liver damage. The cirrhosis of the liver is higher than that of the general population.
(iii) Aflatoxin
Aflatoxins are often found in aromous grains, beans, etc. The chronic ingestion of food contaminated with aflatoxin increases the risk of liver cancer [3].
(iv) Genetic factors
Certain genetic factors may increase the vulnerability of individuals to liver cancer, such as the relatively high risk of contracting liver cancer in families.
(v) Other factors
Chronic alcohol consumption, obesity, diabetes and non-alcoholic fatty liver diseases are also risk factors for liver cancer.
IV. Symptoms and diagnosis of liver cancer
i) Symptoms
In the early stages, liver cancer is generally not visible and, as the condition progresses, patients may suffer from liver pain, abdominal swelling, eating disorders, wasting and inactivity. However, these symptoms generally occur only when the tumour is large or late and are therefore easily ignored.
(ii) Diagnostic methods
1. Visual inspection
Magnetic resonance imaging, ultrasound, CT, etc. can help detect tumours in the liver and determine their size, location and morphology.
Blood testing
The detection of tumor markers such as the AFP has some support for the diagnosis of liver cancer. It is worth noting, however, that some AFPs for liver cancers may be normal and it is not accurate to use AFP alone to diagnose liver cancers.
Pathological examination
Getting the pathology results from a stabbing biopsy is the “gold standard” for the diagnosis of liver swelling.
Treatment for liver cancer
(i) Surgery
Surgery is the preferred method of liver cancer treatment and applies to patients with tumour limitations and good liver function. However, there is a high risk of surgery, which may result in complications such as liver failure, haemorrhaging and infection.
(ii) Hepatitis transplant
For patients with severe impaired liver function, small tumours and no transfer, liver transplant is one of the effective treatment options. However, the application of liver transplants is limited due to, inter alia, the shortage of the supply liver and the high cost of surgery.
(iii) Local digestive treatment
These include technologies such as radio-frequency digestion, refrigeration digestion, microwave digestion, etc., which cause the tumour tissue to die by physical or chemical means for therapeutic purposes. It applies to patients with smaller tumours and limited position.
(iv) Intervention
Hepatovascular embolism is a commonly used interventional method to inhibit the growth of tumours by injecting chemotherapy and embolisms into the tumour for blood artery.
(v) Treatment
For patients who cannot be surgically excised or partially treated, treatment can be used as an assistive treatment.
(vi) Target treatment and immunisation treatment
With the increasing development of medicine, targeted and immunotherapy have made significant progress in liver cancer treatment. Targeting drugs such as Solafeni, Pendini, etc. can inhibit tumour cell growth and vascular formation; immunotherapy drugs such as PD-1/PD-L1 inhibitors can activate the body ‘ s immune system and act as an anti-tumour [4].
VI. Prevention of liver cancer
1. Hepatitis B vaccination: Prevention of Hepatitis B virus infection is one of the important measures to prevent liver cancer.
2. Attention to dietary hygiene: Avoiding the consumption of depraved food and reducing the intake of aflatoxin.
3. Control of alcohol consumption: chronic alcohol consumption can impair liver function, increase the risk of liver cancer, and should be measured in appropriate quantities.
4. Maintaining a healthy lifestyle: balanced diet, adequate exercise, weight control, avoidance of smoking, etc. help prevent liver cancer.
5. Active treatment of chronic liver diseases: for persons with chronic liver diseases such as hepatitis B, C and cirrhosis, there should be active antiretroviral treatment and periodic review for early detection and treatment of possible cancers.
While liver cancer is a disease that seriously endangers human health, by understanding its causes, risk factors, symptoms, diagnostics and treatment methods, and by taking effective preventive and screening measures, we can reduce the incidence of liver cancer to a certain extent and improve the survival and quality of life of patients. At the same time, as medical research continues, it is believed that more and more effective treatments will be available in the future, giving more hope to liver cancer patients.
References:
[1] Sung H, Ferlay J, Siegel RL, et al. Global Council Statuss 2020: GLOBOCAN ESTIMATES of Information and Montality Worldwide for 36 Canadians in 185 Countries. CA Cancel J Clin. 2021; 71(3): 209-249.
European Association for the Study of the Life.
WorldCancer Research Fund/American Institute for Canada Research.
[4] Zhu AX, Finn RS, Edeline J, et al. Pembrarizumab in Spain with advanced hepatocellular carcinoma preliminarily treated with sorafenib (KEYNOTE-224); a non-randomist, open-label please 2 multilateral. Lancet Online. 2018; 19(7): 940-952.
