肝细胞癌
肝癌
肝癌
肝癌始发于肝脏细胞。最常见的肝癌始于名为“肝细胞”的细胞，被称为肝细胞癌。
肝细胞癌（HCC）是最常见的原发性肝癌类型。肝细胞癌最常见于慢性肝病患者，如乙肝或丙肝感染引起的肝硬化。
症状
Hepatocellular carcinoma might not cause symptoms that are noticed right away. This liver cancer happens most often in people with liver scarring, called cirrhosis, caused by hepatitis B or hepatitis C infection. In these people, the cancer symptoms might be the same as the cirrhosis symptoms.
If signs and symptoms of hepatocellular carcinoma develop, they may include:
- Losing weight without trying.
- Loss of appetite.
- Upper abdominal pain.
- A growth in the abdomen.
- Yellowing of the skin and the whites of the eyes, known as jaundice.
When to see a doctor
Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.
病因
It's not always clear what causes hepatocellular carcinoma. This cancer starts as a growth of cells in the liver. Most people with this type of cancer have an ongoing liver condition, such as cirrhosis caused by hepatitis B or hepatitis C infection.
Hepatocellular carcinoma happens when cells in the liver called hepatocytes develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.
The cancer cells form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.
风险因素
Factors that may increase the risk of hepatocellular carcinoma include:
- Older age. Hepatocellular carcinoma is more common in older adults.
- Infection with hepatitis B virus or hepatitis C virus. Ongoing or previous infection with the hepatitis B virus or hepatitis C virus increases the risk of hepatocellular carcinoma.
- Cirrhosis. Cirrhosis is a progressive and irreversible condition that causes scar tissue to form in the liver. It increases the chances of developing hepatocellular carcinoma.
- Certain inherited liver diseases. Some liver diseases that can run in families may increase the risk of hepatocellular carcinoma. Examples include hemochromatosis and Wilson's disease.
- Excess fat in the liver. Nonalcoholic fatty liver disease, also called metabolic dysfunction-associated steatotic liver disease, happens when fat builds up in the liver. People with this condition are at an increased risk of hepatocellular carcinoma.
- Diabetes. People with this blood sugar condition have a greater risk of hepatocellular carcinoma than those who don't have diabetes.
- Obesity. People with obesity have a higher risk of cirrhosis and excess fat in the liver. These conditions increase the risk of hepatocellular carcinoma.
- Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops, such as grains and nuts, can become contaminated with aflatoxins, which can end up in foods made of these products.
- Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase the risk of hepatocellular carcinoma.
- Smoking cigarettes. People who smoke cigarettes are at an increased risk of hepatocellular carcinoma.
预防
Reduce your risk of cirrhosis
Cirrhosis is scarring of the liver, and it increases the risk of hepatocellular carcinoma. You can reduce your risk of cirrhosis if you:
- Drink alcohol in moderation, if at all. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
- Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, ask a healthcare professional about healthy ways to lower your weight. Eat fewer calories and slowly increase the amount of exercise.
Get vaccinated against hepatitis B
Infection with the hepatitis B virus increases the risk of hepatocellular carcinoma. You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine. The vaccine can be given to almost anyone, including infants, children, adults and older adults.
Take measures to prevent hepatitis C
Infection with the hepatitis C virus increases the risk of hepatocellular carcinoma. No vaccine for hepatitis C exists, but you can reduce your risk of infection.
- Know the health status of any sexual partner. Don't engage in unprotected sex unless you're certain your partner isn't infected with hepatitis B, hepatitis C or any other sexually transmitted infection. If you don't know the health status of your partner, use a condom every time you have sexual intercourse.
- Don't use intravenous drugs, but if you do, use a clean needle. Reduce your risk of hepatitis C by not injecting legal or illegal drugs that may be sold on the streets. But if that isn't an option for you, make sure any needle you use is sterile, and don't share it. Contaminated needles are a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
- Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff members about their safety practices. If employees at a shop won't answer your questions or don't take your questions seriously, take that as a sign that the facility isn't right for you.
Seek treatment for hepatitis B or C infection
Treatments are available for hepatitis B and hepatitis C infections. Research shows that treatment can reduce the risk of hepatocellular carcinoma.
