Which one of the following patients is most likely to require screening for hepatocellular carcinoma?
A. A 45-year-old man with liver cirrhosis secondary to hepatitis C
B. A 33-year-old man with HIV. He is taking antiretroviral therapy
C. A 22-year-old man with alpha-1 antitrypsin deficiency. He has no evidence of current liver disease
D. A 52-year-old woman with alcohol-related liver cirrhosis who is still drinking
E. A 75-year-old man who drinks 100 units / week. He has no current signs of liver disease
Answer:
A. A 45-year-old man with liver cirrhosis secondary to hepatitis C
Discussion: Patients with liver cirrhosis secondary to hepatitis C have a 3-5% annual incidence of hepatocellular carcinoma.
Hepatocellular carcinoma
Hepatocellular carcinoma (HCC) is the third most common cause of cancer worldwide. Chronic hepatitis B is the most common cause of HCC worldwide with chronic hepatitis C being the most common cause in Europe.
The main risk factor for developing HCC is liver cirrhosis, for example secondary to hepatitis B & C, alcohol, haemochromatosis and primary biliary cirrhosis.
Other risk factors include:
alpha-1 antitrypsin deficiency
hereditary tyrosinosis
glycogen storage disease
aflatoxin
drugs: oral contraceptive pill, anabolic steroids
porphyria cutanea tarda
male sex
diabetes mellitus, metabolic syndrome
Clinical Features
tends to present late
features of liver cirrhosis or failure may be seen: jaundice, ascites, RUQ pain, hepatomegaly, pruritus, splenomegaly
possible presentation is decompensation in a patient with chronic liver disease
Screening with ultrasound (+/- alpha-fetoprotein) should be considered for high risk groups such as:
patients liver cirrhosis secondary to hepatitis B & C or haemochromatosis
men with liver cirrhosis secondary to alcohol
Management options include
early disease: surgical resection
liver transplantation
radiofrequency ablation
transarterial chemoembolisation
sorafenib: a multikinase inhibitor
i never believed that their could be any complete cure for fibroid with out going for surgery ,i saw people’s testimony on blog sites how Dr Onokun prepare herbal cure for different king of disease,and with the help of his herb they where able to shrink there fibroid naturally. i had to try it too and you can,t believe that in just few weeks i started using it all my pains stop gradually . Right now i want to tell you all that i just give birth to a baby boy last month,and on thin now i have not had any pain, and i have just went for text last week and the doctor confirmed that there is no trace of any fibroid in my system . Glory be to God for leading me to this great Dr onokun I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no herbal cure for fibroid that is Not true ,just contact him and get cure through his email: dronokunherbalcure@gmail.com or whats-app: +2349064844957
ReplyDeletevery informative post. To cure Fatty liver naturally liver herbal supplements is very effective method. Take liver medicine from Cureveda. Its award winning organization by INDIA Govt.
ReplyDeleteI got married to my lovely husband for the past 7 years without conceiving and fibroid was the issue, i took different prescribed medication but could not cure it but my husband was so confident in me and kept encouraging me that one day someone would call me mother, we did not rest searching for solution from different Doctors all they could say was surgery and i was afraid of that then a friend in my office introduced me to Dr.onokun who sent his product to me which i took and it really worked perfectly, and my Doc. confirmed me pregnant after 2 weeks of taken his product. You can contact him on email: Dronokunherbalcure@gmail.com or whats-app: +2349064844957
ReplyDeleteI got married to my lovely husband for the past 7 years without conceiving and fibroid was the issue, i took different prescribed medication but could not cure it but my husband was so confident in me and kept encouraging me that one day someone would call me mother, we did not rest searching for solution from different Doctors all they could say was surgery and i was afraid of that then a friend in my office introduced me to Dr.onokun who sent his product to me which i took and it really worked perfectly, and my Doc. confirmed me pregnant after 2 weeks of taken his product. You can contact him on email: Dronokunherbalcure@gmail.com or whats-app: +2349064844957
ReplyDeleteAs a sign of gratitude for how my wife was saved from fibroid, i decided to reach out to those still suffering from this.
ReplyDeleteMy wife suffered from fibroid for more than 20 year of marriage after our first son and it was really tough and heartbreaking for me because she was my all and the symptoms were terrible, she had irregular and painful menstrual flow and the size of it was 5cm, and she always complain of stomach pain. we tried various therapies prescribed by our neurologist but none could cure her. I searched for a cure and i saw a testimony by someone who was cured and so many other with similar body problem, and she left the contact of the doctor who had the natural cure to fibroid. I never imagined fibroid has a natural cure if not surgery not until i contacted him and he assured me my wife will be fine. I got the herbal medication he recommended and my wife used it as instructed by Dr Godstime, and in one months time we went to the hospital for scan and the doctor confirmed that there is no trace of fibroid and now she is fully okay, even up till this moment she is so full of life. fibroid has a cure and it is a herbal cure contact the doctor for more info on: Drgodstimehealinghome@gmail.com or WhatsApp +2349063469910 on how to get his medication.
God bless Dr. USELU for his marvelous work in my life, I was diagnosed of HERPES SIMPLEX VIRUS since 2018 and I was taking my medications, I wasn't satisfied i needed to get the HERPES out of my system, I searched about some possible cure for HERPES i saw a comment about Dr. USELU , how he cured HERPES with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine within 3 days. I took the medicine as prescribed by him and 2weeks later i was cured from HERPES contact him via email (dr.uselucaregiver@gmail.com) once again thanks to you Dr. USELU cure the flowing virus, contact his email or add him on whatsapp (+2349019328641) cancer cure
ReplyDeletediabetes cure
ringing ear
herpes cure
warts cure
HPV cure
HIV cure
get your ex back
pregnancy herbal medicine
Hepatitis
An amazing testimony on how i conceive and also get cure from my fibroid permanently with his natural herbs , i wonder why people still don't believe that roots and herbs are very essential and fruitful in different aspect, especially when you can't conceive and bear children. I am a living witness because I tried all I could to be pregnant but all to no avail, on this faithful day, i decided to check the net for updates on healthy living and i came across testimonies of lot of women who Dr Onokun has helped with his native herbs to conceive. i decided to put a try because this has been my greatest problem in life so I emailed Dr Onokun, and he told me what to do which i did, after which he sent me some roots and herbs syrup and gave me step by step guild lines on how and when to have sex with my man. I missed my menstrual flow within a short period of taking it, and the doctor confirmed that I am pregnant. I am very glad to tell the world that I just put to bed a bouncing baby boy last week. Contact Dr Onokun for your own testimony on: Dronokunherbalcure@gmail.com Or WhatsApp: +2349064844957
ReplyDelete