Liver

30% of patients have a sudden decrease in liver function. [2] || The most common forms are Rare types
 * **Epidemiolgy:** || In the U.S. the highest number of liver cancers are immigrants from Asian countries (where liver cancer is common). Liver cancer among Caucasians is the lowest, among African Americans and Hispanics it is intermediate. Liver cancer is the highest among Asians. Men are more likely to have liver cancer than women.[1] ||
 * **Etiology:** || Some of the risk factors are: [1]
 * Hepatitis B infection
 * Hepatitis C infection
 * Alcohol
 * Aflatoxin B1
 * Drugs,medications, and chemicals
 * Hemochromatosis
 * Diabetes and obesity
 * Cirrhosis ||
 * **Signs & Symptoms:** || More than 80% of patients show these common symptoms at diagnosis:
 * Right upper abdominal pain
 * Weight loss
 * Anorexia
 * Malaise
 * Fever
 * **Diagnostic Procedures:** || The main imaging modalities are ultrasound, intravenous contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI). X-rays of the chest, CT of the chest, abdomen, and pelvis, portal venography, and bone scans are all used selectively to assess the extent of local disease and possible metastases. [2] ||
 * **Histology:** || There are several types of liver cancer which develop from shared cells of the bile duct and blood vessels. These tumors grown inside or on the surface of the liver and is normally the site of metastatic tumor rather than a primary site.
 * Hepatocellular carcinoma (shared cells of the bile duct)
 * Hemangioendotheliomas (shared cells of blood vessels in the liver)
 * Hepatoblastomsa
 * Angiosarcoma
 * Mesenchymal tissue
 * Bile duct cancers ||
 * **Lymph node drainage:** || The lymph nodes that are involved with liver cancer are.
 * Portal nodes
 * Periportal nodes
 * Celiac nodes
 * Mediastinal nodes ||
 * **Metastatic spread:** || Metastatic spread can include.
 * Lung
 * Portal vein
 * Bone
 * brain ||
 * **Grading:** || Histologic tumor grade also called the Bloom-Richardson grade, Scarff-Bloom-Richardson grade, or Elston-Ellis grade is based on the arrangement of the cells in relation to each other: whether they from tubules; how closely they resemble normal breast cells (nuclear grade); and how many of the cancer cells are in the process of dividing (mitotic count[5]). This system of grading is used for invasive cancers but not for in situ cancers[5].

-Grade 1 (well differentiated) cancers have relatively normal-looking cells that do not appear to be growing rapidly and are arranged in small tubules.

-Grade 2 (moderately differentiated) cancers have features between grades 1 and 3.

-Grade 3 (poorly differentiated) cancers, the highest grade, lack normal features and tend to grow and spread more aggressively." || Although the TNM system defines the extent of liver cancer in some detail, it does not take liver function into account. Several other staging systems have been developed that include both of these factors[5]:
 * **Staging:** || The staging systems for most types of cancer depend only on the extent of the cancer, but liver cancer is complicated by the fact that most patients have liver damage along with their cancer[5]. This also has an effect on treatment options and prognosis.
 * The Barcelona Clinic Liver Cancer (BCLC) system
 * The Cancer of the Liver Italian Program (CLIP) system
 * The Okuda system

Stage 1 – means the cancer is confined, often no bigger than 2 cms[5]. Stage 2 – means there is more than one tumour, and it may be affecting blood vessels. Stage 3 – means that it has spread; to blood vessels or nearby organs. It may have spread to lymph nodes nearby. Stage 4 – means it has spread to distant organs – most usually the brain. || Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can[6]. Radiation therapy to the chest and abdomen may cause nausea, vomiting, diarrhea or urinary discomfort[6]. Radiation therapy also may cause a decrease in the number of healthy white blood cells -- cells that help protect the body against infection[6]. Although the side effects of liver cancer radiation therapy can be distressing, the doctor can usually treat or control them[6]. || concomitant chemotherapy have been studied with some benefit. The limiting factor for radiation is the livers low tolerance dose. [3] || ||  ||   || 2. Lenhard RE, Osteen R, Gansler T. //The American Cancer Society’s Clinical Oncology//. Williston, VT: Blackwell Publishing, Inc; 2001. 3. Chao KS, Perez CA, Brady LW. Radiation Oncology: Management Decisions. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. 4. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991. 5. Liver Cancer Radiation Therapy: An Overview. 2012. Available at: []. Accessed: June 6, 2012. 6. Liver Cancer. //American Cancer Society.// 2012. Available at: []. Accessed : June 6, 2012. ||
 * **Radiation side effects:** || The side effects of liver cancer radiation therapy depend mainly on the treatment dose and the part of the body that is treated[6].
 * **Prognosis:** || For smaller tumors that can be resected the prognosis is excellent. For non-resectable tumors the prognosis is less than 50 % survival. [3] ||
 * **Treatments:** || For liver tumors the treatment of choice is surgery. Hyperfractionated radiation treatments to a low total dose (21-24 Gy) and
 * **TD 5/5:** || TD 5/5 is a statistical guideline to consider which states that there has been a five percent probability of complication in five years. These values are based on a 200cGy 5 fraction a week treatment schedule.[4] The table includes the five most commonly evaluated structures for irradiation
 * **References:** || 1. Stuart KE. Liver cancer. //MedicineNet.// Available at: []. Accessed June 4, 2012.

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