In the era of hepatitis B immunization and health care improvement, liver cancer is still developing in an alarming trend – liver cancer (liver cancer) is one of the common malignant tumors in China, with high mortality rate, ranking third after gastric cancer and esophageal cancer in the order of malignant tumor death, and seriously threatening people’s life and health.
Researchers have pointed out three reasons for the high incidence of liver cancer.
1. very few individuals are tested for hepatitis B, resulting in two-thirds of individuals with hepatitis B not knowing they are infected with HBV
2. only 20% of physicians follow liver cancer screening guidelines to detect the presence of liver cancer in patients with high-risk hepatitis B. And because of the insidious onset, more than 80% of liver cancer patients are diagnosed at an intermediate to late stage, making effective treatment too late.
3. In addition, liver cancer screening guidelines are inadequate and do not provide valuable blood tests to help identify liver cancer at an early stage when it is treatable.
I. Risk factors of liver cancer
Hepatocellular carcinoma accounts for more than 90% of the incidence of primary liver cancer in China, and the everyday term liver cancer mainly refers to hepatocellular carcinoma. The main risk factors of liver cancer in China include viral hepatitis, aflatoxin, alcohol and drinking water pollution.
1.Viral hepatitis
Hepatitis – cirrhosis – liver cancer is called the trilogy of liver cancer. Clinical survey data show that about 10% of viral hepatitis will develop into chronic active hepatitis, while the annual incidence of cirrhosis in patients with chronic active hepatitis is 2% to 10%, and the annual incidence of HCC in patients with cirrhosis is 3% to 6%.
In China, chronic hepatitis B or C virus infection is a major risk factor for HCC, and about one-third of primary liver cancer patients have a history of chronic hepatitis. Epidemiological surveys have found that the HbsAg positivity rate of liver cancer patients in China can reach 90%, and about 5%-8% are positive for anti-HCV antibodies5.
2.Aflatoxin
The content of aflatoxin is often high in moldy food. Aflatoxin B1, a metabolite of aflatoxin, has a strong carcinogenic effect. And aflatoxin has a synergistic carcinogenic effect with HBV, and aflatoxin accumulation can be found in HBV-DNA-integrated hepatocytes.
In addition, the high content of carcinogens or former carcinogens such as nitrite and polycyclic aromatic compounds in pickled, smoked and baked food; nitrite itself is not carcinogenic, but under cooking or other conditions, it can react with amino acid degradation to generate strong carcinogenic nitrosamines.
3.Alcoholism and obesity
Alcohol consumption can induce liver cancer through the following ways.
(1) alcoholics or excessive drinkers in the drinking population can have alcohol-related health problems, of which alcoholic liver disease is the most common organ damage caused by alcohol, which can further lead to alcoholic cirrhosis.
(2) Hepatitis virus infection and alcohol play a synergistic role in liver damage, and drinking alcohol on the basis of hepatitis virus infection or concomitant HBV or HCV infection on the basis of alcoholic liver disease can accelerate the occurrence and development of liver disease.
With the prevalence of obesity, the incidence of non-alcoholic fatty liver disease (NAFLD) in China is on the rise. Non-alcoholic fatty liver disease (NAFLD) can occur through liver inflammation and then cirrhosis and liver cancer, and among primary hepatocellular carcinoma (HCC), the growth rate of non-alcoholic steatohepatitis is rapid.
4.Drinking water pollution
In recent years, it has been found that blue-green algae growing in ponds are strong carcinogenic plants and can contaminate water sources. Parasitic diseases such as Toxoplasma gondii infection can stimulate bile duct epithelial proliferation, which can lead to primary bile duct cancer.
Symptoms of liver cancer
The onset of hepatocellular carcinoma is often insidious, and it is mostly discovered by chance during the follow-up of liver disease or physical examination and ultrasonic examination. Early stage of liver cancer is usually asymptomatic or asymptomatic, and usually when liver cancer is detected, it is already in the middle or late stage.
There may be no symptoms or signs in the early stage of hepatocellular carcinoma, a few patients may experience loss of appetite, upper abdominal stuffiness and weakness, and some patients may have mild hepatomegaly. This is the reason why routine screening is so important for early detection.
Symptoms of hepatocellular carcinoma in the middle and late stages include.
1. pain in the right upper abdomen.
2, a palpable mass or harder, irregular liver surface in the upper abdomen.
3, loss of appetite, feeling of fullness, weight loss.
4. a feeling of weakness or fatigue.
5. nausea and vomiting.
6. splenomegaly, jaundice and ascites.
7. clay-like stools and deepening of urine color.
8.Fever and pain in liver area, weakness and emaciation, etc.
Prevention of liver cancer
To prevent liver cancer, we need to start from daily practice.
1. vaccination against hepatitis B to prevent it.
2. low-fat diet, weight control, avoiding obesity and fatty liver.
3.Reducing alcohol intake to prevent alcoholic liver disease.
4, do not eat moldy food, to avoid the intake of aflatoxin.
5.Pay attention to drinking water hygiene and avoid quoting unclean water.
6, for patients with HBV and HCV infection, it is recommended to review liver function every six months, perform quantitative HBV and/or HCV viral testing, measure methemoglobin, and perform liver ultrasound; patients with antiviral indications should strictly follow medical advice for antiviral treatment and should not discontinue medication casually.
7. American and European guidelines recommend that any patient with cirrhosis should undergo liver ultrasound every 6 months to screen for liver cancer, as 80% of patients with liver cancer have cirrhosis. In addition, patients with a family history of liver cancer, patients co-infected with HIV or HCV, and people with fatty liver should be tested for liver cancer.