Episode Transcript
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Recently, you have noticed that you have lost some weight.
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However, there was no new diet or exercise plan or even New Year's resolution to do
so.
But you have been feeling less like eating, pushing your meals around your dinner plate
rather than actually enjoying your food.
The nausea you have felt lately has made the idea of eating less enjoyable than it used
to be.
As you brush your teeth, you notice that your skin looks odd.
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You move closer to the bathroom mirror and you see that not only does your skin have
a yellow tint, but so do your eyes.
Concerned about this, you decide to go see a doctor.
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Hello and Welcome to Anatomy Of Illness.
Today's episode is about liver cancer.
Before we get into the condition, we are going to start with the history.
So why do we know liver cancer exists?
Just before we get into the episode, I am letting everyone know that we are about to
launch a Kickstarter in the next few weeks to fund the next season.
More info will be coming in the next few episodes.
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Now onto the history.
For this, we are going to begin with the ancient Egyptians with both the Edwin Smith papyrus
from around 3000 BCE and the Ebers papyrus from around 1500 BCE.
In both of these texts, they would describe what they suspected to be liver cancer, however,
they were unable to differentiate it from other inflammatory swelling or chronic ulcerations
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at the time.
We are going to move into the ancient Greeks now.
This is where we would see several things, both in medical advancements and also in some
more interesting aspects of Greek society, more specifically, hepatoscopy.
This is an interesting practice where the liver of a sacrificed animal, more often a
sheep, would be examined to predict this future.
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This practice could be considered one of the precursors to early hepatology, which is the
study of the liver and diseases of the liver.
Also in ancient Greece, we would have the term Karkinoma.
This coming from the word for crab as it reminded Hippocrates of a moving crab.
Being Latinized in ancient Rome by Galen to carcinoma.
With Hippocrates, there were two forms of the term carcinoma.
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This being carcinoma apertus, which meant malignant tumors and carcinoma occlusus for
deep seated or occult tumors.
In some cases, the term fuma could be used to describe any concentrated swelling in the
body.
In the descriptions of either Galen from the second century CE or Paulus of Aegina from
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the seventh century, it would be stated that it appears at length with turgid veins shooting
out from it.
As to resemble the figure of a crab, or as others say, because like a crab, where once
it has got, it is scarcely possible to drive it away.
The theory behind these cancers at the time is that they were caused by an excess of black
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bile.
The cancer would be severe, ulcerated and untreatable if this black bile was especially
thick.
Whereas if the excess black bile was thin, this would cause non-ulcerated curable cancer.
Galen's teacher, Aglancon, also had his own thoughts about what could cause these
cancers.
He believed that these cancers were caused by a liver that was too warm.
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This liver warmed the blood up and created atrabilous blood, which was blood that was
not normal and decomposed.
This would overwhelm the spleen and cause cancers.
The first recognisable description of liver cancer is believed to come from around the
second century from Aretaeus of Cappadocia.
They would describe patients who had livers that had become swollen by inflammation.
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This would cause them to become harder, eventually turning scirrhus and cancerous, causing an
early death because of a deterioration of liver function.
There would be minimal progress between then and throughout the middle ages, this being
in part due to beliefs, laws, limited tools for diagnosis at the physician's disposal,
and that there were other medical conditions that could present like liver cancer.
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These diseases that around the time would often affect the liver and present in a similar
manner included other forms of liver diseases that would cause benign inflammatory nodules
to form on the liver.
We see this in tuberculosis, cirrhosis, and several other diseases.
The progression of the understanding of liver cancer was not helped by several things after
the middle ages, including Rudolf Virchow.
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Virchow, who was a prominent pathologist and is still well known today for many of his
other comments on medicine.
However, his comments on liver cancer and several other cancers could be seen as harmful
to the progression of understanding of this condition.
He would declare, "Organs commonly affected by metastases are rarely the site of primary
neoplasia."
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This would have been potentially in the later part of the 1800s.
Moving on to the 20th century.
