Hepatoma Health Dictionary

A protein that is produced in the liver and gastrointestinal tract of the fetus and by some abnormal tissues in adults.

Alpha-fetoprotein (AFP) can be measured in the maternal blood from the latter part of the 1st trimester of pregnancy, and its concentration rises between the 15th and 20th weeks.

Raised levels of are associated with fetal neural tube defects, such as spina bifida or anencephaly, and certain kidney abnormalities. High levels of also occur in multiple pregnancies (see pregnancy, multiple) and threatened or actual miscarriage. levels may be unusually low if the fetus has Down’s syndrome. For this reason, measurement of blood is included in blood tests, which are used to screen pregnant women for an increased risk of Down’s syndrome.

levels are commonly raised in adults with hepatoma (see liver cancer), cancerous teratoma of the testes or ovaries, or cancer of the pancreas, stomach, or lung.

For this reason, is known as a tumour marker.

(AFP) levels can be used to monitor the results of treatment of certain cancers; increasing levels after surgery or chemotherapy may indicate tumour recurrence.

However, levels are also raised in some noncancerous conditions, including viral and alcoholic hepatitis and cirrhosis.... alpha-fetoprotein

A condition of the liver arising from long-term damage to its cells. In cirrhosis, bands of fibrosis (internal scarring) develop, leaving nodules of regenerating cells that are inadequately supplied with blood. Liver function is gradually impaired; the liver no longer effectively removes toxic substances from the blood (see liver failure). The distortion and fibrosis also lead to portal hypertension. The most common cause of cirrhosis is heavy alcohol consumption. Other causes include forms of hepatitis and, more rarely, disorders of the bile ducts, haemochromatosis, Wilson’s disease, cystic fibrosis, and heart failure.

Cirrhosis may go unrecognized until symptoms such as mild jaundice, oedema, and vomiting of blood develop. There may be enlargement of the liver and spleen and, in men, enlargement of the breasts and loss of body hair due to an imbalance in sex hormones caused by liver failure. Complications of cirrhosis include ascites, oesophageal varices, and hepatoma. Treatment is focused on slowing the rate at which liver cells are being damaged, if possible by treating the cause. In some cases, however, the condition progresses and a liver transplant may be considered.... cirrhosis

The general term used to refer to a malignant TUMOUR, irrespective of the tissue of origin. ‘Malignancy’ indicates that (i) the tumour is capable of progressive growth, unrestrained by the capsule of the parent organ, and/or (ii) that it is capable of distant spread via lymphatics or the bloodstream, resulting in development of secondary deposits of tumour known as ‘metastases’. Microscopically, cancer cells appear different from the equivalent normal cells in the affected tissue. In particular they may show a lesser degree of di?erentiation (i.e. they are more ‘primitive’), features indicative of a faster proliferative rate and disorganised alignment in relationship to other cells or blood vessels. The diagnosis of cancer usually depends upon the observation of these microscopic features in biopsies, i.e. tissue removed surgically for such examination.

Cancers are classi?ed according to the type of cell from which they are derived as well as the organ of origin. Hence cancers arising within the bronchi, often collectively referred to as ‘lung cancer’, include both adenocarcinomas, derived from epithelium (surface tissue), and carcinomas from glandular tissue. Sarcomas are cancers of connective tissue, including bone and cartilage. The behaviour of cancers and their response to therapy vary widely depending on this classi?cation as well as on numerous other factors such as how large the cancer is, how fast the cells grow and how well de?ned they are. It is entirely wrong to see cancer as a single disease entity with a universally poor prognosis. For example, fewer than one-half of women in whom breast cancer (see BREASTS, DISEASES OF) is discovered will die from the disease, and 75 per cent of children with lymphoblastic LEUKAEMIA can be cured.

