Cancer is not clearly understand even if latest scientific developments. But in some cancer types are very strange and differ from others. Barcelona Clinic Liver Cancer (BCLC) is methods help to change differ cancer types according to size and severity of tumor.
What is Liver Cancer (hepatocellular carcinoma (HCC))?
Liver cancer, also known as hepatocellular carcinoma (HCC), is a type of cancer that begin in the liver. Liver is made up of many cells and when these cells develop genetic mutations, they can start to divide and grow uncontrollably, forming a tumor. As the tumor grows, it can invade nearby tissue and spread to other parts of the body, such as the lungs and bones.
Statistics About Liver Cancer
Prevalence and Incidence
- Global Incidence: Liver cancer is the 6th most common cancer worldwide, with an estimated 900,000 new cases diagnosed each year.
- Global Mortality: It is the 3rd leading cause of cancer-related death, resulting in about 830,000 deaths annually.
- Incidence by Region:
- Asia and Africa have the highest rates of liver cancer especially in countries like China, India, and sub-Saharan Africa because of the higher prevalence of hepatitis B and hepatitis C infections.
- In the U.S., the incidence of liver cancer has increased in recent years, with around 42,000 new cases diagnosed annually.
Risk Factors
- Hepatitis B Virus (HBV): Chronic HBV infection is responsible for 50-55% of liver cancer cases worldwide.
- Hepatitis C Virus (HCV): Chronic HCV infection contributes to about 25-30% of cases.
- Cirrhosis: The presence of cirrhosis, caused by chronic liver disease, accounts for approximately 70-90% of liver cancer cases.
- Alcohol Use: Chronic alcohol consumption contributes to 30-40% of liver cancer cases and often cause to cirrhosis.
- Non-Alcoholic Fatty Liver Disease (NAFLD): Increasingly common in Western countries, NAFLD is becoming a significant risk factor particularly for those with obesity and type 2 diabetes.
Survival Rates
- 5-Year Survival Rate:
- Overall: The 5-year survival rate for liver cancer is about 18% in the U.S.
- Localized (confined to the liver): When detected early and if surgically resected or treated with a liver transplant; the 5-year survival rate is higher at 50-70%.
- Advanced Stages: The survival rate drops dramatically in more advanced stages, where treatment options like chemotherapy and radiation are less effective.
Treatment Statistics
- Surgical Resection: Around 20-30% of patients are candidates for curative treatment via surgical resection but liver function and tumor location are key factors.
- Liver Transplantation: Liver transplantation is a treatment option for early-stage liver cancer in patients with cirrhosis, providing a potential cure in some cases.
- Systemic Therapy:
- Immunotherapy and targeted therapies like sorafenib and lenvatinib are commonly used in advanced cases but the response rates are typically lower than for localized treatment.
Mortality Trends
- U.S. Mortality: The mortality rate for liver cancer in the U.S. has been steadily increasing over the past few decades.
- 5-year survival rate: Approximately 18%.
- Expected deaths: The American Cancer Society estimates around 42,000 liver cancer deaths in the U.S. annually.
Liver Cancer and Gender
- Male to Female Ratio: Liver cancer is more common in men than in women, with men having 3 times the incidence rate of women.
Prognosis by Stage
- Localized (Stage I): 5-year survival rate of 50-70%.
- Regional (Stage II-III): 5-year survival rate of around 30%.
- Distant (Stage IV): 5-year survival rate of approximately 5-10%.
What Are The Early Warning Signs of Liver Cancer?
Early warning signs of liver cancer (hepatocellular carcinoma or HCC) can change from person to person and may not be present at all in the early stages of the disease. But some common early warning signs of liver cancer:
- Abdominal pain or discomfort in the upper right side of the abdomen, where the liver is located.
- A lump or mass in the upper right side of the abdomen.
- Weight loss or loss of appetite.
- Fatigue and weakness.
- Jaundice (yellowing of the skin and eyes) caused by the buildup of bilirubin, a substance that is normally excreted by the liver.
- Nausea and vomiting.
- Swelling or fluid build-up in the abdomen (ascites).
- Itchiness due to accumulation of bile salts.
It’s important to remember that these symptoms can also be caused by other conditions not just liver cancer. Early stage liver cancer may not cause any symptoms at all and it may only be found incidentally through an imaging test or a blood test in most cases. If you have any of these symptoms or have risk factors for liver cancer, such as chronic hepatitis B or C or cirrhosis, it is recommended to speak with a doctor to determine the cause and appropriate course of action.
How Can You Prevent Liver Cancer And What is Advices Against Liver Cancer?
There are several ways to reduce the risk of developing liver cancer. Here are some advices for:
- Avoid Viral Hepatitis: The most common cause of liver cancer is chronic infection with the hepatitis B or C virus. Be very careful and avoid infection with these viruses is the best way to prevent liver cancer. Vaccination against hepatitis B is available and can prevent infection.
- Limit Alcohol Consumption: Excessive alcohol consumption can cause cirrhosis of the liver, which is a biggest risk factor for liver cancer. It is recommended to limit alcohol intake or avoid it altogether.
- Healthy Diet: Eating a diet high in fruits and vegetables and low in processed foods and saturated fats may help reduce the risk of liver cancer.