This is when we would have the work of Charles Berman, who was working in South Africa.
He would publish consistently over a quarter of the century about primary carcinomas in
the liver.
This was especially among the Bantu people.
He would play a key role in establishing the relationship between hepatocellular carcinoma
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and hepatitis B virus.
Hepatocellular carcinoma is a form of liver cancer.
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What is liver cancer?
Well, liver cancer is a term for the different forms of cancer that affect the liver, being
the primary cancer, that is.
So cancers that begin there, not cancers that spread there.
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Cancers that spread there are known as liver metastases and are still the same type of
cancer as the primary cancer.
So for example, if the primary cancer was a breast cancer, it would be called metastatic
breast cancer with liver metastases because the cancer cells are still breast cancer cells.
What are the types of liver cancer?
The most common form of liver cancer is hepatocellular carcinoma.
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This form affects the hepatocytes, which are the main liver cells.
There are also two other forms of liver cancer.
However, these are much rarer, these being intrahepatic cholangiocarcinomas and hepatoblastomas.
But what are the risk factors for developing liver cancer?
Well, there are several risk factors that increase the likelihood for developing liver
cancer.
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These include having either a chronic hepatitis C or a chronic hepatitis B infection.
These viruses damage the liver and increase the risk of liver cancer.
Cirrhosis.
Liver cirrhosis is a condition that causes scars to form on the liver.
This condition is progressive and irreversible.
With this condition, it increases the risk of developing cancer.
Cirrhosis can be caused by several things like having chronic hepatitis infections or chronic
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alcohol abuse.
Excessive alcohol consumption.
Consuming more than what is considered a moderate amount of alcohol per day over many years
can lead to permanent liver damage.
And this can increase your risk of liver disease.
Non-alcoholic fatty liver disease.
This is a condition where fat accumulates in the liver.
This can increase your risk of developing liver cancer.
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Having inherited liver diseases.
In some cases, having various medical conditions like hemochromatosis, which we covered in
episode 22, and Wilson's disease, which we covered in episode 47.
Both of these medical conditions can cause damage to the liver.
Diabetes.
Having a blood sugar disorder like diabetes increases the risk of developing liver cancer.
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Exposure to aflatoxins.
Aflatoxins are something that certain moulds can produce.
These moulds grow on incorrectly stored crops.
This is seen in crops like nuts and grains.
These can be contaminated with aflatoxins, which can then end up in foods that are made
with these contaminated producers.
Think like peanut butter or bread.
How do we diagnose liver cancer?
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There are several different tests that can be run to help get a diagnosis of liver cancer.
These tests include blood tests.
Blood tests can show if there are any abnormalities with how the liver is functioning.
Imaging tests.
This can be through a CT, ultrasound, or an MRI.
These help to visualise the liver and see if there is anything that looks a bit abnormal
there.
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These can also be useful when it comes to the staging of the cancer.
Biopsy.
So this is a procedure that takes a piece of tissue for laboratory testing.
This can give more definitive answers about whether or not it is cancer.
As with this, they look at the sample under the microscope.
With this procedure, they take a little thin needle and insert it through your skin.
This takes just a small sample and then sends it to the lab for testing.
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We'll get right into the symptoms and presentation right after this little break.
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What symptoms might you experience if you had liver cancer?
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When it comes to liver cancer, during the early stages, it often does not show symptoms.
However, as it progresses, symptoms will begin to show.
These symptoms include general weakness and fatigue, having a loss of appetite, experiencing
nausea and vomiting, feeling upper abdominal pain, as well as general abdominal swelling,
experiencing jaundice.
This is the discolouration in both skin colour and eye colour.
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This becomes yellow, or having a yellow tinge in this case.
You can also experience white chalky stools.
Are there any complications a doctor should be aware of when it comes to liver cancer?
Yes, there are several complications doctors should be aware of when it comes to liver
cancer.
These include hepatic encephalopathy.
This is when there is brain damage and loss of brain function from the liver being unable
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to filter toxins from the blood.
