HepatocellularCarcinomaAndyFriedtColoradoChristian University HepatocellularCarcinoma The human body is animpressive creation and is capable of some extraordinary things; when it ishealthy. Some significant parts of the body are the organs. Organs like: Thebrain, heart, kidneys, liver and lungs hold specialized job descriptions. Theirroles function independently but also, work together in a partnership for onemain goal, to keep the body functioning.
The liver is an extremely important organand it is imperative to keep it healthy in order to prevent damage to theliver. Thelocation of the liver is in the upper-right quadrant of the abdominal area. Themajority of the liver is protected by a portion of the rib cage. It is a dark,reddish-brown organ that has multiple functions. The main functions of theliver are to control chemical levels in the blood stream as well as excretebile to assist in carrying waste away (University of Rochester, n.d.
). It acts asa storage unit by packing away nutrients from metabolized carbohydrates,proteins, amino acids, and lipids. The liver also serves as a metabolizer of alcoholand some medications (University of Rochester, n.d).
Liver cancer is the fifthmost common cancer worldwide and if damage to the liver occurs, it will beginto fail, causing catastrophic diseases like hepatitis and cirrhosis, both of which can lead to liver cancer. Every year, nearly700,000 people are diagnosed with liver cancer across the world and males areup to five times more likely than females to develop the disease (CDC, 2017).In the United States about 40,710 new cases (29,200 in men and 11,510 in women)will be diagnosed; of that, 28,920 men and women will die from liver cancers (AmericanCancer Society, 2017). That is an disturbing fatality rate of 72%. Among menand women, the Hispanic population is affected at the highest rates of beingdiagnosed with liver cancer (CDC, 2017). Thereare several types of liver cancers but 75% of allliver cancers are diagnosed as hepatocellular carcinoma (HCC)(Lippincott, 2016). HCC is a primary malignancy whicharises within the liver. HCC begins at the cellular level; the mutationstarts with the hepatocyte, the liver cells (CDC, 2017).
The cause of HCC is unknown but factors thatincrease the risk of primary liver cancer include but are not limited to:Hepatitis B and C virus infections, cirrhosis, inherited liver diseases,diabetes, and nonalcoholic fatty liver disease (Medline Plus, 2017). Some signsand symptoms that display there is trouble with the liver are: Abdominal pain or tenderness in theupper-right quadrant, easy bruising or bleeding, ascites, jaundice andunexplained weight loss (Mayo Clinic, 2017). Since there are so many potentialcauses of HCC, it is vital to understand the genetic abnormalities that are associatedwith this terrible cancer. Theprimary affected gene in HCC is the TP53 gene. According to The NationalInstitute of Health (2015), “the TP53 genedelivers instructions for making the protein P53 which acts as a tumorsuppressor that regulates cell division.” When this gene becomes damaged with chronic infections like hepatitis B andC and cirrhosis, this gene begins to produce reactiveoxygen and nitrogen.
The process initiates damage to DNA, mutatingcancer-related genes such as TP53 (Hussain et al, 2007). Whenlooking closer at the genetic mutation of HCC, it is vital to evaluate theoncogenes that are affected in HCC individuals.Oncogenemutations that have been linked with HCC individuals are: N-RAS, C-FOS and C-MYC. N-RAS is an oncogene that is similar to an on and offswitch that regulates the rate of cell growth and division. When N-RAS workscorrectly, it will turn on the cell to activate and attach to a molecule.
Whenit turns off, the cell will become inactivated and stop transmitting signals tothe nucleus. When N-RAS becomes mutated the regulation process becomesinoperative. Meaning, the on and off switch is stuck on and cancerous cells willcontinue to grow uncontrollably (NIH, 2014).
“C-FOS is another oncogenethat creates an overexpression which in turn beginsto increase the proliferation of hepatocytes by stabilizing nuclear Cyclin D1,”(Zender, 2006). C-MYC is the third oncogene that is associated with manytypes of malignant tumors but specifically, it has a critical responsibility inthe cell’s life span. When there is a mutation with C-MYC there will be a malfunctionand the birth and death of a cell will be off balance; consequentially, apoptosisstage will be inhibited. If apoptosis becomes obsolete, normal cell death willnot occur and malignant cell growth builds into cancerous tumors (NIH, 2014). Methylationis a natural adjustment of DNA, and it affects the connection between the twoDNA base pair of cytosine (C) and guanosine (G).
