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Մասնակից:Avdalyan/Ավազարկղ

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Տարբերում են քաղցկեղի կանխարգելման առաջնային, երկրորդային և երրորդային ձևեր։ Առաջնային կանխարգելումը նվազեցնում է լյարդի քաղցկեղի ռիսկի գործոնների ազդեցությունը։ Լյարդի քաղցկեղի ամենահաջող կանխարգելման միջոցներից մեկը հեպատիտ B-ի դեմ պատվաստումն է։ Ներկայումս հեպատիտ C վիրուսի դեմ պատվաստումն անհասանելի է։ Առաջնային կանխարգելման մյուս ձևերն ուղղված են այդ վիրուսների փոխանցման սահմանափակմանը՝ ապահովելով անվտանգ ներարկման պրակտիկաներ, դոնորական արյան սկրինինգ և բարձր ռիսկի խմբում գտնվող ասիմպտոմ անհատների սկրինինգ հետազոտություն։

Aflatoxin exposure can be avoided by post-harvest intervention to discourage mold, which has been effective in west Africa. Reducing alcohol abuse, obesity, and diabetes would also reduce rates of liver cancer. Diet control in hemochromatosis could decrease the risk of iron overload, decreasing the risk of cancer.[1]

Secondary prevention includes both cure of the agent involved in the formation of cancer (carcinogenesis) and the prevention of carcinogenesis if this is not possible. Cure of virus-infected individuals is not possible, but treatment with antiviral drugs such as interferon can decrease the risk of liver cancer. Chlorophyllin may have potential in reducing the effects of aflatoxin.[1]

Tertiary prevention includes treatments to prevent the recurrence of liver cancer. These include the use of chemotherapy drugs and antiviral drugs.[1]

Treatment խմբագրել

Hepatocellular carcinoma խմբագրել

Կաղապար:Update section

 
Left lobe liver tumor in a 50-year-old male, operated in King Saud Medical Complex, Riyadh, Saudi Arabia

Partial surgical resection is the optimal treatment for hepatocellular carcinoma (HCC) when patients have sufficient hepatic function reserve. Increased risk of complications such as liver failure can occur with resection of cirrhotic (i.e. less-than-optimally functional) livers. 5-year survival rates after resection have massively improved over the last few decades and can now exceed 50%. However, recurrence rates after resection can exceed 70%, whether due to spread of the initial tumor or formation of new tumors .[2] Liver transplantation can also be considered in cases of HCC where this form of treatment can be tolerated and the tumor fits specific criteria (such as the Milan criteria). In general, patients who are being considered for liver transplantation have multiple hepatic lesions, severe underlying liver dysfunction, or both. Less than 30-40% of individuals with HCC are eligible for surgery and transplant because the cancer is often detected at a late stage. Also, HCC can progress during the waiting time for liver transplants, which can prevent transplant due to the strict criteria.

Percutaneous ablation is the only non-surgical treatment that can offer cure. There are many forms of percutaneous ablation, which consist of either injecting chemicals into the liver (ethanol or acetic acid) or producing extremes of temperature using radio frequency ablation, microwaves, lasers or cryotherapy. Of these, radio frequency ablation has one of the best reputations in HCC, but the limitations include inability to treat tumors close to other organs and blood vessels due to heat generation and the heat sink effect, respectively.[3][4] In addition, long-term of outcomes of percutaneous ablation procedures for HCC have not been well studied. In general, surgery is the preferred treatment modality when possible.

Systemic chemotherapeutics are not routinely used in HCC, although local chemotherapy may be used in a procedure known as transarterial chemoembolization. In this procedure, cytotoxic drugs such as doxorubicin or cisplatin with lipiodol are administered and the arteries supplying the liver are blocked by gelatin sponge or other particles. Because most systemic drugs have no efficacy in the treatment of HCC, research into the molecular pathways involved in the production of liver cancer produced sorafenib, a targeted therapy drug that prevents cell proliferation and blood cell growth. Sorafenib obtained FDA approval for the treatment of advanced hepatocellular carcinoma in November 2007.[5] This drug provides a survival benefit for advanced HCC.[4]

Radiotherapy is not often used in HCC because the liver is not tolerant to radiation. Although with modern technology it is possible to provide well-targeted radiation to the tumor, minimizing the dose to the rest of the liver. Dual treatments of radiotherapy plus chemoembolization, local chemotherapy, systemic chemotherapy or targeted therapy drugs may show benefit over radiotherapy alone.[6]

 
A surgeon performing photodynamic therapy

Cholangiocarcinoma խմբագրել

Resection is an option in cholangiocarcinoma, but fewer than 30% of cases of cholangiocarcinoma are resectable at diagnosis. After surgery, recurrence rates are up to 60%.[7][8] Liver transplant may be used where partial resection is not an option, and adjuvant chemoradiation may benefit some cases.[9]