Incidence In most western countries, cancer is the second most important cause of death after heart disease and accounts for 20–25 per cent of all deaths. In the United Kingdom in 2003, more than 154,000 people died of malignant disease. There is wide international variation in the most frequently encountered types of cancer, re?ecting the importance of environmental factors in the development of cancer. In the UK as well as the US, carcinoma of the BRONCHUS is the most common. Since it is usually inoperable at the time of diagnosis, it is even more strikingly the leading cause of cancer deaths. In women, breast cancer was for a long time the most common malignant disease, accounting for a quarter of all cancers, but ?gures for the late 1990s show that lung cancer now heads the incidence list – presumably the consequence of a rising incidence of smoking among young women. Other common sites are as follows: males – colon and rectum, prostate and bladder; females – colon and rectum, uterus, ovary and pancreas.

In 2003, of the more than 154,000 people in the UK who died of cancer, over 33,000 had the disease in their respiratory system, nearly 13,000 in the breast, over 5,800 in the stomach and more than 2,000 in the uterus or cervix, while over 4,000 people had leukaemia. The incidence of cancer varies with age; the older a person is, the more likely it is that he or she will develop the disease. The over-85s have an incidence about nine times greater than those in the 25–44 age group. There are also di?erences in incidence between sexes: for example, more men than women develop lung cancer, though the incidence in women is rising as the effects of smoking work through. The death rate from cancer is falling in people under 75 in the UK, a trend largely determined by the cancers which cause the most deaths: lung, breast, colorectal, stomach and prostate.

Causes In most cases the causes of cancer remain unknown, though a family history of cancer may be relevant. Rapid advances have, however, been made in the past two decades in understanding the di?erences between cancer cells and normal cells at the genetic level. It is now widely accepted that cancer results from acquired changes in the genetic make-up of a particular cell or group of cells which ultimately lead to a failure of the normal mechanisms regulating their growth. It appears that in most cases a cascade of changes is required for cells to behave in a truly malignant fashion; the critical changes affect speci?c key GENES, known as oncogenes, which are involved in growth regulation. (See APOPTOSIS.)

Since small genetic errors occur within cells at all times – most but not all of which are repaired – it follows that some cancers may develop as a result of an accumulation of random changes which cannot be attributed to environmental or other causes. The environmental factors known to cause cancer, such as radiation and chemicals (including tar from tobacco, asbestos, etc.), do so by increasing the overall rate of acquired genetic damage. Certain viral infections can induce speci?c cancers (e.g. HEPATITIS B VIRUS and HEPATOMA, EPSTEIN BARR VIRUS and LYMPHOMA) probably by inducing alterations in speci?c genes. HORMONES may also be a factor in the development of certain cancers such as those of the prostate and breast. Where there is a particular family tendency to certain types of cancer, it now appears that one or more of the critical genetic abnormalities required for development of that cancer may have been inherited. Where environmental factors such as tobacco smoking or asbestos are known to cause cancer, then health education and preventive measures can reduce the incidence of the relevant cancer. Cancer can also affect the white cells in the blood and is called LEUKAEMIA.

Treatment Many cancers can be cured by surgical removal if they are detected early, before there has been spread of signi?cant numbers of tumour cells to distant sites. Important within this group are breast, colon and skin cancer (melanoma). The probability of early detection of certain cancers can be increased by screening programmes in which (ideally) all people at particular risk of development of such cancers are examined at regular intervals. Routine screening for CERVICAL CANCER and breast cancer (see BREASTS, DISEASES OF) is currently practised in the UK. The e?ectiveness of screening people for cancer is, however, controversial. Apart from questions surrounding the reliability of screening tests, they undoubtedly create anxieties among the subjects being screened.

If complete surgical removal of the tumour is not possible because of its location or because spread from the primary site has occurred, an operation may nevertheless be helpful to relieve symptoms (e.g. pain) and to reduce the bulk of the tumour remaining to be dealt with by alternative means such as RADIOTHERAPY or CHEMOTHERAPY. In some cases radiotherapy is preferable to surgery and may be curative, for example, in the management of tumours of the larynx or of the uterine cervix. Certain tumours are highly sensitive to chemotherapy and may be cured by the use of chemotherapeutic drugs alone. These include testicular tumours, LEUKAEMIA, LYMPHOMA and a variety of tumours occurring in childhood. These tend to be rapidly growing tumours composed of primitive cells which are much more vulnerable to the toxic effects of the chemotherapeutic agents than the normal cells within the body.

