Welcome to the introduction to Liver Cancer Course. I'm Ken Pienta, professor of Urology and Oncology, as well as, Pharmacology in Chemical and Biomolecular engineering at the Johns Hopkins School of Medicine. This course is designed for people who are familiar with basic cancer biology and would like to develop an understand of liver cancer, and how it is diagnosed and treated. It is highly recommended to have first taken the Johns Hopkins course, introduction to the biology of cancer. This Introduction to Liver Cancer course explains the basics of liver cancer. It describes screening for liver cancer, risk factors for liver cancer, as well as, how it is staged and treated. This course should be helpful to anyone who wants to develop a basic understanding of liver cancer risk factors staging and treatment. It should also be helpful to students, healthcare providers, data managers, and educators, who wish to develop a better understanding of liver cancer. At the end of this course, students should be able to, define the risk factors for liver cancer, understand current liver cancer screening guidelines, understand liver cancer staging. Understand treatments for localized liver cancer, understand treatments for advanced liver cancer. In Section A, we will cover incidence, risk factors and screening. The liver is a large gland that sits right below the rib cage on the right side. The liver is an unusual organ, in that, it has a double blood supply. The hepatic arteries carry oxygenated blood to the liver, and the portal vein carries venous blood from the GI tract to the liver. The normal function of the liver is to process nutrients absorbed from the intestine. It also makes clotting factors, that allow your blood to clot if you are cut. It also secretes bile to help the body absorb fats. You can't live without your liver. Liver cancer, or hepatocellular cancer, is a common cancer worldwide. It affects approximately 700,000 people around the world every year. It is most common in sub Saharan Africa and Southeast Asia. There are about 36,000 new cases in the US yearly. Liver cancer is a lethal disease and it is a leading cause of cancer death. Approximately 600,000 deaths are recorded every year around the world, about 24,000 of those deaths are in the US. Here is a map demonstrating where liver cancer is common around the world. The light yellow country is have a very low incidents and death rate from liver cancer. The dark red countries have a high incidents and death rate from liver cancer. As you can see, as we have said, Asia in sub Saharan Africa are afflicted with this disease. Why is that? What are the risk factors for liver cancer? We don’t know why, but liver cancer is approximately twice as common in men. But the real risk factors for liver cancer are a result of chronic disease in the liver. For example, chronic viral hepatititis, Hepatitis B and C are common causes of liver cancer Because they lead to cirrhosis, or scarring of the liver, which over time, leads to damage to the liver and increased risk of developing liver cancer. Other agents that damage the liver or lead to cirrhosis also increase your risk of developing liver cancer. For example, chronic alcohol use leads to cirrhosis, and an increased risk of further damage that then leads to the developement of liver cancer. Hemochromatosis is a inherited familial condition in which the body holds on to too much iron, again, leading to chronic liver damage. Aflatoxins are a form of fungus that is associated with storing grains in tropical environments, again, leading to damage to the liver. There are lifestyles that also contribute to the risk of developing liver cancer, obesity contributes to cirrhosis. Anabolic steroids contribute contribute to liver damage, and smoking contributes to liver damage. All increasing the risk of developing liver cancer. Let's look a little bit deeper into Hepatitis B and C. Chronic Hepatitis B is the leading cause of liver cancer in Asia and Africa. The relative risk of developing liver cancer in a Hepatitis B carrier is 100 times greater then uninfected individuals. Chronic Hepatitis C is the leading cause of liver cancer in Japan, Europe, and North America. The relative risk of developing liver cancer in a Hepatitis C carrier is 20 times greater than uninfected individuals. As these patients develop cirrhosis, the relative risk of developing liver cancer increases. How then, is it possible to prevent liver cancer? The best way is to prevent and treat hepatitis infections. For example, vaccinating against Hepatitis B is a very effective way to prevent the future treatment of liver cancer. There is now an effective treatment for Hepatitis C. With the drug Harvoni, which is an agent that inhibits the hepatitis C virus and actually cures patients of their hepatitis C. Both of these treatments for hepatitis are very effective in preventing future liver cancer Because they prevent the development of cirrhosis and ongoing liver damage. Other ways to prevent ongoing liver damage include avoiding alcohol abuse, avoiding smoking, and avoiding obesity. Unfortunately, there is no good strategy for screening for liver cancer. For people at higher risk of liver cancer due to cirrhosis from any cause or chronic hepatitis. It is being suggested that looking in the blood for alpha-fetoprotein or doing an ultrasound exam every 6 to 12 months maybe helpful, but this strategies are unproven. This ends our section on liver cancer etiology, incidents, screening, and prevention.