60% of cholangiocarcinomas form in the perihilar region and photodynamic therapy can be used to improve quality of life and survival time in these unresectable cases. Photodynamic therapy is a novel treatment that utilitizes light activated molecules to treat the tumor. The compounds are activated in the tumor region by laser light, which causes the release of toxic reactive oxygen species, killing tumor cells.[7][10]

Systemic chemotherapies such as gemcitabine and cisplatin are sometimes used in inoperable cases of cholangiocarcinoma.[9]

Radio frequency ablation, transarterial chemoembolization and internal radiotherapy (brachytherapy) all show promise in the treatment of cholangiocarcinoma.[8]

Radiotherapy may be used in the adjuvant setting or for palliative treatment of cholangiocarcinoma.[11]

Hepatoblastoma խմբագրել

Removing the tumor by either surgical resection or liver transplant can be used in the treatment of hepatoblastoma. In some cases surgery can offer a cure. Chemotherapy may be used before and after surgery and transplant.[12]

Chemotherapy, including cisplatin, vincristine, cyclophosphamide, and doxorubicin are used for the systemic treatment of hepatoblastoma. Out of these drugs, cisplatin seems to be the most effective.[13]

Epidemiology խմբագրել

 
Deaths from liver cancer per million persons in 2012
     6–18     19–24     25–32     33–40     41–50     51–65     66–72     73–90     91–122     123–479

Globally, as of 2010, liver cancer resulted in 754,000 deaths, up from 460,000 in 1990, making it the third leading cause of cancer death after lung and stomach.[14] In 2012, it represented 7% of cancer diagnoses in men, the 5th most diagnosed cancer that year.[15] Of these deaths 340,000 were secondary to hepatitis B, 196,000 were secondary to hepatitis C, and 150,000 were secondary to alcohol.[14] HCC, the most common form of liver cancer, shows a striking geographical distribution. China has 50% of HCC cases globally, and more than 80% of total cases occur in sub-Saharan Africa or in East-Asia due to hepatitis B virus.[16][17] Cholangiocarcinoma also has a significant geographical distribution, with Thailand showing the highest rates worldwide due to the presence of liver fluke.[16][18]

India խմբագրել

The number of new cases of hepatocellular carcinoma per year in India in males is about 4.1 and for females 1.2 per 100,000. It typically occurs between 40 and 70 years of age.[19]

United Kingdom խմբագրել

Liver cancer is the eighteenth most common cancer in the UK (around 4,300 people were diagnosed with liver cancer in the UK in 2011), and it is the twelfth most common cause of cancer death (around 4,500 people died of the disease in 2012).[20]

United States խմբագրել

Liver cancer death rates for adults aged 25 and over increased 43 percent from 7.2 per 100,000 U.S. standard population in 2000 to 10.3 in 2016. Liver cancer death rates increased 43 percent from 10.5 in 2000 to 15.0 in 2016 for men and 40 percent from 4.5 to 6.3 for women. The death rate for men was between 2.0–2.5 times the rate for women throughout this period.[21]

Research խմբագրել

Hepcortespenlisimut-L is an oral immunotherapy that is going through a phase 3 clinical trial for HCC.[22]