Unfortunately neither radiotherapy nor currently available chemotherapy provides a curative option for the majority of common cancers if surgical excision is not feasible. New e?ective treatments in these conditions are urgently needed. Nevertheless the rapidly increasing knowledge of cancer biology will almost certainly lead to novel therapeutic approaches – including probably genetic techniques utilising the recent discoveries of oncogenes (genes that can cause cancer). Where cure is not possible, there often remains much that can be done for the cancer-sufferer in terms of control of unpleasant symptoms such as pain. Many of the most important recent advances in cancer care relate to such ‘palliative’ treatment, and include the establishment in the UK of palliative care hospices.

Families and patients can obtain valuable help and advice from Marie Curie Cancer Care, Cancer Relief Macmillan Fund, or the British Association of Cancer United Patients.

www.cancerbacup.org.uk

www.mariecurie.org.uk... cancer

ACUTE LIVER DISEASE The hepatitis viruses (A– F) are of paramount importance. Hepatitis E (HEV) often produces acute hepatic failure in pregnant women; extensive epidemics – transmitted by contaminated drinking-water supplies – have been documented. HBV, especially in association with HDV, also causes acute liver failure in infected patients in several tropical countries: however, the major importance of HBV is that the infection leads to chronic liver disease (see below). Other hepatotoxic viruses include the EPSTEIN BARR VIRUS, CYTOMEGALOVIRUS (CMV), the ?avivirus causing YELLOW FEVER, Marburg/Ebola viruses, etc. Acute liver disease also occurs in the presence of several acute bacterial infections, including Salmonella typhi, brucellosis, leptospirosis, syphilis, etc. The complex type of jaundice associated with acute systemic bacterial infection – especially pneumococcal PNEUMONIA and pyomiositis – assumes a major importance in many tropical countries, especially those in Africa and in Papua New Guinea. Of protozoan infections, plasmodium falciparum malaria, LEISHMANIASIS, and TOXOPLASMOSIS should be considered. Ascaris lumbricoides (the roundworm) can produce obstruction to the biliary system. CHRONIC LIVER DISEASE Long-term disease is dominated by sequelae of HBV and HCV infections (often acquired during the neonatal period), both of which can cause chronic active hepatitis, cirrhosis, and hepatocellular carcinoma (‘hepatoma’) – one of the world’s most common malignancies. Chronic liver disease is also caused by SCHISTOSOMIASIS (usually Schistosoma mansoni and S. japonicum), and acute and chronic alcohol ingestion. Furthermore, many local herbal remedies and also orthodox chemotherapeutic compounds (e.g. those used in tuberculosis and leprosy) can result in chronic liver disease. HAEMOSIDEROSIS is a major problem in southern Africa. Hepatocytes contain excessive iron – derived primarily from an excessive intake, often present in locally brewed beer; however, a genetic predisposition seems likely. Indian childhood cirrhosis – associated with an excess of copper – is a major problem in India and surrounding countries. Epidemiological evidence shows that much of the copper is derived from copper vessels used to store milk after weaning. Veno-occlusive disease was ?rst described in Jamaica and is caused by pyrrolyzidine alkaloids (present in bush-tea). Several HIV-associated ‘opportunistic’ infections can give rise to hepatic disease (see AIDS/HIV).

A localised (focal) form of liver disease in all tropical/subtropical countries results from invasive Entamoeba histolytica infection (amoebic liver ‘abscess’); serology and imaging techniques assist in diagnosis. Hydatidosis also causes localised liver disease; one or more cysts usually involve the right lobe of the liver. Serological tests and imaging techniques are of value in diagnosis. Whilst surgery formerly constituted the sole method of management, prolonged courses of albendazole and/or praziquantel have now been shown to be e?ective; however, surgical intervention is still required in some cases.

