Dr. Keith E. Stuart is a medical oncologist specializing in the study and treatment of cancers involving the gastrointestinal tract, with a special interest in tumors involving the liver. He was educated at Harvard University (graduating magna cum laude) and Albert Einstein College of Medicine and did his medical training at the New England Deaconess Hospital.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Liver cancer is not diagnosed by routine blood tests, including a standard
panel of liver tests. This is why the diagnosis of liver cancer depends so much on the
vigilance of the physician screening with a tumor marker (alpha-fetoprotein) in
the blood and radiological imaging studies. Since most patients with liver
cancer have
associated liver disease (cirrhosis), their liver blood tests
may not be normal to begin with. If these blood tests become abnormal or worsen
due to liver cancer, this usually signifies extensive cancerous involvement of
the liver. At that time, any medical or surgical treatment may be too late.
Sometimes, however, other abnormal blood tests can indicate the presence of
liver cancer. Remember that each cell type in the body contains the full complement of
genetic information. What differentiates one cell type from another is the
particular set of genes that are turned on or off in that cell. When cells
become cancerous, certain of the cell's genes that were turned off may become
turned on. Thus, in liver cancer, the cancerous liver cells may take on the
characteristics of other types of cells. For example, liver cancer cells sometimes can
produce hormones that are ordinarily produced in other body systems. These
hormones then can cause certain abnormal blood tests, such as a high red blood
count (erythrocytosis), low blood sugar (hypoglycemia) and high blood calcium
(hypercalcemia).
Another abnormal blood test, high serum cholesterol (hypercholesterolemia),
is seen in up to 10% of patients from Africa with liver cancer. The high cholesterol
occurs because the liver cancer cells are not able to turn off (inhibit) their
production of cholesterol. (Normal cells are able to turn off their production
of cholesterol.)
There is no reliable or accurate screening blood test for liver cancer. The most
widely used biochemical blood test is alpha-fetoprotein (AFP), which is a
protein normally made by the immature liver cells in the fetus. At birth,
infants have relatively high levels of AFP, which fall to normal adult levels by
the first year of life. Also, pregnant women carrying babies with neural tube
defects may have high levels of AFP. (A neural tube defect is an abnormal fetal
brain or spinal cord that is caused by folic acid deficiency during pregnancy.)
In adults, high blood levels (over 500 nanograms/milliliter) of AFP are seen
in only three situations:
Liver cancer
Germ cell tumors (cancer of the testes and ovaries)
Metastatic cancer in the liver (originating in other organs)
Several assays (tests) for measuring AFP are available. Generally, normal levels
of AFP are below 10 ng/ml. Moderate levels of AFP (even almost up to 500
ng/ml) can be seen in patients with chronic hepatitis. Moreover, many patients
with various types of acute and chronic liver diseases without documentable
liver cancer
can have mild or even moderate elevations of AFP.
The sensitivity of AFP for liver cancer is about 60%. In other words, an elevated AFP
blood test is seen in about 60% of liver cancer patients. That leaves 40% of patients
with liver cancer who have normal AFP levels. Therefore, a normal AFP does not exclude
liver cancer. Also, as noted above, an abnormal AFP does not mean that a patient has
liver cancer.
It is important to note, however, that patients with cirrhosis and an abnormal
AFP, despite having no documentable liver cancer, still are at very high risk of
developing liver cancer. Thus, any patient with cirrhosis and an elevated AFP,
particularly with steadily rising blood levels, will either most likely develop
liver cancer or actually already have an undiscovered liver cancer.
An AFP greater than 500 ng/ml is very suggestive of liver cancer. In fact, the blood
level of AFP loosely relates to (correlates with) the aggressiveness of the liver cancer. Finally,
in patients with liver cancer and abnormal AFP levels, the AFP may be used as a marker of
response to treatment. For example, an elevated AFP is expected to fall to
normal in a patient whose liver cancer is successfully removed surgically (resected). People with higher AFP levels generally do not live as long as those with lower AFP levels.
There are a number of other liver cancer tumor markers that currently are research tools and
not generally available. These include des-gamma-carboxyprothrombin (DCP), a
variant of the gamma-glutamyltransferase enzymes, and variants of other enzymes
(for example, alpha-L-fucosidase), which are produced by normal liver cells. (Enzymes
are proteins that speed up biochemical reactions.) Potentially, these blood
tests, used in conjunction with AFP, could be very helpful in diagnosing more
cases of liver cancer than with AFP alone.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Polycythemia (elevated red blood cell count) causes are either primary (aquired or genetic mutations) or secondary (diseases, conditions, high altitude). Treatment of polycythemia depends on the cause.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from simple fatty liver (steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis (irreversible, advanced scarring of the liver). All of the stages of NAFLD have in common the accumulation of fat (fatty infiltration) in the liver cells (hepatocytes).
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Hereditary hemochromatosis (iron overload) is an inherited disorder in which there is excessive accumulation of iron in the body. Individuals may have no symptoms or signs, or they can have severe symptoms and signs of iron overload. The most effective treatment for hemochromatosis is therapeutic phlebotomy.
Primary Biliary Cirrhosis is a chronic disease characterized by progressive inflammation and destruction of small bile ducts within the liver. The bile ducts transport bile from the liver to the intestine for the absorption of fat and elimination of waste products. The causes of Primary Biliary Cirrhosis may involve autoimmunity, infection, or genetic predisposition, acting alone or in combination. There are many medications and treatment options available for those with this and other associated diseases of Primary Biliary Cirrhosis.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Mold exposure may cause symptoms in people who are sensitive to molds. Symptoms of mold allergy include sneezing, runny nose, wheezing, coughing, redness of the eyes, and rash. Prevent mold growth by keeping indoor humidity low, between 30%-50%, using bathroom fans when showering, repairing plumbing leaks quickly, and using an air conditioner during humid seasons.
Primary sclerosing cholangitis (PSC) is a chronic, progressive disease of the bile ducts that channel bile from the liver into the intestines. There is an association between primary sclerosing cholangitis and ulcerative colitis and Crohn's disease. Symptoms of primary sclerosing cholangitis include abnormal liver blood tests, itching, fatigue, and jaundice. Primary sclerosing cholangitis is treated with medications and in some cases, liver transplant.
Anabolic steroids are synthetic substances that are related to testosterone and promote skeletal muscle growth and the development of male sexual characteristics in both men and women. In the 1930s, it was discovered that anabolic steroids could promote skeletal muscle growth in lab animals, which lead to anabolic steroid abuse by bodybuilders and weight lifters.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Alpha-1 antitrypsin deficiency is an inherited disorder that may cause liver and lung disease in adults. Signs and symptoms include shortness of breath, wheezing, weight loss, respiratory infections, fatigue, vision abnormalities. Advanced lung disease from alpha-1 antitrypsin deficiency include emphysema. Liver damage from alpha-1 antitrypsin deficiency causes a swollen abdomen, swollen legs or feet, and jaundice.
Hepatitis A and hepatitis B are the two most commnon viruses that infect the liver. Hepatitis A and Hepatitis B can be prevented and treated with immunizations (vaccinations) such as Havrix, Vaqta, Twinrix, Comvax, Pediarix, and hepatitis b immune globulin (HBIG).
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