The Role of Diagnosis and Treatment of Underlying Liver Disease for the Prognosis of Primary Liver Cancer

Abstract

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. Underlying chronic liver disease has been associated with an increased risk of developing HCC. This study is a review of the current literature regarding the diagnosis, prognostic significance, and role of treating underlying liver disease in patients who are at risk of primary liver cancer. Relevant peer review of the English literature between 1980 and 2017 within PubMed and the Cochrane library was conducted for scientific content on current advances in managing chronic liver diseases and the development of hepatocellular carcinoma. Hepatitis C virus, hepatitis B virus (HBV), nonalcoholic steatohepatitis, autoimmune hepatitis, hereditary hemochromatosis, Wilson disease, primary biliary cirrhosis, α 1-antitrypsin deficiency, and certain drugs lead to an increased risk of developing HCC. Patients with underlying liver disease have an increased incidence of HCC. Hepatitis C virus, HBV, and hemochromatosis can directly lead to HCC without the presence of cirrhosis, while HCC related to other underlying liver diseases occurs in patients with cirrhosis. Treating the underlying liver disease and reducing the progression to cirrhosis should lead to a decreased incidence of HCC.

Abandonment of surveillance, followed by emergency surgery for a second spontaneous rupture of hepatocellular carcinoma: A case report and review of the literature

“…In addition, it has been a policy of our department that patients who have undergone surgery for cancer have regular, organized check‐ups every three months in the first two years and every six months thereafter. In summary, our patient's lifestyle modification was unsuccessful since the goals of weight loss and smoking cessation were not achieved . Furthermore, the control of arterial hypertension, dyslipidemia, and diabetes mellitus type 2 was also insufficient .…”

“…Later, the liver parenchyma progressed to bridging fibrosis in 2016 . Moreover, by means of a careful history, excessive alcohol consumption had been excluded . Consequently, a change of lifestyle was recommended to the patient, and he was prescribed drugs for every single MS element .…”

“…He was a full‐time employed construction worker and smoked more than 40 cigarettes per day. Later, tests for hepatitis C virus, hepatitis B virus, aflatoxin B1, autoimmune hepatitis, hereditary hemochromatosis, Wilson disease, primary biliary cirrhosis, and alpha‐1 antitrypsin deficiency were all negative . The tumor marker alpha‐fetoprotein (AFP) was elevated at 35.0 IU/mL .…”

“…Follow‐ups during the first two years revealed no signs of tumor recurrence, and the elevated AFP diminished to a reference value. A change in lifestyle was suggested, including weight loss, special diet, and cessation of smoking . He was prescribed therapy for diabetes, arterial hypertension, and dyslipidemia .…”

“…1,7 He was prescribed therapy for diabetes, arterial hypertension, and dyslipidemia. 1,7 However, he did not follow through, and the proposal was unsuccessful. In 2013, for unknown reasons, he abandoned surveillance appointments, with the last visit still detecting no signs of a new HCC alongside laboratory and radiology findings.…”