See also խմբագրել

References խմբագրել

  1. ↑ 1,0 1,1 1,2 Hoshida, Y; Fuchs, BC; Tanabe, KK (Nov 1, 2012). «Prevention of hepatocellular carcinoma: potential targets, experimental models, and clinical challenges». Current Cancer Drug Targets. 12 (9): 1129–59. doi:10.2174/156800912803987977. PMC 3776581. PMID 22873223.
  2. ↑ Bruix J, Sherman M, American Association for the Study of Liver, Diseases (March 2011). «Management of hepatocellular carcinoma: an update». Hepatology. 53 (3): 1020–2. doi:10.1002/hep.24199. PMC 3084991. PMID 21374666.
  3. ↑ Wang, ZG; Zhang, GF; Wu, JC; Jia, MK (August 2013). «Adjuvant therapy for hepatocellular carcinoma: Current situation and prospect». Drug discoveries & therapeutics. 7 (4): 137–143. doi:10.5582/ddt.2013.v7.4.137. PMID 24071575.
  4. ↑ 4,0 4,1 de Lope, CR; Tremosini, S; Forner, A; Reig, M; Bruix, J (2012). «Management of HCC». Journal of Hepatology. 56 Suppl 1: S75–87. doi:10.1016/S0168-8278(12)60009-9. PMID 22300468.
  5. ↑ Keating GM, Santoro A (2009). «Sorafenib: a review of its use in advanced hepatocellular carcinoma». Drugs. 69 (2): 223–40. doi:10.2165/00003495-200969020-00006. PMID 19228077.
  6. ↑ Feng, M; Ben-Josef, E (October 2011). «Radiation therapy for hepatocellular carcinoma». Seminars in radiation oncology. 21 (4): 271–7. doi:10.1016/j.semradonc.2011.05.002. PMID 21939856.
  7. ↑ 7,0 7,1 Ulstrup, T; Pedersen, FM (Feb 25, 2013). «[Photodynamic therapy of cholangiocarcinomas]». Ugeskrift for laeger. 175 (9): 579–82. PMID 23608009.
  8. ↑ 8,0 8,1 Kuhlmann, JB; Blum, HE (May 2013). «Locoregional therapy for cholangiocarcinoma». Current Opinion in Gastroenterology. 29 (3): 324–8. doi:10.1097/MOG.0b013e32835d9dea. PMID 23337933.
  9. ↑ 9,0 9,1 Razumilava, N; Gores, GJ (January 2013). «Classification, diagnosis, and management of cholangiocarcinoma». Clinical Gastroenterology and Hepatology. 11 (1): 13–21.e1, quiz e3–4. doi:10.1016/j.cgh.2012.09.009. PMC 3596004. PMID 22982100.
  10. ↑ Ortner, MA (September 2011). «Photodynamic therapy for cholangiocarcinoma». Lasers in surgery and medicine. 43 (7): 776–80. doi:10.1002/lsm.21106. PMID 22057505.
  11. ↑ Valero V, 3rd; Cosgrove, D; Herman, JM; Pawlik, TM (August 2012). «Management of perihilar cholangiocarcinoma in the era of multimodal therapy». Expert Review of Gastroenterology & Hepatology. 6 (4): 481–95. doi:10.1586/egh.12.20. PMC 3538366. PMID 22928900.{{cite journal}}: CS1 սպաս․ թվային անուններ: authors list (link)
  12. ↑ Meyers, RL; Czauderna, P; Otte, JB (November 2012). «Surgical treatment of hepatoblastoma». Pediatric blood & cancer. 59 (5): 800–8. doi:10.1002/pbc.24220. PMID 22887704.
  13. ↑ Perilongo, G; Malogolowkin, M; Feusner, J (November 2012). «Hepatoblastoma clinical research: lessons learned and future challenges». Pediatric blood & cancer. 59 (5): 818–21. doi:10.1002/pbc.24217. PMID 22678761.
  14. ↑ 14,0 14,1 Lozano, R; Naghavi, M; Foreman, K; Lim, S; Shibuya, K; Aboyans, V; Abraham, J; Adair, T; Aggarwal, R; Ahn, S. Y.; Alvarado, M; Anderson, H. R.; Anderson, L. M.; Andrews, K. G.; Atkinson, C; Baddour, L. M.; Barker-Collo, S; Bartels, D. H.; Bell, M. L.; Benjamin, E. J.; Bennett, D; Bhalla, K; Bikbov, B; Bin Abdulhak, A; Birbeck, G; Blyth, F; Bolliger, I; Boufous, S; Bucello, C; և այլք: (Dec 15, 2012). «Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010». Lancet. 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. PMID 23245604.
  15. ↑ World Cancer Report 2014. International Agency for Research on Cancer, World Health Organization. 2014. ISBN 978-92-832-0432-9.
  16. ↑ 16,0 16,1 Քաղվածելու սխալ՝ Սխալ <ref> պիտակ՝ «pmid21296855» անվանումով ref-երը տեքստ չեն պարունակում:
  17. ↑ El-Serag, HB; Rudolph, KL (June 2007). «Hepatocellular carcinoma: epidemiology and molecular carcinogenesis». Gastroenterology. 132 (7): 2557–76. doi:10.1053/j.gastro.2007.04.061. PMID 17570226.
  18. ↑ Khan, SA; Toledano, MB; Taylor-Robinson, SD (2008). «Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma». HPB. 10 (2): 77–82. doi:10.1080/13651820801992641. PMC 2504381. PMID 18773060.
  19. ↑ «Overview of Hepatocellular Carcinoma». Liver Cancer. Արխիվացված է օրիգինալից 18 March 2017-ին. Վերցված է 18 March 2017-ին. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (օգնություն)
  20. ↑ «Liver cancer statistics». Cancer Research UK. Արխիվացված է օրիգինալից 17 October 2014-ին. Վերցված է 28 October 2014-ին. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (օգնություն)
  21. ↑ Xu, Jiaquan (July 2018). Trends in Liver Cancer Mortality Among Adults Aged 25 and Over in the United States, 2000-2016. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Վերցված է 17 September 2018-ին.
  22. ↑ Immunitor Phase 3 trial of hepcortespenlisimut-L, Liver Cancer Immunotherapy «Archived copy». Արխիվացված է օրիգինալից 2015-05-30-ին. Վերցված է 2015-05-29-ին. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (օգնություն)CS1 սպաս․ արխիվը պատճենվել է որպես վերնագիր (link)

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