Hepato-biliary disease is also a problem in many tropical/subtropical countries. In southeast Asia, Clonorchis sinensis and Opisthorchis viverini infections cause chronic biliary-tract infection, complicated by adenocarcinoma of the biliary system. Praziquantel is e?ective chemotherapy before advanced disease ensues. Fasciola hepatica (the liver ?uke) is a further hepato-biliary helminthic infection; treatment is with bithionol or triclabendazole, praziquantel being relatively ine?ective.... liver disease in the tropics

Linn.

Family: Labiatae; Lamiaceae.

Habitat: Kashmir at 1,500-2,400 m.

English: Skullcap (equated with S. lateriflora Linn.), Scurvy Grass.

Action: Central nervous relaxant and restorative, brain and CNS vasodilator, sedative, antispasmodic, anticonvulsive. Used for nervous stress, disturbed sleep, menstrual tension, headache, migraine, neurological and neurimotor conditions, epilepsy.

Roots, stem and flowers of S. galer- iculata gave flavonoids and their gly- cosides, chrysin-7-glucuronide, baica- lein, baicalin, apigenin, apigenin-7- glucoside and galeroside (baicalcin-7- beta-L-rhamnofuranoside). Cytotoxi- city of baicalin and baicalein (isolated from S. barbata D. Don synonym S. rivularis Wall.) has been investigated on human hepatoma cell lines, human liver cells and human pancreatic cancer line. (Chem Abstr, 121, 292196y, 1994.)

S. galericulata is used as an adulterant of S. lateriflora. (See also WHO monograph on Scutellaria grandiflora Adams.)

In Oriental medicine, Skullcap refers to S. baicalensis Georgi. It contains the flavonoids baicalin, baicalein, wogonin, skullcapflavones I and II in addition to other flavones. Baicalin exhibits anti-inflammatory and antiallergic properties.

S. baicalensis inhibited lipid perox- idation in rat liver and has been clinically tested in China; patients with chronic hepatitis showed improvement (above 70%) in various symptoms. (Potter's New Cyclopedia.)

According to The British Herbal Pharmacopoeia, S. lateriflora can be used as a mild sedative.... scutellaria galericulata

Caused by the hepatitis C virus and formerly known as non-A non-B hepatitis, this infection is often transmitted through sharing needles. Blood transfusions no longer pose a significant risk because of blood screening.

Hepatitis C has an incubation period of 6–12 months and begins as a mild illness which may go undetected. In about 3 in 4 patients, chronic hepatitis develops (see hepatitis, chronic), which can progress to cirrhosis of the liver and an increased risk of hepatoma.... hepatitis c

large irregular masses abnormally located in the hepatocytes of the liver. They are found in patients with alcoholic hepatitis, alcoholic cirrhosis, Wilson’s disease, primary biliary cirrhosis, clinical obesity, and hepatoma. [F. B. Mallory (1862–1941), US pathologist]... mallory bodies

criteria used to select patients with cirrhosis and *hepatoma for liver transplantation. Transplantation can be considered if patients have a single tumour under 5 cm in size, or no more than three tumours that are less than 3 cm in size, and show no evidence of extrahepatic symptoms and no vascular invasion.... milan criteria

Technically, those diseases occurring in the area of the globe situated between the Tropic of Cancer and the Tropic of Capricorn: pertaining to the sun. They include many ‘exotic’ infections – many of them parasitic in origin – which fall under the umbrella of ‘TROPICAL MEDICINE’. However, disease in the tropics is far broader than this and includes numerous other infections, many of them with a viral or bacterial basis: for example, the viral hepatidises, streptococcal and pneumococcal infections, and tuberculosis. The prevalence of other diseases, such as rheumatic cardiac disease, cirrhosis, heptocellular carcinoma (‘hepatoma’), and various nutrition-related problems, is also much increased in most areas of the tropics. With people from developed countries increasingly travelling to worldwide destinations for business and holiday, the ‘importation’ of tropical diseases to temperate climates should be borne in mind when people fall ill.