This builds up and, of course, leads to brain damage.
Intraperitoneal bleeding.
This is a form of internal bleeding that occurs in the abdominal cavity.
Cancer metastases.
This is when the tumour spreads to other places in the body.
How do we treat liver cancer?
Well, this will really depend on the stage of cancer, your own health, age, and your
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personal preferences as well.
There are several different types of options when it comes to the treatment of liver cancer.
These include surgery.
There are two different main kinds of surgery that are normally considered with liver cancer.
These include surgery to remove the tumour.
In this surgery, a doctor will remove the tumour and some of the healthy liver surrounding.
This is done to ensure that all of the cancer cells are removed.
With this surgery, it will, of course, depend on several things, as with whether or not
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they are able to perform it.
These being your liver's function, as you need a decently healthy liver for this, your
overall health, and where the tumour is located.
Liver transplant surgery.
Liver transplant surgery is when your liver is removed and replaced with a liver from
a donor.
In the case of liver cancer, there is only a small amount of patients during the early
stages who would be eligible for this surgery.
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There are also other treatments when it comes to liver cancer.
Some of these are considered localised treatments.
These localised treatments include radiofrequency ablation.
This interesting treatment uses an electrical current to heat up the cancer cells.
This is done by using small needles and an ultrasound to guide them to the tumour.
Cryo ablation.
This treatment freezes cancer cells by using extreme cold.
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This procedure uses a cryo probe with liquid nitrogen.
This is placed directly into the tumour cells.
Alcohol injection.
This form of treatment involves injecting alcohol into the tumour.
Pure alcohol.
Not the tequila you might have on the weekend.
This can be either through the skin or during an operation.
This causes the cancer cells to die.
Chemoembolisation.
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In this form of treatment, chemotherapy is injected into the tumour and the liver.
Radiation-filled beads.
This is where they place radiation-filled beads inside of the liver right near the tumour.
So there can be radiation directly delivered to the tumour.
Speaking of radiation, another form of treatment is radiation therapy.
This form of treatment uses radiation through x-rays or protons to deliver strong doses
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of radiation to the cancer cells.
This is done to shrink and destroy tumours.
There is also targeted drug therapy.
This kind of therapy uses medications that block certain abnormalities in the cancer
cells.
This causes the cancer cells to die.
This only works with those who have various DNA mutations inside of the cancer cells.
So not everyone is eligible for these therapies.
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Immunotherapy.
This kind of therapy teaches your body's immune system to fight the cancer cells.
This is normally used in more advanced cases of liver cancer.
Chemotherapy.
Chemotherapy is another treatment option that can be used for liver cancer.
This uses medications that kill off the cancer cells.
Are there any famous people who have or have had liver cancer?
Yes, there are a few famous people who have had liver cancer.
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These include Mickey Mantle.
He was a famous baseball player who played for the New York Yankees.
He had issues with alcohol which would lead to his cirrhosis as well as his flares of
hepatitis C which he had caught at some point.
All of these would contribute to him developing liver cancer which would spread throughout
his body causing him to pass away in 1995.
If you would like to check out our foundation, for those in the US there is the American
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Liver Foundation.
They provide funding for research into liver diseases including liver cancers.
They support those currently experiencing liver diseases and provide education about
the prevention of these conditions.
For those in the UK there is the British Liver Trust.
They provide support and information to patients and their families who are currently facing
liver diseases including liver cancer as well as raising awareness of these conditions and
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their risk factors.
And for those in Australia, there is the Liver Foundation.
They fund research into liver diseases and cancer, provide support for those experiencing
liver diseases and liver cancer as well as connecting people to resources to help them
manage their condition.
If you want to check out the sources, social media links or any other links you can head
to anatomyofillness.com.
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Did you know that the liver is the largest solid organ in the body?
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In men this can weigh up to 1.8 kilograms and in women it can weigh up to 1.3 kilos.
In pounds this is almost 4 pounds for men and almost 3 pounds for women.