你需要知道的关于肝癌

StephenW

What You Need to Know About Liver Cancer
LISA SCHULMEISTER, MN, RN, ANCS-BC, FAAN | October 13, 2016
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What You Need to Know About Liver Cancer
Although primary hepatocellular cancer or “liver cancer” is a relatively rare cancer, its incidence in the United States increased 72% from 2003-2012. Less than half (43%) of the 40,000 people diagnosed each year have early-stage disease, and their 5-year survival rate is only 31%.

Fortunately, new treatment modalities and clinical trial results are promising. Yet despite these advances, the 5-year survival rate for metastatic liver cancer is a dismal 3%. The Centers for Disease Control and Prevention (CDC) also note that the mortality rate for liver cancer is increasing faster than the  rate for any other type of cancer.

Some of the risk factors associated with the development of liver cancer include obesity, type II diabetes, heavy alcohol consumption, cirrhosis, non-alcoholic fatty liver disease, an autoimmune disease called primary biliary cirrhosis, and inherited metabolic diseases, such as hereditary hemochromatosis. A few rare diseases increase the risk of liver cancer (eg, tyrosinemia, porphyria, Wilson disease). Long-term exposure to aflatoxins, produced by a fungus that contaminates certain grains, and exposure to the chemicals vinyl chloride and thorium dioxide are associated with the development of liver cancer. Long-term anabolic steroid use slightly increases the risk of liver cancer, whereas corticosteroids do not increase the risk of liver cancer.

A major contributing factor for liver cancer is infection with hepatitis B or C. Worldwide, chronic infection with hepatitis causes 80% of all primary liver cancers. In the United States, hepatitis disproportionately affects Asian Americans and Pacific Islanders; although they make up less than 5% of the population, they account for more than half of Americans infected with hepatitis B. In fact, two of three Asian Americans with hepatitis B are unaware that they are infected.

The CDC now recommends hepatitis B testing for anyone born in Asia or the Pacific Islands (except New Zealand and Australia) and anyone born in the United States, who was not vaccinated at birth, and has at least one parent who was born in East or Southeast Asia (except Japan) or the Pacific Islands (except New Zealand and Australia).

Although there is no vaccine to prevent hepatitis C, there is an effective vaccine against hepatitis B infection. Receiving all three doses of hepatitis B vaccine provides greater than 90% protection to infants, children, and adults who are immunized before being exposed to the virus. In fact, the hepatitis B vaccine is known as the “world’s first anticancer vaccine.” In many countries, including the United States, vaccinating newborns with the hepatitis vaccine has reduced the number of new cases of liver cancer caused by hepatitis B.

The American Association for the Study of Liver Diseases issued screening recommendations for liver cancer, and they include screening people at high risk for developing liver cancer and screening people who are awaiting liver transplants. Screening should include ultrasound imaging in conjunction with alfa-fetoprotein (AFP) blood test monitoring (the AFP is not sensitive nor specific enough to be used alone). People with chronic hepatitis B or C infection need to be screened every 6 months.

The treatment of liver cancer depends on the stage of the disease and patient factors (eg, comorbidities, expected lifespan, the patient’s goals). Options may include surgery (partial hepatectomy or liver transplant), tumor ablation or embolization, radiation therapy, targeted therapy, and chemotherapy. A number of clinical trials are enrolling people diagnosed with liver cancer.

Because liver cancer is an uncommon disease, patients may benefit from referral to national and online resources. Online support for patients with liver cancer includes the American Liver Foundation (www.liverfoundation.org) and Liver Cancer Connect  (www.livercancerconnect.org), a dedicated program of the Hepatitis B Foundation. The site includes a directory of liver cancer specialists and liver cancer treatment centers, informational webinars, resources for healthcare providers, and information on new drugs and clinical trials.

Numerous unproven “cures” and treatments for liver cancer are advertised online, which may appeal to both the newly diagnosed as well as those who have not responded to treatment. As oncology nurses, we can help our patients navigate through the misinformation and identify reputable sources of information. For patients with liver cancer, as well as many other types of cancer, the best outcomes occur when patients make informed, evidence-based decisions.
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Lisa Schulmeister, MN, RN, ACNS-BC, FAAN, is an oncology nursing consultant and editor-in-chief of Oncology Nursing News.