C-MYC develops a mutation whichis considered to be hypomethylation and therefore, C-MYC will decrease thenatural connection causing a loss of imprinting core sequence from DNA to RNA,resulting in an interference with the development of microRNA (Zender, 2006). MicroRNA’s (miRNAs) play an intricate rolemonitoring gene expression. In HCC miRNAs have a specific connection tomiR-222, miR-106a, miR-92, miR-17–5p, miR-20, and miR-18 which mightcontribute to HCC tumor development (Braconi et al., 2011). MiR-122 is one of the most abundant miRNAs that is presentin the liver. According to Braconi et al (2011), “miR-122 is present in normal hepatocytes but demonstrations adecrease in up to 70% of human HCCs.” With the knowledge of genetic mutationsof HCC, it is important to evaluate how this cancer is diagnosed and treated.Early identification of HCC with aggressiveintervention provides an improved survival for individuals.
HCC is diagnosedusing several procedures which include: Laboratory testing, imaging and diagnostic procedures. Blood tests thatneed to be measured are liver function and complete blood count. Also, a HCCDNA test may be performed to assess genetic alterations from primary cancerssuch as HCC. Imaging procedures will include computed tomography, medicalresonance imaging and ultrasound (Mayo Clinic, 2017). Lastly, a diagnosticprocedure that potentially will be performed is a liver biopsy, in order to remove a sample of liver tissue to send off tothe laboratory for further testing. Once all diagnostic procedures arecompleted and HCC is confirmed, treatment options will be discussed with theindividual.Treatment of HCC will depend on the size as well as the location/involvementof the cancerous tumor on the liver. The individual’s overall liver functionand health will also be taken into consideration.
Treatment options for HCC willbegin with surgery to remove the cancer or liver transplant surgery may need to be an option.The majority of the liver can actually be removed because it can regrow itself. But, unfortunately, most liver cancersspread quickly and will consume too much of an individual’s liver. Anotheroption is radiation therapy with or withoutchemotherapy or radiofrequency ablation or cryotherapy. Radiofrequency ablationor cryotherapy is a procedure that uses extreme heat or cold which is a greatoption for individuals that cannotundergo surgery (Lippincott, 2016). Adult stem cell transplant may be a newemerging option for treatment of HCC. A group of surgeons from Germany havebegun trials of injecting blood stem cells into an individual’s liver to growmore liver cells. This in turn will leave enough of the liver behind after surgery(Stanford at the Tech, 2008).
Lastly, because HCC can cause weightloss, abdominal pain, appetite loss and nausea, it is vital to evaluate thediet of the individual. A high-calorie, low-protein diet is most appropriatebecause proteins may not be correctly processed(Lippincott, 2016). Withthe rapid rise in incidence of HCC and little advancement in research, theprognosis of HCC is unfortunately poor.
According to Schlachterman et al (2015)”Sorafenib was the first approved systemic therapy bythe FDA to demonstrate improved survival in patients with advanced-stage HCC.” Sorafenib is a multi-kinase inhibitor which occludescell growth. TACE is anothertreatment option for individuals. The main goal of TACE is to increase theexposure of tumor cells to cytotoxic agents, which then tamponades bloodsupply to the lobe of the liver that is being affected by HCC (Schlachterman et al, 2015). It has been studied that treatmentof HCC is shifting fromchemotherapy to a more targeted approach. Also, studies are focusing onalternative molecular pathways that are associated with biomarkers. “Epigeneticmodifications have also been suggested to drive progression to HCC and includeDNA methyltransferases and miRNAs,” (Eatrideset al, 2017).”Or do you not know thatyour body is a temple of the Holy Spirit within you, whom you have from God?You are not your own, for you were bought with a price.
So, glorify God in yourbody,” 1 Corinthians 6:19-20 ESV(Bible Gateway, n.d). We must treat our bodies as though they are the structureof God’s word. We must care for our bodies as though it is invaluable;maintaining physical, emotional and spiritual well-being. There are steps toachieving strength within our physical bodies to support our inner spirits suchas: Eating a clean, healthy diet,physical activity, stress reduction and keeping our bodies pure and free oftoxins such as tobacco and alcohol.
“God make me a hollow vessel and breathesomething through me that would turn people’s eyes to you” – Toby Mac