The following diseases and conditions are treated under their separate dictionary entries: ANCYLOSTOMIASIS; BERIBERI; BLACKWATER FEVER; CHOLERA; DENGUE; DRACONTIASIS; DYSENTERY; ELEPHANTIASIS; FILARIASIS; HEAT STROKE; LEISHMANIASIS; LEPROSY; LIVER, DISEASES OF; MALARIA; ORIENTAL SORE; PLAGUE; PRICKLY HEAT; SCHISTOSOMIASIS; SLEEPING SICKNESS; STRONGYLOIDIASIS; SUNBURN; YAWS; YELLOW FEVER.... tropical diseases

DC.

Synonym: V. jatamansi Jones. Nardostachys jatamansi (Jones) DC.

Family: Valerianaceae.

Habitat: Temperate Himalayas from Kashmir to Bhutan, above 3,000 m, and Khasia Hills.

English: Indian Valerian.

Ayurvedic: Tagara, Sugandhabaalaa, Kaalaanusaari, Kaalaanusaarikaa, Nata. (Delphinum brunonianum Royle, Ranunculaceae, syn. Kutila, Nata, Vakra, is also used as Tagara.)

Unani: Asaarun, Tagar Reshewaalaa.

Siddha: Tagarai.

Folk: Taggar, Baalaka, Mushkbaalaa, Asaarun, Tagar-ganthodaa.

Action: Rhizomes and roots— used as a substitute for Valeriana officinalis; prescribed as a remedy for hysteria, nervous unrest and emotional troubles, and as a sedative.

Rhizomes and roots contain cyclop entapyrans, acacetin-7-O-rutino- sides, valtrate, didrovaltrate, linarin iso-valerinate, valepotriates and an iri- doid ester glycoside, valerosidatum. Cyclopentapyrans exhibit sedative, tranquilizing and bacteriocidal properties.

Valtrate and didrovaltrate were cy- totoxic to hepatoma cells in culture and inhibited synthesis of DNA and protein in tumor cells.

Root—spasmolytic. Essential oil— antibacterial. (Indian Valerian oils are considered poor as compared to those of V. officinalis oils.) The essential oil from roots contains calarene, beta- bargamotene, valeranone, ar-curcu- mene, maalioxide and maalitol. Main acids present are isovaleric acid and (+)-beta-methyl valeric acid.

Valeriana jatamansi auct. non Jones, synonyms Nardostachys grandiflora DC. and N. jatamansi DC. is equated with Indian Spikenard, Musk-Root and Jataamaansi.

Dosage: Rhizome—1-3 g powder. (API, Vol. I.)... valeriana wallichii

combining form denoting a tumour. Examples: hepatoma (of the liver); lymphoma (of the lymph nodes).... oma

A cancerous tumour in the liver. The tumour may be primary (originating within the liver) or secondary (having spread from elsewhere, often the stomach, pancreas, or large intestine). There are 2 main types of primary tumour: a hepatoma, which develops in the liver cells, and a cholangiocarcinoma, which arises from cells lining the bile ducts.The most common symptoms of any liver cancer are loss of appetite, weight loss, lethargy, and sometimes pain in the upper right abdomen.

The later stages of the disease are marked by jaundice and ascites (excess fluid in the abdomen).

Tumours are often detected by ultrasound scanning, and diagnosis may be confirmed by liver biopsy.

A hepatoma can sometimes be cured by complete removal.

In other cases, anticancer drugs can help to slow the progress of the disease.

It is usually not possible to cure secondary liver cancer, but anticancer drugs or, in some cases, removal of a solitary metastasis may be advised.... liver cancer