- Healthy Weight: Being overweight or obese can increase the risk of liver cancer. Maintaining a healthy weight through regular exercise and a healthy diet can help reduce the risk. Also as you know, healthy diet and regular exercise is very important overall health conditions.
- Avoid Exposure to Toxins: Exposure to certain toxins and chemicals, such as aflatoxins (found in contaminated food), pesticides and certain industrial chemicals can increase the risk of liver cancer. It is important to limit exposure to these toxins as much as possible.
- Avoid Tobacco: Smoking or using any form of tobacco products increases the risk of liver cancer as well as other health risk.
- Get Tested and Treated For Any Underlying Medical Conditions: If you have a condition such as chronic hepatitis B or C or cirrhosis, it is important to be tested and treated as early as possible, as these conditions can increase the risk of liver cancer.
It is also very important to have regular check-ups with your doctor and if you have any risk factors for liver cancer, you should be screened for it. Early detection and treatment can improve the chances of survival.
What Are Survival Rates For Liver Cancer?
The 5-year survival rate for liver cancer can range from less than 5% for advanced stages (BCLC stage C and D) to as high as 20-30% for early stages (BCLC stage A) if treated with curative intent. But it should be noted that many patients with early stage liver cancer may not have symptoms and are often discovered incidentally.
It is important to know that these figures are general statistics and cannot predict an individual’s outcome. Survival rate depends on many factors such as the size of the tumor, the number of tumors, the location of the tumors and the patient’s overall health condition. A combination of treatments such as surgery, radiation therapy and chemotherapy can improve survival rate.
What is Barcelona Clinic Liver Cancer (BCLC staging)?
The Barcelona Clinic Liver Cancer (BCLC) staging system is a mostly used system for classifying liver cancer (hepatocellular carcinoma or HCC) into different stages based on the size and spread of the tumor as well as the overall health conditons of the patient. The BCLC system is designed to help guide treatment decisions and predict patient outcomes. Stages range from early-stage (0 and A) to advanced (B, C and D) and the treatment options and prognosis change accordingly.
What is BCLC (Barcelona Clinic Liver Cancer) Stages?
BCLC stages are:
0: Very early stage HCC that is not visible on imaging but can be found by biopsy or other ways. Patients with HCC 0 have a small number of very small tumors (less than 2 cm) that have not spread to nearby blood vessels or organs. HCC 0 is considered a highly curable stage and these patients are considered good candidates for surgery or local therapy such as radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI).
A: Early-stage HCC that is confined to the liver and can be treated with curative intent some methods such as surgery or local therapy. Patients with HCC A have a single tumor that is less than 5 cm in diameter and has not spread to nearby blood vessels or organs. They also have no significant liver dysfunction and good performance status.Treatment options for HCC A include surgery, such as liver resection or transplantation and local therapies such as radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI).
B: Intermediate stage HCC with either one or more tumors that are larger than 5 cm or multiple tumors that are smaller than 5 cm and can’t be treated with curative intent. Patients with HCC B have one or more tumors that are larger than 5 cm in diameter or multiple tumors that are smaller than 5 cm and have not spread to nearby blood vessels or organs, but cannot be treated with curative intent. They also have no significant liver dysfunction and good performance status. Treatment options for HCC B include systemic therapy (such as sorafenib) or local therapy (such as RFA or PEI) with a goal of controlling the disease and improving symptoms. Surgery is not considered curative at this stage. Early detection and treatment can improve the chances of survival for HCC B patients.
C: Advanced HCC that has spread to nearby organs or distant parts of the body. Patients with HCC C have tumors that have spread to nearby organs or distant parts of the body and have significant liver dysfunction and poor performance status. They are not suitable for curative treatment options like surgery or local therapy. Treatment options for HCC C include systemic therapy (such as sorafenib) or local therapy (such as RFA or PEI) with a goal of controlling the disease and improving symptoms, as well as palliative care.
D: End-stage HCC with significant liver dysfunction and weak performance status, not suitable for any treatments. Stage D is the most advanced stage of HCC, characterized by the presence of distant metastases or extrahepatic spread of the cancer. Patients with stage D HCC typically have a poor prognosis and may require palliative or hospice care, rather than curative treatment.
The BCLC stages help guide treatment decisions and predict patient outcomes. The treatment options and prognosis differ for each stage, for example, stage A is curable with surgery or local therapy, while stage D is end-stage and not suitable for treatments.
What is PST in BCLC?
PST, or “performance status” is a component of the Barcelona Clinic Liver Cancer (BCLC) staging system for liver cancer (hepatocellular carcinoma or HCC). PST is a way to evaluate a patient’s overall health and ability to tolerate treatment.
In the BCLC staging system, PST is used to classify patients into two groups: those with good performance status (PST 0) and those with poor performance status (PST 1). Good performance status is defined as the ability to carry out normal daily activities and having no major symptoms. Poor performance status is defined as the inability to carry out normal daily activities and having significant symptoms, such as fatigue, weakness or weight loss.
PST score is important in determining the appropriate treatment and prognosis for patients with liver cancer. Patients with good performance status are generally considered to be good candidates for more aggressive treatments such as surgery or radiation therapy, while those with poor performance status may be best suited for palliative care or supportive therapy.
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