StephenW

你需要知道的关于肝癌
LISA SCHULMEISTER，MN，RN，ANCS-BC，FAAN | 2016年10月13日
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你需要知道的关于肝癌
虽然原发性肝细胞癌或“肝癌”是相对罕见的癌症，但其发病率在美国从2003年至2012年增加了72％。每年诊断的40,000人中有不到一半（43％）患有早期疾病，他们的5年生存率只有31％。

幸运的是，新的治疗方式和临床试验结果是有希望的。然而，尽管这些进展，转移性肝癌的5年存活率是令人沮丧的3％。疾病控制和预防中心（CDC）还指出，肝癌的死亡率增长速度快于任何其他类型的癌症。

与肝癌发展相关的一些风险因素包括肥胖症，II型糖尿病，重酒精饮用，肝硬化，非酒精性脂肪肝病，称为原发性胆汁性肝硬化的自身免疫性疾病和遗传性代谢性疾病，例如遗传性血色素沉着病。少数罕见疾病增加了肝癌的风险（例如，酪氨酸血症，卟啉症，Wilson病）。长期暴露于由污染某些颗粒的真菌产生的黄曲霉毒素，以及暴露于化学品氯乙烯和二氧化钍与肝癌的发展相关。长期合成代谢类固醇使用稍微增加肝癌的风险，而皮质类固醇不增加肝癌的风险。

肝癌的主要致病因素是乙型肝炎或丙型肝炎的感染。全世界，肝炎的慢性感染导致所有原发性肝癌的80％。在美国，肝炎不成比例地影响亚裔美国人和太平洋岛民;虽然他们占人口的不到5％，他们占感染乙型肝炎的美国人的一半以上。事实上，三个亚裔美国人中有两个乙型肝炎并不知道他们感染了。

CDC现在推荐对在亚洲或太平洋岛屿（新西兰和澳大利亚除外）和在美国出生，在出生时没有接种疫苗，且至少有一个父母出生在东部或东部的任何人出生的任何人东南亚（日本除外）或太平洋岛屿（新西兰和澳大利亚除外）。

虽然没有预防丙型肝炎的疫苗，但是存在针对乙型肝炎感染的有效疫苗。接受所有三个剂量的乙型肝炎疫苗提供对暴露于病毒之前被免疫的婴儿，儿童和成年人的超过90％的保护。事实上，乙型肝炎疫苗被称为“世界第一抗癌疫苗”。在许多国家，包括美国，用肝炎疫苗接种新生儿减少了由乙型肝炎引起的新的肝癌病例数。

美国肝病研究协会发布了针对肝癌的筛查建议，包括筛查高风险的发展为肝癌的人群以及筛选等待肝移植的人群。筛查应包括超声成像与甲胎蛋白（AFP）血液检测监测（AFP不敏感或不足以单独使用）。慢性乙型或丙型肝炎感染的患者需要每6个月进行一次筛查。

肝癌的治疗取决于疾病的阶段和患者因素（例如，合并症，预期寿命，患者的目标）。选择可以包括手术（部分肝切除术或肝移植），肿瘤消融或栓塞，放射治疗，靶向治疗和化疗。许多临床试验正在招募诊断患有肝癌的人。

由于肝癌是一种罕见的疾病，患者可能会受益于国家和在线资源。肝癌患者的在线支持包括美国肝脏基金会（www.liverfoundation.org）和肝癌联盟（www.livercancerconnect.org），乙型肝炎基金会的专门计划。该网站包括肝癌专家和肝癌治疗中心的目录，信息网络研讨会，医疗保健提供者的资源，以及关于新药物和临床试验的信息。

许多未经证实的“治愈”和肝癌的治疗在线公布，这可能吸引新诊断以及没有对治疗响应的那些。作为肿瘤学护士，我们可以帮助我们的病人通过错误的信息和确定信誉的信息来源。对于肝癌患者，以及许多其他类型的癌症，最佳结果发生在患者做出明智的，基于证据的决定时。
__________________________________________________________________________
Lisa Schulmeister，MN，RN，ACNS-BC，FAAN，是肿瘤学护理顾问和肿瘤学护理新闻主编。

tacolynn

肝癌的主要致病因素是乙型肝炎或丙型肝炎的感染。全世界，肝炎的慢性感染导致所有原发性肝癌的80％。在美国，肝炎不成比例地影响亚裔美国人和太平洋岛民;虽然他们占人口的不到5％，他们占感染乙型肝炎的美国人的一半以上。事实上，三个亚裔美国人中有两个乙型肝炎并不知道他们感染了。

关键还在这里。