(therapeutic embolization) n. the introduction of any material to reduce or completely obstruct blood flow. Conditions such as varicocele, fibroids, hepatoma, congenital arteriovenous malformations (see angioma), angiodysplasia, malignant tumours, or arterial rupture are commonly treated with embolization. Under X-ray screening control, a catheter is guided to the blood vessel (artery or vein) supplying the affected area and occluding material, such as microspheres, metallic coils, PVA (polyvinyl alcohol), or gel foam, is injected. The procedure may treat the underlying problem or simplify subsequent surgery. See also chemoembolization; coiling; uterine artery embolization.... embolization

n. inflammation of the liver caused by viruses, toxic substances (including alcohol), autoimmune disease, metabolic disease, or the excess deposition of fat (see nonalcoholic fatty liver disease). Infectious hepatitis is caused by viruses, several types of which have been isolated. These include hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E. Other viral causes of hepatitis include *Epstein-Barr virus, *cytomegalovirus, and rarely *herpes simplex virus. Hepatitis A is transmitted by food or drink contaminated by a carrier or patient and commonly occurs where sanitation is poor. After an incubation period of 15–40 days, the patient develops fatigue, anorexia, nausea, vomiting, arthralgia, and fever. Yellow discoloration of the skin (see jaundice) appears about a week later and persists for up to three weeks. The patient may be infectious throughout this period. Serious complications are unusual and an attack often confers immunity. Injection of *gammaglobulin provides temporary protection, but active immunization is preferable.

Hepatitis B (formerly known as serum hepatitis) is transmitted by infected blood or blood products contaminating hypodermic needles, blood transfusions, or tattooing needles, by unprotected sexual contact, or (rarely) by contact with any other body fluid. It often occurs in drug users. Symptoms, which develop suddenly after an incubation period of 1–6 months, include headache, fever, chills, general weakness, and jaundice. Treatment includes *interferon alfa and other oral antivirals (e.g. *lamivudine, *adefovir dipivoxil, entecavir). Most patients make a gradual recovery but the mortality rate is 5–20%. A vaccine is available.

Hepatitis C (formerly known as non-A, non-B hepatitis) has a mode of transmission similar to that of hepatitis B (predominantly intravenous drug abuse). Treatment is with interferon alfa, peginterferon alfa, ribavirin, telaprevir, and boceprevir.

Hepatitis D is a defective virus that can only proliferate when there is infection with hepatitis B. Patients with D virus usually have severe chronic hepatitis.

Hepatitis E is transmitted by infected food or drink and can cause acute hepatitis; it is especially severe in a pregnant patient.

Chronic hepatitis continues for months or years, eventually leading to *cirrhosis and possibly to malignancy (see hepatoma). It is usually caused by chronic viral hepatitis, alcohol, or autoimmune disease.... hepatitis

n. the largest gland of the body, weighing 1200–1600 g. Situated in the top right portion of the abdominal cavity, the liver is divided by fissures (fossae) into four lobes: the right (the largest lobe), left, quadrate, and caudate lobes. It is connected to the diaphragm and abdominal walls by five ligaments: the membranous falciform (which separates the right and left lobes), coronary, and right and left triangular ligaments and the fibrous round ligament, which is derived from the embryonic umbilical vein. Venous blood containing digested food is brought to the liver in the hepatic portal vein (see portal system). Branches of this vein pass in between the lobules and terminate in the sinusoids (see illustration).

Oxygenated blood is supplied in the hepatic artery. The blood leaves the liver via a central vein in each lobule, which drains into the *hepatic vein. The liver is supplied by parasympathetic nerve fibres from the vagus nerve, and by sympathetic fibres from the solar plexus. The liver has a number of important functions. It synthesizes *bile, which drains into the *gall bladder before being released into the duodenum. The liver is an important site of metabolism of carbohydrates, proteins, and fats. It regulates the amount of blood sugar, converting excess glucose to *glycogen; it removes excess amino acids by breaking them down into ammonia and finally *urea; and it stores and metabolizes fats. The liver also synthesizes *fibrinogen and *prothrombin (essential blood-clotting substances) and *heparin, an anticoagulant. It forms red blood cells in the fetus and is the site of production of plasma proteins. It has an important role in the detoxification of poisonous substances and it breaks down worn out red cells and other unwanted substances, such as excess oestrogen in the male (see also Kupffer cells). The liver is also the site of *vitamin A synthesis; this vitamin is stored in the liver, together with vitamins B12, D, and K.

The liver is the site of many important diseases, including *hepatitis, *cirrhosis, amoebic *dysentery, *hydatid disease, and *hepatomas.... liver