Ask about liver cancer screening
For most people, screening for liver cancer hasn't been proved to reduce the risk of dying of liver cancer, and it isn't generally recommended. People with conditions that increase the risk of liver cancer might consider screening. People with an increased risk include those who have:
- Hepatitis B infection.
- Hepatitis C infection.
- Liver cirrhosis.
Talk about the pros and cons of screening with your healthcare team. Together you can decide whether screening is right for you based on your risk. Hepatocellular carcinoma screening typically involves a blood test and an abdominal ultrasound every six months.
诊断
诊断肝细胞癌的检查和医疗程序包括：
- 旨在测定肝功能的血液检测
- CT 和 MRI 等影像学检查
- 肝活检（在某些情况下需要取出肝组织样本进行化验）
治疗
哪种治疗方法最适合您将取决于肝细胞癌的大小及其位置、肝脏的功能状况以及您的整体健康状况。
肝细胞癌的治疗方法包括：
- 外科手术。正常肝功能的早期肝癌患者可选择手术切除癌症以及癌症周围健康组织的边缘部位。
- 肝移植手术。对于其他方面健康的人群来说，如果肝癌尚未扩散到肝脏以外的部位，可以选择手术切除整个肝脏并使用捐赠者的肝脏代替。
- 以高温或低温破坏癌细胞。建议不能手术治疗的患者可采用消融技术，即使用极高温度或极低温度杀死肝脏中的癌细胞。这些技术包括射频消融术、冷冻消融以及酒精或微波消融。
- 直接化疗或放射靶向癌细胞。医生使用一根穿过血管进入肝脏的导管，将化疗药物（化疗栓塞）或带有辐射的小玻璃球（放射性栓塞）直接输送至癌细胞。
- 放射疗法。如果不能选择手术治疗，建议采用 X 线或质子的能量进行放射疗法。立体定向放疗（SBRT）是一种特殊类型的放射疗法，该疗法涉及将多个辐射束同时集中在人体的一点上。
- 靶向药物治疗。靶向药物可攻击癌细胞的特定弱点，这类药物可能有助于减慢晚期肝癌患者的疾病进展。
- 免疫疗法。免疫疗法药物是利用人体的抗细菌免疫系统来攻击癌细胞。免疫疗法可能是晚期肝癌的一种治疗选择。
- 临床试验。临床试验使您有机会尝试新的肝癌治疗方法。请咨询医生您是否有资格参加临床试验。
妥善处理与支持
With time, you'll find ways to cope with feelings that happen after a cancer diagnosis. Until then, here are some ideas for coping with hepatocellular carcinoma.
Learn enough about cancer to make decisions about your care
Ask your healthcare team about your cancer, including your test results, treatment options and, if you like, your prognosis. As you learn more about hepatocellular carcinoma, you may become more confident in making treatment decisions.
Keep friends and family close
Keeping your close relationships strong can help you deal with hepatocellular carcinoma. Friends and family can provide the practical support you may need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.
Find someone to talk with
Find someone who is willing to listen to you talk about your hopes and worries. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.
Ask your healthcare team about support groups in your area. Other sources of information include the U.S. National Cancer Institute and the American Cancer Society.
Preparing for your appointment
Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.
If your healthcare professional thinks you might have hepatocellular carcinoma, you may be referred to a doctor who specializes in diseases of the liver, called a hepatologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.
Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
- Write down important personal information, including major stresses or recent life changes.
- Make a list of all medicines, vitamins or supplements you're taking and the doses.
- Take a family member or friend along. Sometimes it can be very hard to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
- Write down questions to ask your healthcare team.
Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For hepatocellular carcinoma, some basic questions to ask include:
- Do I have hepatocellular carcinoma?
- What is the stage of my hepatocellular carcinoma?
- Has my hepatocellular carcinoma spread to other parts of my body?
- Will I need more tests?
- What are the treatment options?
- How much does each treatment increase my chances of a cure or prolong my life?
- What are the potential side effects of each treatment?
- How will each treatment affect my daily life?
- Is there one treatment option you believe is the best?
- What would you recommend to a friend or family member in my situation?
- Should I see a specialist?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
Don't hesitate to ask other questions.
What to expect from your doctor
Be prepared to answer questions, such as:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?